When
someone mentions Medical Aid in Dying, many people will have their own
opinions, whether that be good or bad, this type of practice is offered for a
reason and is incredibly helpful to those who are dying and need it most.
Medical Aid in dying is defined as the practice in which a doctor provides an aware
adult who has been suffering from a terminal illness a prescription for a deadly
dose of a drug at the request of the patient, knowing that the patient intends
to use it to end their life. Some illnesses are due to terminal illness,
age, or disability.
Within bodily
autonomy, it is essential to point out that the patient is in full control. When
they feel ready, they request the medication and take it. The nice thing about
it is that the patient can change their mind anytime. Another impactful safety
feature that exists is that 2 doctors and two independent witnesses must
confirm that no coercion of any type exists upon the patient's decision. Many
other practices are also present, such as legislation that puts more safety
precautions in place. Some of them include that two doctors must confirm that
the patient has 6 months or less to live. It is nice to see that Colorado,
California, New Mexico, Vermont, Washington, Oregon, Hawaii, New Jersey, Maine,
and Montana offer it to individuals who qualify.
Though it
is offered in so many states, with each of them offering a variety of benefits,
Washington was one of the first to accept it as a line of care, besides Oregon.
In the state of Washington, death is defined as “when an individual is determined to be dead by
the attending physician, county coroner, or county medical officer.” (Washington
State Legislature) In 2008 it followed its neighbor to the south,
Oregon, and was able to pass the Medical Aid in Dying Act by a decent percent
margin. The Washington State Department of Health declared that “The Washington
Death with Dignity Act of the Initiative 1000 was passed on November 4, 2008,
and went into effect on March 5, 2009. This Act allows some terminally ill
patients to request and use lethal doses of medication from qualified medical
providers as part of their end-of-life care.” After that within the state, it
was officially accepted as a new type of treatment within life care. Many
training practices among medical staff and volunteers were also implemented
making treatment a much more compassionate experience. A notable difference
between the states of Oregon and Washington compared to everywhere else is that
the patient must place three different requests seeking end-of-life treatment
and there is a waiting period in place. There is also an assessment that must
be taken so that the individual understands more about the decision that they
are making. Another concept to be aware of is that the article, Trends in
Medical Aid in Dying in Oregon, and Washington showcases the “differences
in the framework of MAID legislation between each state may result in different
outcomes, and, to our knowledge, data on the implementation and uniformity of
this practice have never been compared between two US states. Notably, policy
researchers in Canada identified significant interprovincial differences in
Canadian MAID program processes and practice.” (Luai Al Rabadi et al.,
2019)
As of 2023 ten
states offer this kind of assistance and it is important to look back at the
history of Medical Aid in Dying and suicide. It’s hard to believe that these
types of practices have been happening for at least two millennia. Many people
often thought that it was best to trust the divine with the physician not
having a direct role. That all started to change within the principles of
philosophy showing that medicine can have support from the physicians. This
sort of philosophy showed that a physician can be justifiable if they do cause
some harm. Though Medical Aid in Dying practice has been legal in Canada and
parts of the United States legislature, there are still scenarios that require
more attention like those of minors and ones where mental health is the sole
condition.
Medical Aid in
Dying is a modern take on an idea from ancient times with an ethical side of
wondering why delay death. If one knows they are dying they should be able to
take charge of their existence, regardless of the religious narrative that says
it might come between God's plans. In ancient times there was still the implication
that “one should trust God” and in the 13th century, there were laws
that didn’t allow any suicide, whether it was self-inflicted or physician-assisted.
It’s also important to point out that in ancient Roman and Greek times,
physicians would on occasion provide some sort of assistance and medicine that
would provide a source of euthanasia.
The concept of
Medical Aid in dying has been around for a good chunk of time, with some events
of a similar practice dating back to Athens as listed in the article, A Brief
History of Medical Assistance in Dying. This article uses the example of “Athens, 399 BCE the Greek
philosopher Socrates – imprisoned and sentenced to death by ingesting hemlock
on the charges of impiety and corrupting Athenian youth – famously raised a cup
of the poison to his lips. Descriptions of Socrates’ equanimity at the end
of his life, and of his refusal to escape this fate when the opportunity
presented itself, have invited the question of whether Socrates’ death was a
case of euthanasia or suicide. The distinction may seem peripheral, but we
can imagine it likely to have been an important consideration for both Socrates
and the jailer who provided his poison.” (Connor T. A. Brenna) Even though this
reference leaves a bit to the imagination it is important to see how long of a
history even an accidental case of medical aid in dying has on the world.
