For
those interested in end-of-life issues, there’s apparently a new
right-to-die bill proposed in New Jersey that would let doctors
prescribe life-ending drugs to patients with less than six months to
live. According to this Star-Ledger article,
there would be a lot of hoops for patients to jump through to make sure
the person is nearing death and capable of making the decision,
including multiple patient requests, witnesses, doctor certifications
and counseling. If the Death With Dignity Act passes, New Jersey would
fall in line with Oregon and Washington, which enacted similar measures
in 1997 and 2009. (An LA Times article says a total of 809 people in
those two states have since died by taking the drugs they requested from
their doctors.)
As
with all end-of-life issues, it’s an ethically and emotionally charged
debate. There are the medical ethics surrounding whether doctors should
be able to prescribe medication to help a patient die when their goal is
usually to keep patients alive. Here, the line between “healing” and
“harming” can be nebulous.
From
a public health perspective, we talk about the disproportionate amount
of health care spending in the last years of life and the need for a
cultural shift surrounding end-of-life issues. Is this a step in the
right direction? Or should a culture shift be more focused on other
options such as hospice care and getting people to fill out advance
directives?
I'm
not sure I have the answers to these questions, although I do think
that a comprehensive approach to this issue should involve getting
people to think about end-of-life early on, making sure they have
options when they're nearing death, and giving them the information and
support they need to make those choices. Regardless of the outcome, I
hope the bill will spur some honest public debate about the issue.
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1 comment:
I'm surprised to hear about this in New Jersey. It seems like this legislation has sprung up from under the radar.
An important thing to keep in mind is that those 809 physician-assisted suicides represent such a miniscule percentage of all the people who had that right and did not use it. What I have heard many times is that the ability to have that choice is a great relief for terminal patients, and the reality is that very, very few actually use it.
Even though I'm one of those who feels strongly that we have that right, at the same time I am a believer in those safeguards mentioned, such as counseling beforehand, confirmation of terminal disease, and verification of cogency of mind (although I would be wary that a professional with an agenda could very easily claim someone "lacks mental capacity" and deny them this right, if enacted).
Financially (and this is just a guess), I don't think physician-assisted suicide is a big money saver. Anyone who would choose suicide is probably already on hospice or is at least a DNR. My sense is that the real end-of-life healthcare spending goes in the ICUs of our hospitals, recurring emergency admissions, and other aggressive treatments like chemotherapy and surgeries -- all things that this population would most likely not be participating in. If that's the case, then it is truly about ethics and the scope of patient-directed care.
Regardless, I think the real important piece is getting people to fill out advance care directives, like you suggested. But who is going to push people to do it? And with what time?
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