Physician’s guide to healthcare reform

NEW YORK AND ILLINOIS HAVE BECOME THE LATEST STATES TO ENACT MEDICAL AID IN DYING LAWS. Acts in both states take effect this year, making what physicians should know about medical aid in dying laws increasingly important as more states consider similar legislation. The practice goes by different names, including “end of life options” and “physician-assisted suicide.”

Currently, 13 states, the District of Columbia and at least 13 foreign countries have enacted medical aid in dying laws. In addition, at least 14 states are considering such laws. Oregon was the first state to implement an assistance in dying law, in 1997.

Terminal illness diagnosis required in U.S.

All states with medical assistance in dying laws require the patient exercising the option to end their life to have a terminal illness. Laws generally define “terminal illness” as an incurable disease which, within reasonable medical judgment, will result in death within six months. The patient also must be more than 18 years old and have mental capacity to make an informed decision.

Most states also require the patient be referred to a consulting physician, who will confirm the patient’s terminal illness and mental capacity. As part of the informed consent process, the attending physician must explain other options to the patient, including hospice and palliative care.

The patient must make at least two requests for medical aid in dying, one of which must be in writing. The requests must be spaced a specified time apart, generally between two and 15 days, although in Illinois if the attending physician determines the patient is likely to die within five days of the initial request, the second request may be made any time after the initial request.

The written request usually must have two witnesses, neither of which can be a relative or healthcare provider of the patient.

The patient can withdraw consent at any time. When the patient dies, the death certificate shall list the patient’s underlying terminal illness as the cause of death. The cause of death shall not be listed as suicide or homicide.

Residency requirements and immunity

Most states with assistance in dying laws require the patient be a resident of the state. Oregon and Vermont do not have such a requirement. 

Healthcare professionals, including physicians and pharmacists, are not required to provide aid in dying. Most state laws provide immunity from civil, liability, criminal liability and disciplinary actions for health care professionals who choose to provide or not provide assistance in dying.

Most state laws provide immunity from civil, liability, criminal liability and disciplinary actions for health care professionals who choose to provide or not provide assistance in dying.

Healthcare professionals, however, would be obliged to transfer relevant medical records to another provider if the patient requests it.

In addition, health care institutions (such as Catholic hospitals) are allowed to prohibit providers from giving assistance in dying while practicing at the institution.

More flexibility in Canada

The general end-of-life framework in Canada is known as Medical Assistance in Dying (MAID). Instead of requiring a terminal illness, a patient in Canada may receive assistance if the patient has “a grievous and irremediable medical condition.” Canadian rules also inform patients they must “experience unbearable physical or mental suffering from your illness, disease, disability or state of decline that cannot be relieved under conditions that you consider acceptable.”

In Canada, if the patient’s only basis for seeking medical assistance in dying is mental illness, that portion of the eligibility rule does not take effect until March 2027. If the patient has mental illness, along with other medical conditions, the patient may be eligible for assistance in dying without having to wait until then.

Methods of assisting in death

In the United States, patients must self-administer the lethal medication. It also is common for providers to prescribe medications for nausea or pain control.

In Canada, a physician or nurse practitioner may directly administer the substance that causes death.

Response of AMA and the Catholic Church

The American Medical Association has given a mixed response to laws regarding medical assistance in dying. Opinion 5.7 of the AMA Code of Medical Ethics, last

modified in 2017, states: “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”

On the other hand, a note accompanying the ethical opinions provides: “However, individual physicians who, after due moral consideration, exercise their conscience… and legally engage in the practice of physician-assisted suicide will not have acted in violation of the Code.”

After the Illinois legislature passed the End-of-Life Options Act, Pope Leo XIV spoke with Illinois Governor J.B. Pritzker, urging him to veto the act. The Pope said

he was “very clear about the necessity to respect the sacredness of life from the very beginning to the very end.” Governor Pritzker nonetheless signed the law, saying: “I have been deeply impacted by the stories of Illinoisans or their loved ones that have suffered from a devastating terminal illness.” •