Medical aid in dying issue rekindled

Washington, D.C., Calif. laws are in jeopardy

Debbie Gatzek Kratter, a California attorney with Stage 4 pancreatic cancer, wants to die on her own terms. She’s had chemotherapy treatment, but at a point, it will stop working.

She doesn’t know if she’ll be able to. Under current California law, Kratter will soon qualify for medical aid in dying — a procedure by which physicians prescribe lethal medications to patients with terminal illnesses who are at least 18 years old and have a prognosis of six months or less to live.

But that law is in jeopardy. So is a similar law in Washington, D.C. And medical aid in dying — a controversial subject that’s sparked contentious debate since the first law allowing it was passed in 1997 — is back in the spotlight.

In California, an appeals court put the End of Life Option Act temporarily back in place after a trial judge ruled it constitutional in May. But opponents of the act have until July 2 to file objections, so while the legal process plays out in the coming weeks, the law’s future is uncertain.

In Washington, a government appropriations bill includes a policy rider — a provision added to a bill that’s unconnected to the subject matter of the bill and probably wouldn’t pass on its own — that would repeal medical aid in dying in the District. The repeal is in the version of the bill that a House subcommittee approved but not in the Senate subcommittee version. It’s unclear whether it will make it into the final bill.

For patients counting on access to the procedure, not knowing their options during an already-trying time is deeply frustrating. “People who have a diagnosis like I have, I’m effectively on death row,” Kratter said. “But someone is saying, ‘When your time comes, we want you to suffer.’ ”

A decades-old debate

Current battles over these laws are only the latest iterations of a debate that dates to 1997 when Oregon passed the first medical aid in dying law.

A key turning point in the debate came with Brittany Maynard, a 29-yearold with terminal brain cancer who moved to Oregon to voluntarily end her life. Before she died in November 2014, she became a public advocate for the cause of legalizing medical aid in dying.

When Maynard died, only Oregon, Vermont and Washington had laws that permitted medical aid in dying. Since then, California, Colorado, Hawaii, Montana and Washington, D.C., have legalized the procedure. And movements in several other states, including New York, are pushing for similar laws. Sentiment on both sides runs high. Advocates argue that medical aid in dying allows terminally ill patients to avoid prolonged suffering by ending their lives voluntarily. Opponents worry that the procedure could take advantage of certain vulnerable groups — the elderly and people with disabilities — and could lead to voluntary death for people with mental illnesses and physical ones.

The debate doesn’t necessarily break down along partisan lines: Disability rights groups on the left and religious groups on the right have been some of the strongest voices against medical aid in dying.

“Vulnerable people know that assisted suicide puts them at risk of deadly harm, so any push-back on this dangerous public policy is a win. People who live with terminal illness, economic disadvantage and disabilities are the first to experience the adverse effects of these laws and deserve protection from them,” said Matt Valliere, the executive director of the Patients’ Rights Action Fund, in a statement. Patients’ Rights Action Fund is a group advocating against medical aid in dying.

Doctors divided

Doctors themselves don’t agree on whether the procedure should be allowed.

The American Medical Association’s current position on medical aid in dying holds that such procedures are “fundamentally incompatible with the physician’s role as healer,” though delegates at an AMA meeting in Chicago voted narrowly to continue “studying that position” — a process that could lead to an official change to neutrality. “Many doctors think that they just should not and can’t kill a patient, that it’s a fundamental violation of the Hippocratic Oath,” said Art Caplan, a bioethics professor at New York University, referencing the ancient oath sworn by physicians that, in part, promises to “do no harm.”

Other doctors disagree. Omega Silva, a Washington, D.C., doctor and former president of the American Women’s Medical Association, has practiced medicine for more than 50 years. Her decades of work and her personal battles with three cancer diagnoses have convinced her that ending a terminally ill patient’s suffering through medical aid can often be the right thing to do.

The current battles

In Washington, D.C., the debate is contentious because the city’s situation is unique: Congress has the authority to control the District’s budget and local laws if it chooses to do so. Similar laws in states cannot be repealed through a federal appropriations bill.

“The repealing of the law in D.C. does not impact any other state; however, anytime Congress is acting on something you want to pay attention to it,” said Kim Callinan, the CEO of Compassion & Choices, a group that advocates for legalization of medical aid in dying.

Public support is largely in favor of laws that legalize the procedure. A May Gallup poll found that 72 percent of respondents believe doctors should be able to help terminally ill patients die. The group with the highest support was people identifying as liberal at 89 percent. The only group below majority was weekly churchgoers, at 37 percent.

But while the legal and political battles rage, patients seeking the procedure are left without the control they were looking for in the first place.

“It is frightening,” Kratter said. “Because to the extent that I am able, I do not intend to have my poor family stand around and feel badly for me.”

AP Stacey Richter protests outside a federal courthouse in Portland, Ore., in 2002 as a hearing begins to decide the fate of Oregon’s physician-assisted suicide law.