The proposed “End-of-Life Option Act” being considered by the Maryland legislature isolates persons with terminal illness at a time when doctors, nurses and other health team members seek to stand in solidarity with their patients and their families to deliver compassionate quality care (“Retired radio host Diane Rehm describes husband’s ‘agony,’ supports Maryland medically assisted suicide bill,” Feb. 15).
Along with colleagues in medicine and public health and funding from the National Institute of Nursing Research, I have studied patient and family decision making about care and treatment at the end of life for over 20 years and have developed supportive approaches to patients and families during this most vulnerable time of life.The End-of-Life Option Act is wrong on so many important aspects of quality care at the end of life.
First, it ignores the fear of being a burden on family. Our research revealed that many terminally ill patients worry about this. Having a doctor ask patients with limited resources about the desire for a terminal dose of medication may seem like a recommendation to some and an obligation to others.
Second, it is grounded in a false sense of autonomy. The elderly and those with less than college education are more likely to defer to a physician for treatment decisions. It is wrong to assume that a patient who accepts a terminal dose of medication is making an independent decision.
Third, it ignores inter-professional care. High quality care at the end of life involves doctors, nurses, social workers, pastoral care members and others. A doctor in a closed door conversation with a patient about the option for a terminal dose of medication does not represent this care.
Although the end of life can be a heartbreaking time of loss for families, it can also be a time of unparalleled richness for those who are able to be present to their loved one in the final weeks, days and hours of life. Our efforts as doctors, nurses and fellow human beings should be to support persons with terminal illness and their families at this time, not abandon them by assisting in their suicide.
Marie T. Nolan, Baltimore
The writer is a professor and executive vice dean at the Johns Hopkins School of Nursing.
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