When it comes to practices such as Medical Aid
in Dying there will be many pros and cons that people will see and argue about
or stand with. Some of the pros that make the biggest statements are the fact
that there is the utmost respect for the autonomy of the individual seeking
treatment. This allows them to choose their timing and how they would like to
end their life. Another pro is justice, which allows patients who are suffering
from similar conditions to be treated alike, allowing individuals to have equal
treatment, this type of care opens another level of compassion that is also
represented as a pro. The compassion side of everything considers how one must
feel during the process of dying and relieves the social and psychological
burdens that many often face. It should be noted that even though being
compassionate may not relieve suffering it will help with the care of
continuous prolonged suffering. It is
known that society wants to preserve life, oftentimes when the individual
doesn’t want that sort of preservation. When this happens, it denies the
individual a sort of “personal liberty.” This should be case enough that within
certain situations Medical Aid in Dying should be allowed, this would allow
another pro known as “individual liberty” to be assisted. Many of the pros make
very valid points but the biggest point that should be shown is how much
honesty can be shown in a situation like this where one can be open enough with
themselves to know that this is the route that they want to take with their
care. This not only allows a direct response to the request but also shows the
honesty in care the medical staff must have in helping one wanting to end their
life.
On
the other side, one must look at the cons that have come up over the years. The
biggest one that seems to come up is the sanctity of life and that often ties
with religious practices. In many religions, Medical Aid in Dying is seen as
morally wrong. Another known con states that there is a link between one
needing treatment, and one being pushed into doing so with some type of
corrosion. This is a definite line of abuse that should not be taken lightly.
The last con is physicians making mistakes and giving the wrong diagnosis. This
is why it’s so important for an individual to get multiple opinions, if possible,
to confirm the terminal diagnosis.
One point
that doesn’t seem to get brought up too often is the case of pets, one can’t
help but think about the scenario where one decides that it’s time to euthanize
their pet. When this happens it’s often because they don’t want their pet to
suffer anymore. With all this in mind, it’s continually baffling why this type
of practice and ideals aren’t more available to individuals in more states than
ten. We don’t want our pets to suffer but then are expected to suffer ourselves
if medical practices and societal norms deem it necessary.
Many
of the individuals who are enrolled in end-of-life care within the state of
Washington are more commonly white and over the age of 65 with a cancer
diagnosis. In the article, Trends in Medical Aid in Dying in Oregon, and
Washington medical director (Luai Al Rabadi et al.,
2019); notes that “The vast majority are non-Hispanic white individuals
(94.8%) with some level of college education (71.5%), and public or private
programs insured 88.5%. These data reinforce the belief that MAID has not been
directed toward traditionally vulnerable populations based on age,
race/ethnicity, level of educational attainment, or insurance status. These
types of statistics show that often this type of help is not as procurable from
people of other ethnicities.” One of the main reasons why a patient would choose
to end their own life is the loss of autonomy with a lower quality of life
compared to what that person previously had; this is often caused by cancer.
When it comes to Washington having a very similar program compared to Oregon’s,
the most documented difference is that within the hospice, there are more
people actively enrolled in hospice at the time of dying in Oregon than in
Washington. It is also noted in the same article that “Reasons patients choose
to pursue MAID include loss of autonomy, impaired quality of life, inadequate
pain control, and, in a small percentage, financial concerns. The reasons
underlying MAID may be representative of the larger population of individuals
facing the end of life and should be formally studied.” (Luai
Al Rabadi et al., 2019) This is interesting because it furthers the
understanding of why people are seeking assistance within the program.
Many
individuals who seek assistance in medical aid in dying can often be enrolled
in palliative care or hospice. In Washington, many types of medical workers
help with both types of care. Within the understanding of palliative care on
the Washington Report Card website, it is listed that “Physicians, advanced
practice registered nurses, registered nurses, social workers, and chaplains
can all pursue specialty certification in palliative care. Not all who work on
palliative care teams have received palliative care certification, and there
may be some palliative care–-certified clinicians who work in other
capacities.” (State Policy Resources) This information shows that within this
area of expertise, many people want to help. Showing this can improve one's
overall satisfaction of knowing that they will be taken care of in the best way
possible.
