emancipated patients: medical aid in dying

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M.A.I.D.

By Patrick Neustatter, MD

Virginia's congress is once again preparing to come to grips with the highly emotive business of medical aid in dying (MAID) which term protagonists prefer to the alternative that some use of "physician assisted suicide."

In the ten states, and District of Columbia that have legalized MAID it means doctors can prescribe a lethal dose of medicine (usually a barbiturate, pentobarbital or secobarbital) to cause the patients to die of respiratory failure in their sleep - though experience in states where it is already sanctioned, only about half the people prescribed the medicine actually take it. Knowing it is available is comfort enough.

Kay Kory, the Democratic delegate for Virginia's 38th District in Falls Church introduced a bill in January 2020 but it never got out of committee. She is trying again, possibly with cosponsorship from other delegates.

Hot Button Issue Whether you support MAID or not depends on your theological and ethical beliefs. Whether deliberately hastening someone's death is justified to save their suffering.

Opponents believe this is a slippery slope, and people will be coerced in to ending their life in a capricious way, by family, insurance companies, doctors, for convenience or economy. Or people who are not truly terminal or who are just depressed will be opting to end it all.

Disability groups like Not Dead Yet fear the disabled will be coerced in particular. Though the evidence from states that have legalized MAID is that there is no evidence of coercion. And all have stringent safeguards to be sure people are terminal, not depressed, and are mentally competent.

There is no obligation for any doctor or pharmacist to participate - they can opt out.

Within the profession there is opposition - though overall 57 per cent of doctors are in favor (and 74 percent of the general public according to a Gallup Poll survey in May of 2020). The American Medical Association says "physician-assisted suicide is fundamentally incompatible with the physician's role as healer." "My" bunch - the American Academy of Family Physicians - after initial opposition, has taken the bold step of declaring neither for nor against. Rather "engaged neutrality."

My Take I have attended several patients whose pain, nausea, air hunger, loss of autonomy and other suffering cannot be fully relieved by all the wonders of palliative care. I see this as the ultimate in patient-autonomy, that they be allowed to opt for hastening of their inevitable death. Opt to not have to endure days or weeks more suffering.

I do not go along with the argument that MAID is incompatible with a physician's role. Rather I believe that denying someone the means to end their suffering is really the policy that is incompatible. And the idea of being a healer in this circumstance is unrealistic. These patients are, sadly, unhealable.

Not being willing to allow aid in dying promotes "back street" alternatives uncontrolled stuff like Dr. Jack Kevorkian driving around the country in his VW Minibus with his "Thanatron" delivering IV medicines when the patient hit the button. Or the "Mercitron" that administered carbon monoxide.

As with so many needed reforms in medicine, implementation requires us to convince our representative politicians - who tend to be antsy about anything the slightest bit controversial.

If you are a believer like me, join forces with organizations like Compassion and Choices or bend the ear of your representative.

Allow a merciful release for the very few patients who want to opt for medical aid in dying.

Patrick Neustatter, MD is the Medical Director of the Moss Free Clinic