Compassionate Care at End of Life

This column will feature articles from members of the organization, Silver City End of Life Options Coalition, who offer education on choosing how to die.

As with all columns on the Grant County Beat, the opinions do not necessarily reflect the opinions of the Beat.

By Adrienne Dare of the Silver City End of Life Options Coalition

In a previous article in this column, I discussed Medical Aid in Dying (MAID, an important End of Life Option) and listed the states where MAID is legal. Though currently not legal in New Mexico, we have seen a number of MAID-related developments in the state, as outlined here.

March 2012: The Morris v. New Mexico case is filed, asking the court to declare that a physician who provides a prescription to a mentally capable, terminally ill adult for medication that the patient could consume to bring about a peaceful death would not be subject to criminal prosecution under existing NM Law. The case is argued by ACLU-NM and Compassion & Choices (C&C). The plaintiffs are two Albuquerque physicians, Dr. Katherine Morris and Dr. Aroop Mangalik, plus a patient plaintiff, Aja Riggs.

Dec 11-12, 2013: A trial is held in 2nd District Court Bernalillo with support from ACLU-NM and C&C, with Judge Jan Nash presiding. I present a personal story of my mom’s experience with MAID. Several physicians also serve as witnesses in the trial.

By Karen Love

Silver City End of Life Options Coalition

Although planning for the end of life is usually not high on anyone’s to-do list (perhaps right behind cleaning your rain gutters or pulling weeds), many resources exist that can make this important task much easier. Compassion & Choices (C&C), the nation’s oldest and largest nonprofit organization committed to improving care and expanding options for the end of life, provides tools to facilitate having discussions, making decisions, and documenting your choices regarding care at the end of life.

My mother, who recently died at the age of 91, used C&C’s resources years ago to specify her end of life wishes, and we had many discussions around her preferences; as a result, when the crisis situation arose and I took her to the hospital and then to hospice, I had all her documentation in hand and no doubt in my mind as to her wishes. That was a great comfort to me and to her. According to the staff at the hospital and hospice, however, in many instances the family does not know the individual’s wishes, leading to arguments among family members and elevation of already stressful situations. Most importantly, though, the dying individual may not receive the care they had wanted.

By Adrienne Dare of the Silver City End of Life Options Coalition

Medical Aid in Dying (MAID) is a medical practice in which a mentally capable adult, with a prognosis of six months or less to live, requests from their doctor a prescription for medication that they may self-ingest to bring about a peaceful death.

Medical Aid in Dying is optional for patients and optional for doctors. No person is required to use it. No one can force a patient to use it. No doctor is mandated to write a prescription.

There are numerous safeguards:

  • The requesting adult must be terminally ill with a prognosis of six months or less to live.
  • The adult must be mentally capable to make their own healthcare decisions.
  • The physician must make sure the patient is fully informed of all other available options.
  • A consulting physician must verify both the person’s prognosis and mental capacity.
  • The terminally ill adult must be free from undue influence or coercion.
  • The terminally ill adult must be able to self-administer the medication.
  • The physician must offer their patient multiple opportunities to rescind the request for the medication.
  • No guardian, conservator, power of attorney of health care agent or proxy may request medical aid in dying on behalf of the dying person.

In the United States, Oregon was the first state to allow this practice. During more than 20 years of this practice there has been no abuse, no “slippery slope.” In fact the end of life care for all residents has improved. More people die at home and fewer in hospitals. Oregon’s law is the model for all other jurisdictions where MAID is legal.

Language is important. Medical Aid in Dying or Aid in Dying or Death with Dignity are all correct terms. Opponents often use the term “assisted suicide”; however, health organizations agree that MAID is not suicide. A person using MAID is dying of their disease but wants to live. They simply use MAID to end unbearable suffering. In contrast, a person who commits suicide is not dying but chooses death over life. He/she may be depressed. Suicide would often be a great trauma to family and friends. The term euthanasia also does not apply to MAID, as it implies the physician injects medicine into the patient. In the United States euthanasia is not permitted. A person using MAID must self-administer the medication.

In reality, the process of MAID is rarely used; for example, of all deaths in Oregon, at most 0.4% (4 out of 1000) can be attributed to MAID. But it can bring great comfort to a terminally ill person because they feel they have control at the end of life whether or not they ever use the medication: of those patients who get the medication, over one-third do not use it but instead die naturally. Because they feel in control at their end of life, their death may be more peaceful.

As a daughter who experienced my mother’s death by MAID in Oregon 16 years ago, I have felt great comfort over these years because my mother had this choice. It was clearly what she wanted for herself.

In the United States, MAID is currently legal in 8 jurisdictions, constituting about 19% of the U.S. population.   Those jurisdictions, with the year and process of MAID legalization shown in parentheses, are: Oregon (1994 & 1997, by voter-approved ballot initiative); Washington (2008, by voter-approved ballot initiative); Montana (2009, by court decision); Vermont (2013, by legislation); California (2015, by legislation**); Colorado (2016, by voter-approved ballot initiative); District of Columbia (2016, by legislation); and Hawaii (2018, by legislation).

Hopefully, with the End of Life Options Act in the New Mexico 2019 legislative session, New Mexico will be the next state to allow Medical Aid in Dying.

**May 25, 2018: A Riverside County Superior Court judge officially overturned the California End of Life Option Act. The Act was not in effect until June 15, when the 4th Court of Appeal issued a stay on the lower court ruling, reinstating the law while it considers the case. The law continues to be in effect.

For more information on End of Life options see the following resources.

Compassion & Choices here and Death with Dignity National Center here.

To leave comments sceolocoalition@innerconnections.us

By Adrienne Dare

Silver City End of Life Options Coalition

In a previous article, I mentioned Medical Aid in Dying (MAID) and discussed some general end of life topics. But now I want to share my very positive personal experience with Medical Aid in Dying as a family member. My mother was able to use Oregon’s Death with Dignity Act to have a peaceful death at home surrounded by family when her pain from a terminal illness became unbearable. Clearly this was what Mom wanted for herself.

In 2002 Mom was 90 and had terminal cancer. Unfortunately her pain couldn’t be controlled. Fortunately she lived in Oregon. Since MAID was legal in Oregon it was not a lonely and scary experience and this allowed me to be able to spend some valuable quality time with my Mom. She was comforted knowing I would be there to help take care of things. I received a very special gift from her, something I had never seen. It was an onyx heart that my father had given her when they were first married. There was some damage on one edge; as it turns out, this was where I had teethed on it as a baby.  

By Adrienne Dare
Silver City End of Life Options Coalition

Talking about the end of life and planning for death isn’t something most people want to do; however, death remains an unavoidable major event in life. In spite of that, we do not plan for this event like we do for other major events such as marriage, childbirth or a new job. But end of life can be improved when people begin talking about their wishes and understand all their options.

The Silver City End of Life Options coalition has been meeting regularly to learn about, discuss, and communicate end of life issues, including what is happening in New Mexico regarding the End of Life Options Act that will be a topic during the 2019 legislative session. We decided to write a series of articles to help inform our community, with this article serving as the introductory one for the column. We hope these articles will help readers plan for a comfortable end of life experience that reflects their wishes.