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New Jersey ‘Aid in Dying’ law for terminally ill takes effect
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New Jersey has become the eighth state to allow terminally ill patients to request a prescription from a physician for medication to end their lives.
The Medical Aid in Dying for the Terminally Ill Act — which the state Legislature approved in March and Gov. Phil Murphy signed in April — took effect today.
“Allowing residents with terminal illnesses to make end-of-life choices for themselves is the right thing to do,” Murphy said when he signed the bill. “By signing this bill ... we are providing terminally ill patients and their families with the humanity, dignity and respect that they so richly deserve at the most difficult times any of us will face.”
Under the law, New Jersey residents diagnosed with a terminal disease who are expected to live less than 6 months may request a prescription for medication that patients can self-administer “in order to bring about the patient’s humane and dignified death.”
Patients must be at least age 18 years, acting voluntarily, properly informed of the process and able to administer the drugs themselves.
The patient must make two oral requests and one written request to his or her attending physician. At least 15 days must elapse between the first request and the writing of the script, and at least 48 hours must elapse between receipt of the written request and the writing of the script.
A second consulting physician also must examine the patient, examine his or her relevant medical records, and agree to the determination that the patient is terminally ill.
Eight states and the District of Columbia have laws that allow some terminally ill patients to end their lives. The first such measure passed in Oregon in 1994. Hawaii, Maine and New Jersey enacted their laws this year. The other states are California, Colorado, Vermont and Washington.
“The eligibility [in New Jersey] is similar to almost everywhere else,” Charles D. Blanke, MD, FACP, FASCO, professor of medicine and chair of Knight Cancer Institute at Oregon Health & Science University, as well as a HemOnc Today Editorial Board member, told HemOnc Today. “The one difference is Oregon has an exception to the 15-day waiting period for patients who are imminently dying.”
Reporting of aid-in-dying data varies by state. In 2018, 103 physicians in Oregon wrote 249 prescriptions for terminally ill patients who qualified for life-ending medications. Of the 249 patients who received the prescriptions, 168 (67.4%) took the drugs and died.
More than 60% of these patients had cancer, and 90% were on hospice at the time of death.
“Across the board, zero to 60% of patients never take the medication,” Blanke said. “Some never filled the script to begin with, some want the control but don’t need to actually imbibe, and some become too ill and are no longer eligible.”
If the patient fills the prescription but changes their mind, the medication must be disposed of following state guidelines.
Despite the growing number of states enacting laws, physician-assisted death remains controversial.
In May, AMA published ethics guidelines to help doctors balance their duty to their patients and their beliefs.
“Preserving opportunity for physicians to act — or to refrain from acting — in accordance with the dictates of conscience in their professional practice is important for preserving the integrity of the medical profession as well as the integrity of the individual physician, on which patients and the public rely,” the ethics guidelines state. “Thus, physicians should have considerable latitude to practice in accord with well-considered, deeply held beliefs that are central to their self-identities.”
The New Jersey law allows the attending or consulting physician to decide whether to refer patients requesting life-ending drugs to a mental health professional, which also has been controversial.
“The laws require the patient to have decisional capacity,” Blanke said. “Referral to a psychiatrist is optional and almost never done. Some doctors think depression should disqualify patients, but that is not part of the law.” – by John DeRosier
References:
Medical Aid in Dying for the Terminally Ill Act. Available at: www.njleg.state.nj.us/2018/Bills/S1500/1072_R1.pdf. Accessed on Aug. 1, 2019.
Oregon Death with Dignity Act: 2018 data summary. Available at:
www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf. Accessed on Aug. 1, 2019.
For more information:
Charles Blanke , FACP, FASCO , can be reached at blankec@ohsu.edu.
Disclosure: Blanke reports no relevant financial disclosures.