A bill introduced this fall in both houses of the Legislature, titled the New Jersey Death with Dignity Act, A-3328/S-2259, would, according to its synopsis, “permit qualified patient[s] to self-administer medication to end life in humane and dignified manner, subject to voter approval.”
Presently, only two states, Washington and Oregon, have right-to-die laws. Oregon’s law, passed in 1997, has resulted in 596 people ending their lives while, under Washington’s law, passed in 2009, 213 people have done so. These laws are carefully constructed and contain protections to insure that the actor has competently, knowingly and understandably opted to terminate. The process under which these acts operate is hardly similar to the lawless and unregulated process utilized by Dr. Jack Kevorkian.
The New Jersey bill’s legislative findings and declarations state, in part, “The public welfare requires a defined and safeguarded process, with procedural safeguards to protect the interests of patients and health care providers, by which a patient who is an adult New Jersey resident with the capacity to make health care decisions, and who has been determined by that individual’s attending physician and consulting physician to be suffering from a terminal disease that will cause death within six months, may obtain medication that the patient may self-administer to end his life in a humane and dignified manner.”
The attending physician must determine whether the patient is terminal, capable, and making his request voluntarily. Therefore, at the inception of the process, the patient initiates a writing signed by two witnesses who attest that the patient is capable and acting voluntarily in signing the written request. The otherwise qualifying patient who seeks to terminate life by self-administered medication is required to make an informed decision after the attending physician explains diagnosis, prognosis, risks of the medication to be prescribed, probable result of taking the medication and other feasible alternatives such as palliative care, hospice and pain control.
If such a determination is made by the attending physician, confirmation also must be made by a consulting physician regarding diagnosis (terminal disease), capacity and voluntariness. The consulting physician, to reach his opinions, must review the patient’s medical records, confirm, in writing, the attending physician’s diagnosis that the patient is terminal, and verify that the patient is acting voluntarily and has made an informed decision to request the medication “to end the person’s life in a humane and dignified manner.” Thereafter, counseling, if necessary, is ordered, next of kin is advised of the patient’s wishes (but they otherwise have no veto over the patient’s election), and the patient is advised of the importance of having another person present when he administers the medication (although that is not a mandate).
The patient is provided a waiting period to rescind the end-of-life decision “at any time and in any manner” and a 15-day waiting period commences before the process continues. If not rescinded by then, the attending physician, again, must make certain that the patient is making an informed decision to request the medication to end life. The medication cannot be prescribed if found by either physician (or both) that the patient is suffering from a psychiatric or psychological disorder or depression causing impaired judgment.
Initially, the request of the patient is effected by both a written and oral request for the medication, but after the 15-day waiting period, the patient must orally reiterate that request to the attending physician. After that second oral request, a rescission offer is again made by the attending physician. All of the above process is to be medically charted exhaustively by the attending physician.
The proposed act expressly provides that a physician is not authorized to end a patient’s life by lethal injection, active euthanasia or mercy killing and provides that the applicable standard of care to be provided by a health-care professional who participates in this end-of-life process is not lowered. The act contains civil immunities and provisions that bar charges of criminality if the processes of the act are followed.
We recognize that this proposed legislation will touch the nerves of both those in favor and those in disfavor. The discussion may take on the vitriol that commonly attaches to the issues of the lawfulness of abortion and other consequential aspects of the abortion issue. However, in this bill, we are faced with the individual person who seeks to self-administer a prescribed drug to end a medically terminal life in a humane and dignified fashion. Involved is the life and death of one person. The right of that person to address solely his own life is the subject of the statute. The debate may invoke morality, religion, self-determination, medicine, psychiatry, liability, immunity, quality of life, death other than by natural causes, costs of health care in prolonging life, and the desire of a patient not to exhaust his net worth through prolonged terminal illness. But in this twenty-first century the proponents argue that we should not forget our own individuality and the right to pursue one’s ultimate destiny. Quality of life is personal to the patient and, if it does exist, the individual should decide ultimately whether to surrender his life or to persist against insurmountable odds. The heartache and agony of others is not a consideration. Yes, some patients could defy the medically probable and survive and others may survive through “miracle.” It is of no moment. To those advocates, the patient rolls his own dice; it is his right.
Many of the opponents of this legislation regard it as a masked form of assisted suicide. They regard it as euthanasia, which violates the right to life. They state that suicide involves the primacy of personal preference and the protection of pleasure. Further, they urge that a physician cannot engage in the process since it violates the Hippocratic Oath. Assisting the patient to terminate, for the opponents, is murder, contrary to the dignity of the human person and to the “respect due to the living God, his creator.”
It is time for the Legislature to take this complex issue seriously. The New Jersey Supreme Court has been imploring the Legislature for many years to address certain end-of-life issues that, in the continuing absence of statute, must be dealt with on a common-law basis by the court. Therefore, let the debate begin and the issues aired in the bicameral legislative committees and let it be done in a calm, nonhysterical, respectful atmosphere. If the bills, now in committee, are reported out, let the legislators vote the wills of their constituents. The residents of the state deserve no less.