Dr. Richard Feldman: A difficult question: Is medical aid in dying ethical?

One of my best friends, Jim in South Bend, died of an unusual intestinal cancer. This experience moved me to explore the issue of “medical aid in dying.” Is MAID ethical and moral? Is it the right and justified choice for some individuals?

After a time, unfortunately, Jim’s cancer progressed with a vengeance, leaving him with extensive intestinal obstructions. Further chemo would be of little help, and further surgery was impossible. Toward the end, my friend couldn’t receive any real nutrition and could tolerate only water. He lost 65 pounds in 10 weeks and was essentially skin over bone.

Jim was Catholic and very religious. He was a splendid husband and father to his nine children. He worked hard, was responsible and was a good citizen. He was a good man. The best.

When I last saw him, I told him that I envied both his courage and his faith. Jim had no doubt that, in passing, he was entering the next phase of his life and that he would be with God. Jim’s character and faith sustained him. His religious beliefs would not allow him to consider anything but a natural death. So, he never would have considered MAID. And of course, it’s not legal in Indiana.

Ten states and the District of Columbia have now legalized MAID. Oregon was first, in 1994. The Oregon law has worked well and has served as the model for other states. Generally, these laws have a minimum patient age of 18, and the individual must have a terminal illness with a life expectancy of six months or less. The patient must be mentally competent and capable of making health care decisions without impaired judgment (including from depression).

These laws require two concurring physicians’ opinions concerning diagnosis, competence and compliance with the law, and the patient must be informed of other alternatives. There are safeguards against coercion. The prescription medications used are self-administered; this is not euthanasia.

New Mexico led the way in making changes to Oregon’s original law, including a shortened mandatory waiting period after the patient’s MAID request before receiving aid-in-dying prescriptions (from 15 days to 48 hours).

Although unmanageable symptoms despite optimal hospice care is a reason to use MAID, autonomy and maintaining dignity are the primary reasons MAID is chosen. These patients want control, without dependence on others for care.

My elegant 92-year-old dear friend Kathryn in Santa Fe, New Mexico, was a very intelligent, worldly and gracious person. She and her husband enjoyed fascinating foreign-service careers with the State Department. My wife and I loved our many dinners with wonderfully engaging conversation at her home.

When multiple medical problems, including multiorgan failure, caught up with Kathryn, she made a different decision from Jim’s—but a decision very much right for her. She chose MAID to die with dignity on her own terms surrounded by family and close friends.

MAID is controversial, but dynamic, in the medical community. The American Medical Association has now affirmed that physicians can provide MAID “according to the dictates of their conscience without violating their professional obligations.” The American Academy of Family Physicians recently changed its position to one of neutrality.

Although it will be a long time before Indiana considers MAID legislation, the majority of Americans support MAID for terminal illness. Is MAID a slippery slope, an unconscionable act, or a caring act of compassion?

Difficult questions.•

__________

Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon. Send comments to ibjedit@ibj.com.

Click here for more Forefront columns.