Opponents of the end-of-life care option for terminally ill patients to gently end their suffering, medical aid in dying, claim it is not necessary because hospice and palliative care are sufficient to relieve the suffering of terminally ill patients.
But while hospice and palliative care can ease suffering for most terminally ill patients, as a physician, I know that there are some with extremely painful diseases, like ALS and brain, ovarian and pancreatic cancer, who need another end-of-life care option: medical aid in dying.
The reality is medical aid in dying does not replace hospice and palliative care, it improves and complements them. Don’t just take my word for it. Let’s review the data, evidence and experience.
- Medicare hospice use has nearly doubled over the past decade. Yet, studies estimate that 65 to 85 percent of patients with advanced cancer (the most common diagnosis among terminally ill individuals who qualify for medical aid in dying) experience significant pain that can be attributed to the disease itself or to treatment.
- Connecticut’s medical aid in dying legislation, SB88, specifically requires that the attending (i.e., prescribing) physician must inform the requesting individual about all of their end-of-life care options, including comfort care, hospice and palliative care.
- Annual reports from nine jurisdictions that have implemented medical aid-in-dying laws show the vast majority of terminally ill people who use medical aid in dying — more than 85% — received hospice services at the time of their deaths. In Oregon, where the nation’s first medical aid-in-dying law took effect in 1997, 98% of individuals who used medical aid in dying in 2021 were receiving hospice services at the time of their death.
- A survey of physicians published in the Journal of the American Medical Association about their efforts to improve end-of-life care after Oregon’s medical aid-in-dying law passed, showed 30% of responding physicians had increased the number of referrals they provided for hospice care. In addition, more than three out of four of responding physicians (76%) made efforts to improve their knowledge of pain management.
- A 2015 Journal of Palliative Medicine study found that Oregon has one of the nation’s highest rates of hospice use and the lowest rate of inappropriate hospice use (very short enrollment, very long enrollment or disenrollment). The study also found that Oregon’s medical aid-in-dying law may have contributed to more open conversations between doctors and patients about end-of-life care options, which led to the more appropriate hospice use. In addition, after the Oregon law passed, the healthcare community focused unprecedented attention on improving the care of dying patients.
A University of Pittsburgh School of Law report in 2019 confirmed that the experience across the jurisdictions where medical aid in dying is authorized “puts to rest most of the arguments that opponents of authorization have made — or at least those that can be settled by empirical data. The most relevant data — namely, those relating to the traditional and more contemporary concerns that opponents of legalization have expressed — do not support and, in fact, dispel the concerns of opponents.”
Medical aid in dying is not for every terminally ill person. People who utilize medical aid in dying represent less than one percent of the annual deaths in the jurisdictions where it’s authorized.
But voters are demanding this end-of-life care option: three out of four Connecticut voters (75%) support medical aid-in-dying legislation, according to the GQR poll.
Connecticut residents who testified before the Public Health Committee in February described the progression of their own terminal illnesses and the potential for a painful and difficult death.
I urge our lawmakers to review the data, evidence, experience, and strong public support for this end-of-life care option and pass it this legislative session.
Terminally ill residents don’t have the luxury of endless deliberations; they need the relief that this law affords them right now. Not a single additional person will die if you authorize medical aid in dying, but far fewer will suffer.
Laura Belland, MD practices hospice and palliative medicine, geriatric medicine, and internal medicine at Yale-New Haven Bridgeport Hospital.