By Ava Mandel, Staff Writer
Dr. Timothy Quill, the acting director of the University of Rochester Medical Center Paul M. Schyve Center for Bioethics, held a discussion regarding physician-assisted death (PAD) with an emphasis on the patient’s right to autonomy and control over their own passing, in the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell on Tuesday, Oct. 3.
A range of topics were brought up at the panel, all pertaining to one question: is it possible now or in the future for New York to adopt PAD? This discussion included issues like palliative care – the patient’s right to their own medical choices up to and including death, end of life choices and the legalities surrounding these issues.
“There should be no hesitation to [this kind of death],” Quill said.
As of 2017, PAD has been legalized in California, Colorado, the District of Columbia, Oregon, Vermont and Washington.
“Personally, I think it should be an issue that’s left up to the state governments since we’re such a large and diverse country,” said Mary Anna Mcfarlin, a senior liberal arts major. “More education on the subject should be a priority since a lot of people think it just lets doctors assist death for patients when they want to, but I think a federal law that legalized it across the board could see a lot of opposition across the middle states.”
Quill has been an advocate for PAD for over 30 years. “When we are using medicine to help people die, we are doing a good thing,” he said.
Generally, those who ask their attending physician about PAD tend to be patients with cancer or neurologic diseases and have access to hospice care, but this is not to say that PAD is not an option for all terminally-ill patients, depending on their location.
“The best learning for [PAD] is to talk to patients who are really sick,” Quill said. “What do they think about? What are they afraid of? And is hospice working for them or are they afraid of hospice? So, learn from patients and families and then, try to figure out what their own personal values.”
Palliative options like PAD are a last resort. The process is extremely intricate because of heavy reliance on the patient’s autonomy, reassurance for witnesses of the death, their awareness of potential options important to some patients, families and caregivers and for the potential escape they provide when suffering is unacceptable.
“These conversations are hard to have. It’s in an intense environment and only brought up when there’s truly no other possibility,” Mcfarlin said. “Showing the patient that the doctor is with them through the process and willing to take time for it could greatly increase the depth of relationship between doctor and patient.”
PAD provides the means to go at the patient’s request, along with a potential out if the patient decides not to go through with the suicide. Additionally, a moral responsibility is placed on the physician as an accomplice. However, the patient must carry out the final act.
Synonyms for PAD include physician aid-in-dying and physician-assisted suicide.
Dr. Kris Smith, a medical doctor on the panel, said allowing the patient to make this decision is incredibly important for their autonomy, especially “when [patients] rise out of their suffering and look down at their body and see the horror and say, ‘This is not what I wanted.’” While PAD has been legalized in five states and the District of Columbia, other states have a variety of conceptual issues with PAD including its legalities, definitions of the word “suicide,” medical and mental health to rational and heroic suicide, the potential abuse of PAD by physicians and the politics of PAD’s label.
“[PAD] allows terminally ill, mentally competent, adult patients the right to receive a prescription of medications which they can take (if they choose to do so) to achieve a peaceful death,” Quill said.
Stressing the patient’s necessity for their physician to be with them every step of the way until death, Quill said, “We as a society, are not used to being present for [the death] … learning how to be present is something that needs to be taught again.”
The bottom line of PAD is that this is an available last resort for terminally-ill patients and is only sensible in the context of excellent palliative care. Before acting on a PAD request, the patient’s physician will ensure that all other palliative care options have been exhausted, search for the least harmful alternative, have respect for the values of major participants in the decision and have the patient’s full, informed consent.