I hope to peacefully die in my sleep. But if fated to contract a nasty illness — the sort that drags out over an inordinate amount of time, offers numerous encouraging moments followed by crushing defeats and entails considerable suffering and deterioration — I’d like to assume final control over the manner and timing of my death. I would also want a physician to actively help me end my life.
Rep. Elijah E. Cummings, who died this past month, sent a letter urging passage of the 2019 Maryland’s End of Life Options Act that read: “As a just and compassionate society, we cannot value life in the abstract and deny to those who are about to die the self-determination that they deserve. For these reasons, I commend and support those who would enact this reform in our laws.” In March, the Maryland House of Delegates passed the act, but it failed nonetheless after a tie vote in the Senate.
Nine states and the District of Columbia have passed legislation or secured judicial rulings legalizing “death with dignity,” including most recently New Jersey and Maine. This past month marks the 25th anniversary since Oregon citizens voted to pass America’s first aid-in-dying law, which has become the national model.
Advocates are only beginning to question whether such laws are due for an overhaul. Oregon just took a baby step forward in changing its protocol for individuals who are imminently dying, by shortening the protocol’s waiting period. However, patients whose medical conditions prevent them from swallowing oral medications continue to be largely barred from using the laws. Also, all the protocols require people to be terminally ill — defined as likely to die within the next six months. This and the requirement that patients demonstrate mental competence combine to exclude many people with progressive neurodegenerative diseases, like amyotrophic lateral sclerosis, as well as dementing illnesses, like Alzheimer’s disease.
And then there is Canada. In 2015, the Canadian Supreme Court issued a landmark ruling on medical assistance in dying. Since then, all Canadian citizens are eligible, and the provincial governments are working together to support the implementation within the national health care system. Like Americans, Canadians may request a prescription for an oral lethal medication, but in addition they have another death facilitating option: Patients can grant permission for a physician to set up an intravenous line and inject the lethal dose. Patients overwhelmingly prefer this method, and in the first 10 months of 2018, there were 2,614 instances of medical assistance in dying with only one that involved ingesting pills.
Another major difference from the American approach is that death from the underlying condition merely need be “reasonably foreseeable,” which leaves considerably greater prognostic latitude. The Canadian statute emphasizes the patient’s “irremediable suffering” rather than the imminence of death. In September, a Quebec Superior Court justice declared parts of both federal and provincial laws on medically assisted dying to be unconstitutional, stating the existing criteria is unduly restrictive, according to English-language online service of the Canadian Broadcasting Corporation. “We heard the heartfelt cries of those who are suffering and have been asking for a broadening [of the law],” Danielle McCann, the provincial health minister announced.
The government wants to allow those diagnosed with diseases like Alzheimer’s to be able when they are well to provide advance consent for medically assisted dying. In response to the public’s increasing support, the Alzheimer Society of Canada has altered a key aspect of its position on medical assistance in death, saying it is accepting of these potential legal changes.
So, while everyone naturally prefers to remain hale and healthy to a satisfyingly old age before “shuffling off this mortal coil,” we need to appreciate that there are many ways to “shuffle.” Personally, I’d feel better if our legislators displayed some courage and were prepared to follow the example of Canadians when it comes to offering end-of-life options. Along with my son, Baltimore Councilman Zeke Cohen, I testified last year at the Maryland General Assembly and we’re hopeful the legislators will revisit this issue.
Dr. Lewis M. Cohen (firstname.lastname@example.org ) is a physician in Springfield, Mass., and author of a book on medically assisted dying. He will be doing a reading at Greedy Reads on Jan. 23.