Currently, the issue of medical aid in dying (MAID) for patients suffering from incurable illnesses has become widely discussed and utterly controversial. More scientists and physicians are starting to hold an opinion that physician aid in dying truly contributes to the terminally ill patients’ rights and provides these patients with certain benefits. Recently, an official bill on the legalization of MAID in New Jersey has been discussed and was then turned into a law.
Although currently, MAID is becoming a legal and widespread practice in the US, according to Buchbinder (2018), “AID is not universally viewed positively” (p. 757). As a result, it causes various complications in relationships between law, ethics, justice, and access to AID. Though there are many contradictions and challenges regarding physician aid in dying, such an approach may have a positive impact on the US medicine policy, especially if applied within certain strict frames and limitations.
To start with, it is essential to define the notion of MAID (AID) or PAD. Medical or physician aid in dying is a practice of an assisted suicide of patients suffering from incurable illnesses, such as cancer. Over the decades, it has created many ethical, professional, and public policy debates. Spence, Blanke, Keating, and Taylor (2017) note that “whether physicians view PAD as unethical or are supportive of the practice, they must have a framework within which to process PAD” (p. 693).
Therefore, it is possible to acknowledge that the main issue in terms of MAID that must be discussed and agreed on is frames and limitations, not the approach itself. Currently, according to Shavelson (2020), MAID is legal in nine states, which means that only a small percentage of the US population has access to the practice. By contrast, the number of people who claimed they would prefer to be able to use PAD in case they were terminally ill equals 75 percent of the polled Americans. Therefore, it is possible to confirm that the legalization of MAID is not considered unethical by the majority of society and is needed.
As for benefits that MAID provides terminally ill patients with, first of all, it gives them a significant feeling of agency. PAD allows dying and suffering people to feel that they have a choice and that they are in control. Undoubtedly, it affects patients positively psychologically. However, Buchbinder (2018) notes that “the reproductive justice framework highlights the gaps between laws as written and laws as practised” (p. 754). As a response, it is possible to claim that, as was mentioned above, the main issue to be discussed, carefully thought through, and regulated are restrictions and frames within which the practice can exist.
Currently, some specific limitations and frames exist in the states where physician aid in dying is legal. The examples of such restrictions for patients who request PAD are age (18 or older), being terminally ill, the mental capability of making decisions, and a prognosis of six or fewer months to live. In addition, such a patient must be a resident of a state where it is legal to perform MAID, must act voluntarily, and must be able to self-administer medications (“New Jersey Senate Bill 1072”, 2019). All these requirements must be proved by documents and officially confirmed. It makes the process of PAD complicated and, taking into account requirements for a physician and witnesses, it can also be time-consuming. However, such precautions are understandable, since they provide safety of the process.
It is impossible to deny that such restrictions and requirements are crucial in the policy of MAID. However, apart from being a complicated and time-consuming process, it also creates certain barriers that prevent terminally ill patients from gaining this assistance. For instance, there are patients with neurologic illnesses, such as amyotrophic lateral sclerosis, who experience difficulties with swallowing because of declining mobility in later stages. These patients cannot fulfill the terms and, consequently, cannot obtain PAD, though their disease is also terminal and their state matches other requirements.
One more significant point about barriers to MAID is the moral objections of physicians. According to Shavelson (2020), this issue has reached such a massive scale that a tiny number of physicians take part in PAD. Interestingly enough, these objections include a lack of experience and training. In other words, many physicians rejecting applying MAID solely feel uncomfortable about using technics and methods that they have not been taught. Consequently, even legalized MAID is not widely used because of the lack of physicians able to perform it. It turns into an utterly challenging task for terminally ill patients to successfully find a doctor who would respond positively to such a request.
However, the fear and unwillingness of doctors to perform MAID is utterly understandable. For instance, Anderson’s (2000) film shows the story of Dr. Kevorkian, who had been practicing MAID long before it started to become so widely legalized and used. The point is, Dr. Kevorkian, revealed the nature of PAD by taping one of his patients desiring to die because of severe suffering. As a result, despite enlightening the issue with a good intention of studying it more, Kevorkian was sentenced and went to prison. The patient who was tapped signed the agreement papers twice, but still, it was not considered as an argument in favor of Dr. Kevorkian.
It is also essential for both patients and physicians to be aware of all the aspects of the process of MAID. There are some cases when the lack of information on PAD resulted in a lost opportunity to gain it for a patient. For instance, some physicians can make a mistake during the formalization of documents, which, consequently, would lead to a patient missing an opportunity and dying before the process of paperwork is finished. Besides, both a physician and a patient can have not enough knowledge about the prices of medications and the whole process of prescribing a lethal dose. Overall, it is possible to note that more access to the information on MAID is needed, and public awareness on the issue must be raised.
In addition, there are some justice-based concerns connected with the practice of MAID. Researchers note that the most frequently appearing end-of-life concerns are loss of autonomy, loss of dignity, and declining ability to take part in activities making life enjoyable (Spence et al., 2017). All these solicitudes are more than understandable and can be considered as the reasons for a patient having “the right to die.”
Thinking more thoroughly, this point can outweigh other moral and ethical hesitations, since the majority of terminally ill patients, being through the hardest time of life possible, deserve an opportunity to choose. It is important to note that there are some particular terminally ill patients disabled of seeking a doctor who would agree to perform MAID on them and travel to such a physician. Besides, there are also patients whose illnesses prevent them from fulfilling the requirements. Such patients must be taken into a special account, and specific frames regarding them must be created in the policy of PAD.
In conclusion, the issue of MAID and its legalization, though utterly controversial, is becoming more widely discussed and accepted. Many factors are influencing its position in the scientific and medical worlds, such as ethical, moral, sociological, psychological, law- and justice-based concerns. Nevertheless, for the majority of terminally ill patients, an opportunity to apply and obtain PAD seems to be equal fulfillment of the desire to prevent or at least minimize suffering and losing dignity. It is one of the primary reasons for further studying and discussion of the issue. Besides, the debates between social and government departments are to be conducted, and many aspects of PAD are to be negotiated.
References
Anderson, R. G. (Director). (2000). 60 minutes, death by doctor. Web.
Buchbinder, M. (2018). Access to aid-in-dying in the United States: shifting the debate from rights to justice. American Journal of Public Health, 108(6), 754-759.
New Jersey Senate Bill 1072. LegiScan. Web.
Shavelson, L. (2020). Opinion: Why terminally ill, suffering patients don’t use aid in dying?The Mercury News. Web.
Spence, R. A., Blanke, C. D., Keating, T. J., & Taylor, L. P. (2017). Responding to patient requests for hastened death: Physician aid in dying and the clinical oncologist. Journal of Oncology Practice, 13(10), 693-699.