What’s left out of arguments on aid in dying

Re: “Opinion: Our jobs as doctors is not to end life,” April 22: As a hospice medical director and certified physician licensed in Connecticut, I disagree and have had multiple patients beg me to help them end their lives. Let me walk through your points.

1. Prognostication: You state, “Our ability as physicians to determine the timing of death in the setting of illness is imperfect.” While I agree the medical community is unable to accurately prognosticate timing of death, the majority of people who have taken advantage of medical aid-in-dying laws in states where it is available do not act on these requests until they are close to death. There is no question that they will be dead, usually within weeks. The fact that there are other circumstances when prognostication turns out to underestimate how much time a patient has to live therefore is not relevant in this context.

2. Safeguards: You state, “Safeguards do not work.” The safeguards that are in place not only work but have been working for over 20 years in Oregon with absolutely no cases of inappropriate prescribing or deaths. To jump to the use of euthanasia in Holland is ridiculous. There is a comfortable place in between not having this option and active physician participation in deaths where someone does not have a terminal disease.

3. You state that “medical care has improved dramatically” and that therefore we can always cure someone’s suffering. I have witnessed people with unrelieved physical or emotional suffering and our current advances do not prevent painful or undignified deaths. Any health care provider working in the end-of-life sphere knows this. In fact, I would argue that medical advances have added to our culture’s inability to accept death and has added to many people suffering through fruitless medical treatments at the end of their lives. When all other options to relieve a patient’s suffering and pain have been exhausted, one can offer to withdraw life-sustaining treatments, assist them with voluntarily stopping eating and drinking or palliative sedation, a process of inducing a coma while hydration and nutrition are stopped. These options, though, are not sufficient for everyone and I believe these patients have the right to medical aid in dying.

4. You mention, “The qualifications of a responsible attending physician are not clearly specified in the legislation.” Physicians without experience in this field or who are opposed to medical aid in dying are not required to participate. Requiring two doctors to certify that a patient has a terminal illness and is asking for this option from their own free will has been shown to adequately prevent inappropriate use of medical aid in dying. Again, in 20 years there has not been a single case of wrongful death from medical aid in dying in Oregon.

This legislation was not about asking yourself what you belief in or what you would do. It is about options and choices. The reality is that very few patients will request this option and even fewer, about half, will actually go forward with taking medication. For most people and their loved ones, knowing they have this option would be enough.

Dr. Maggie Carpenter New Paltz, N.Y.