It’s been my pleasure to be a member of EOLCNY’s board for more than a decade. My concerns about end of life decision-making are rooted in experience. As a consultant in clinical medical ethics, I have spent decades working in hospitals (in large cities and very small towns), long-term care facilities, and hospices, alongside healthcare professionals, patients and their families/friends dealing with serious, often terminal, illness. For twenty-eight years, I conducted “ethics rounds” in an urban teaching hospital, asking questions and sometimes making suggestions to young medical residents, clinical fellows and their physician mentors. I’ve witnessed many deaths.
Approximately 80% of deaths in the United States are anticipated — meaning as the result of disease. The other 20% of deaths are unanticipated — for example, sudden cardiac events, massive strokes, or traumatic accidents. It’s only in that first 80% of cases that decisions about the quantity and quality of life must be faced, and they are often difficult or problematic. In some such cases, patients themselves, or their designated decision-makers (if patients have lost decisional-capacity), can make a determination to withhold or withdraw life-sustaining treatments such as ventilatory support or use of artificial hydration and nutrition.
In most of the United States, Medical Aid in Dying (MAID) is not yet a legal option which can be offered to a competent patient who can self-administer prescribed medications and then designate the time, place and circumstances to peacefully end her or his life. In some nearby states, for example New Jersey and Vermont, MAID has been legalized. In New York State, even with years of legislative and judicial efforts, we still await the availability of this most significant of choices. It is a central focus of EOLCNY to continue to work, assiduously and empathically, until the option is available to all New Yorkers who want, after careful consideration, to choose MAID.