MEDICAL AID IN DYING (MAiD)
“Having a good death is not the issue. It is having a good life during our last few days, weeks, years. That is to say, death is death; it is not good or bad –just inevitable. It is the process of dying that needs our attention, but it needs it before the process starts.”
Dr. Atul Gawande, from a review of his book, Being Mortal.
WHAT ARE THE REASONS PEOPLE CHOOSE TO END THEIR LIFE??
Throughout this website choosing to end life, sometimes called early exit or self-deliverance or other such term, always excludes ending life by violent means and by reason of depression and insanity. Legally, they are all suicide. The right-to-die movement has not yet accepted a term to distinguish between the two. Medical Aid in Dying (MAiD) laws, discussed below, in fact say that assisted DEATHS occurring within the terms of the LAWS are not suicide. But the MAiD laws don’t say what it is!
There are many reasons why people, especially people near the end of their life anyway, choose not to wait for nature to take it course. These reasons include:
- When doctors have determined that your illness cannot be cured, and your quality life will continue to decline. For example:
- Unremitting pain from disease.
- Loss of one or more of your five senses.
- Existential suffering (a distress arising from an inner realization that life has lost its meaning).
- When you can’t do certain activities important to you. Examples are:
- You can’t get out of bed, or go to the bathroom on your own.
- You are incontinent, especially your bowels.
- When you have dementia but have not yet lost mental capacity, and you want to prevent yourself from such personality changes as the following:
- You don’t recognize your familiy.
- You don’t understand the simplest things.
- Your personality changes and you are difficult, even abusive.
- When you are elderly.
- When you have decided your productive life is complete.
MEDICAL AID IN DYING (MAiD)
Riddle:
What is it that you can legally do yourself, but if someone helps you, he or she is committing a felony?
Keep reading for the answer.
In about a fifth of the U.S. population a doctor may legally give you a lethal prescription, IF you qualify. As of Fall 2023 these state laws have different names. The first such law was adopted in Oregon in 1997 with the name the Death With Dignity Act. Since then these states, Washington, Colorado, Maine, California, New Mexico, Hawaii, New Jersey, Vermont and the District of Columbia have adoped quite similar laws. Because of the similarity of these laws, collectively they are known as Medical Aid in Dying (MAiD). Montana does not have a MAiD law, but its Supreme Court has held that doctors may administer euthanasia. There is no data from Montana to know to what extent euthanasia has occurred; no reporting is required.
Limitations in the MAiD laws restrict their applicability to very few of the many people suffering near death. There are three main restrictions.
- One has to be terminally ill; that is two doctors must determine that you have, in their opinion, less than six months to live.
- One has to be mentally competent.
- One has to be able the take (“ingest”) the medication yourself.
- Find a doctor willing to participate in MAiD. (New Mexico allows nurse practitioners to participate as prescribers),
- Make an oral request of that doctor.
- Consult with that doctor who must determine that:
- You are terminal (six months to live or less).
- You are competent.
- You know you are choosing to end your life.
- That you know that you have options other than killing youself.
- Make a written request that must be witnessed and signed by two people.
- Make a second oral request at least two days after you made the first.
- See a second doctor who also must determine that you are terminal and competent.
- If either one of the two is unsure, then you must see a psychiatrist or licensed psychologist who will make the final determination of competency.
- If all this goes well, the first doctor will electronically send a prescription for the lethal medication to a compounding pharmacy, which, after it is compounded, someone can pick up for you.
Finally you must ingest the distasteful medication; this usually means swallowing it. There are some work-arounds swallowing, but the bottom line remains the same: no one can help you.
Have you figured out the answer to the riddle yet? What if someone helped you by holding the glass to your lips?
There’s your answer: It is not a crime to kill yourself. Suicide used to be a crime – you could go to jail or lose your property if you failed. But it is a crime to assist someone to commit suicide – except in the MAiD states where the doctors and others are exempt. However, if the doctor, or your agent, or your family help you by feeding you the medication, the exception under the MAiD laws doesn’t apply; you must take the lethal dose yourself.
Here are some miscellaneous facts about the MAiD laws:
The opponents to MAiD laws are some religious groups, primarily the Catholic church, some politically conservative groups, and some groups of disabled persons (they fear the slippery slope – some day we may be asked to end our lives).
The MAiD laws have been successful. They have survived many legal challenges. The slippery slope arguments have failed – there is no abuse. The valid criticisms of the law are its strict limitations. Many people want MAiD to be similar to Canada’s.
Canada Does it Better
“Euthanasia is not killing; it is loving.”
Peter Bolland, The Seven Stone Path (2023), p. 242
Laws in some European countries are even broader than Canada’s and have been in existence much longer. The Netherlands seems to be the most liberal.
In Canada:
- Euthanasia is legal, that is, self-ingestion is not required.
- The patient need not be terminal in six months, but must have a “grievous and irremediable condition.”
- Costs are covered by the government’s medical system.
- Nurse practitioners can prescribe as well as doctors.
- The law applies to the citizens of the whole country but is not available to visitors.
- A doctor may refuse to participate, but referral to a doctor who does is mandatory.