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Don’t change eligibility for Death-with-Dignity Laws

Thanks in large part to Brittany Maynard’s very public utilization of the nation’s first death-with-dignity law in Oregon and advocacy for similar laws nationwide, it is now the model for bills introduced since last year in 24 state legislatures and the District of Columbia.

The states include Alaska, California, Colorado, Connecticut, Hawaii, Iowa, Kansas, Maine, Maryland, Massachusetts, Minnesota, Missouri, Montana, Nevada, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Wisconsin, Wyoming and Utah.

There is good reason for modeling bills in other states after the Oregon law: It has worked flawlessly for 17 years since it took effect.

Yet, this year’s Oregon state legislative docket includes a bill that would amend the Oregon Death with Dignity Act.

The current law authorizes the medical practice known as aid in dying.

It enables terminally ill, mentally competent adult residents to request medication from their physician, and self-administer it to advance the time of death if their suffering becomes unbearable.

The law defines “terminally ill” to mean two physicians determine the person is likely to die within six months.

The proposed bill would extend that time to a one-year prognosis.

This change would confuse the request and eligibility procedure and separate it from long-familiar and well-established eligibility for hospice services.

It is ill-advised and simply not needed.

For the vast majority of situations, even for people with paralyzing illnesses, such as ALS, a six-month prognosis is sufficient time to request and receive medication for aid in dying.

In fact, ALS is the second most common diagnosis, after cancer, among people who have utilized the Oregon law over the past 17 years.

People may not be able to walk or lift a cup when they enter the terminal phase, but they almost always retain the ability to sip through a straw and swallow.

Sipping and swallowing are voluntary actions and qualify as “self-administration.”

If swallowing has become difficult and the person takes nutrition through a feeding tube, they can self-administer medication through the same tube, so long as it is their own voluntary action that delivers the medication.

Yes, sometimes a person who has qualified and obtained medication does not take it.

Sometimes it sits at their bedside as weakness or unconsciousness overtakes them, and they could no longer self-administer it by any means.

These folks die naturally of their disease. A decision not to take the medication, as the window of opportunity begins to close, is just as valid, and deserving of our respect, as a decision to take it.

I don’t see the fact that some people allow the window of opportunity to close as a reason to change the law.

The truth is: If state legislatures were to open the qualification window to a one-year prognosis, doctors would have a great deal of trouble determining who qualifies and who does not.

Terminal illness would no longer be readily distinguished from chronic illness and uncertainty would reign.

No organization, including hospice care facilities and Compassion & Choices, which actually works with the terminally ill or helps to implement the law, support the pending bill to amend it.

While well meaning, this legislation would push the law out of synch with hospice care and established medical standards of care. It should be left alone.

Barbara Coombs Lee, PA, FNP, JD, is president of Compassion & Choices, the nation’s leading end-of-life choice advocacy organization. Previously, she was an ER and ICU nurse and physician assistant. This oped originally was published in The Oregonian newspaper.

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