In its current format, I oppose SB 88, An Act Concerning Aid in Dying for Terminally Ill Patients because it does little to actually increase care and support the dying.
Connecticut has an end-of-life problem where people with a terminal illness and prognosis of less than six months are currently not receiving the comfort care they need.
I regularly speak with terminally ill people who request aid in dying. In so many cases their request is based on a lack of understanding of our healthcare system. Many people who request aid in dying from me do not even know palliative and hospice care exists. The pervasive misconception is that once people no longer want to be cured, our healthcare system will simply abandon them and “pull the plug.” However, whether you opt for curative care or comfort care, you will get medical care either way. We do not abandon you.
However, if you follow the procedures for aid in dying as described in SB 88, it is possible that you will only receive a prescription to hasten death after minimal evaluation. If you were asking for care and options at end of life, from SB 88 you would receive a pill. But if you are asking for support at the end of life, shouldn’t we respond with support at the end of life?
The healthcare answer to this question is better palliative care and hospice services.
Too many people would opt for medical assistance to die simply because Connecticut does not promote or utilize end of life care. When it comes to hospice awareness and use, Connecticut falls behind many other states and U.S. territories.
If you read SB 88 closely, it equates palliative and hospice care as simply an alternative to medical aid in dying. If anything, medical aid in dying is only a small facet of what palliative care and hospice could offer. Palliative and hospice care can surround a person with a care team for potentially months to years. Aid in dying provides minimal evaluation before prescribing a medication to be used at the very end of life. These two things are not equal.
SB 88 does little to support those with chronic and terminal conditions with a prognosis that falls outside the six-months-or-less prognosis window. Those people would be appropriate for palliative care. Here I think of those with ALS or Parkinson’s dementia, for example. Palliative and hospice care can increase quality of life with a terminal disease, provide pain management, and have even been correlated to increased length of original prognosis.
Hospice provides nursing care under the supervision of two medical doctors. It provides social worker support. It provides spiritual support. Hospice provides bereavement counseling for 13 months after death to the family unit. It sometimes also provides volunteers or pet therapy for companionship. Some hospice organizations can provide a hospice musician, an expressive artist, or massage therapist. It has regularly been speculated that increasing our hospice utilization would improve quality of life.
A wise course of action for moving forward with medical aid in dying would be to take steps to include it in the healthcare spectrum that exists to meet the needs of patients. Without palliative and hospice, medical aid in dying simply provides access to medicine without guaranteeing any additional care is required.
Perhaps it would be possible to make involvement in a palliative care program or admission into hospice care essential to the process. This would meet the need for supportive care, allow easy access to helpful services which could even assist in advocating on behalf of the patient should they wish aid in dying. Hospice could even provide oversight and accountability for the potent medicine prescribed and this would hinder any misdirection of medicine which might occur.
Aid in dying is, in my opinion, an option that is out of alignment with the current climate of end-of-life care options in Connecticut. We need to invest in the lives of the terminally ill first. There is so much that can be done to respond in productive ways to the terminally ill.
Again, this bill currently has the same requirements that hospice care requires. At least, please consider amending the bill to incorporate additional palliative care medicine or hospice care as a requirement of this process. The added benefits would ensure the ill person would know that skilled medical and social interventions exist first before they move forward with aid in dying. Then, if that person continues to move forward with self-determining the time of their death, at least they have the support they need to make their decision wisely in this vulnerable time.
The Rev. Dr. Daniel Warriner, DMin, of Rocky Hill is an ordained minister. He was a hospice chaplain for eight years and for two years has been the Chaplain at UConn John Dempsey Hospital. His views are his own.