Hospice
is also a crucial point to look at within one seeking care. Individuals who are
enrolled in hospice often become enrolled because they do not have long to
live, with many dying before their required 6-month diagnosis. Much like
palliative care, many medical workers and volunteers are working to help individuals
and their families with their acceptance in the process of dying. Hospice care
is a very powerful asset to families that often seems to be overlooked. Many
individuals and their families are sometimes not fully aware of the type of
help and reassurance that hospice care can bring in this time of need. Much of
the care will be tailored to the needs of the patient with the full
understanding that the individual is in full control of how they want to live
and the care that they will receive, this also helps because many people that
start receiving hospice care have been seen to live longer than those that are
not receiving hospice care treatments. One big misconception is that after the
individual who is dying and in hospice care passes the care stops there. Many
families can still seek support and assistance within the program even after
their loved one has passed. In the state of Washington, they try to emphasize
that getting treatment earlier is better to improve the overall quality of life
of the individual.
Washington,
like many other states, has a variety of care to assist with their elderly.
Their Community First Choice program (CFC) formally known as Medicaid Personal
Care (MPC) within the state's plan allows disabled or elderly individuals
assistance that would come with everyday living. This type of plan can be given
for one to get help in an assisted living facility or personal home. Another
benefit that Washington has for their elderly is a nurse program. This program
allows a nurse to offer care so that one can avoid getting placed in a nursing
home. Some of these types of help can include injections or tube feedings.
Washington
seems to offer a wide variety of help for the elderly patients who live there.
One way or the other one should be able to get help with all the available
options. Many times, once an individual requests and fills the script to end
their lives they cannot follow through with the action themselves but giving
someone the option feels like the most humanistic choice. When people choose to
go the route of euthanasia, they often feel hopeless, and this choice gives
them a sense of control over the life that they are leading to come to an end
on their terms. It takes a lot of self-awareness to come to that sort of
conclusion and though it should be seen as admirable, many times it is not.
It’s hard to understand what a person might be going through when they make this brave and bold decision but, in many cases, reports of loneliness are a key factor. The concept of having a life while one is losing a life is a hard reality to break into. Many times, the medical staff of the individual often becomes their family as they are the ones that become closest to them. They also can be more compassionate than the family who may not understand the intensity of everything that is happening. The hope is that over the years Medical Aid in Dying becomes a more recognized treatment not only in America but all over the world.
©️The Rosebud Writings
Citations
·
Al Rabadi, Luai, et al. “Trends in medical aid
in dying in Oregon and Washington.” JAMA Network Open, vol. 2, no. 8, 2019.
·
Starks, H., Braddock III, C. H., White, N.,
& Dudzinski, D. (n.d.). Physician aid-in-dying.
https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/detail/73
·
States where medical aid in dying is
authorized. Compassion & Choices. (n.d.).
https://www.compassionandchoices.org/resource/states-or-territories-where-medical-aid-in-dying-is-authorized
·
The Facts About Medical Aid in Dying.
Compassion & Choices. (n.d.-b).
https://www.compassionandchoices.org/resource/the-facts-about-medical-aid-in-dying
·
Brenna, C. T. A. (2021). Regulating death: A
brief history of medical assistance in dying. Indian journal of palliative
care. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8655630/
·
Washington: Hospital Palliative Care: State
by State Report Card. Palliative Care, Report Card. (2020, November 24).
https://reportcard.capc.org/state/washington/
·
Cobb, D. (2023, October 16). Paying for
assisted living & and home care in Washington. Payment Options &
Financial Assistance for Senior Care.
https://www.payingforseniorcare.com/washington#:~:text=In%20Washington%2C%20the%20Medicaid%20Personal,bathing%2C%20mobility%2C%20and%20toileting.
·
Bourke, K. (2022, June 30). Turning medicine
on its head, doctors reflect on a year of voluntary assisted dying in WA.
ABC News.
https://www.abc.net.au/news/2022-07-01/doctors-reflect-on-wa-voluntary-assisted-dying-scheme-a-year-on/101194566
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