By Deborah Pasik
Three years after New Jersey’s historic “Medical Aid in Dying for the Terminally Ill Act” took effect on Aug. 1, 2019, the evidence is clear: lawmakers need to amend and improve this law. The reason: a large percentage of terminally ill adults who want to access it cannot. As a result, they’re dying with needless suffering that the law was designed to prevent.
I have always been an advocate for medical aid in dying (MAID), became one of the first prescribers in the state, and since August 2020 devoted my practice exclusively to MAID. I testified in support of the legislation before the Senate Health Committee and founded New Jersey Death with Dignity, a centralized, New Jersey-based platform for medical aid-in-dying education and access for the terminally ill, their loved ones, physicians, and the community. In this leadership role, I have mentored numerous New Jersey physicians on the process and procedures of medical aid in dying care.
First, the good news: the law is enabling a significant number of terminally ill New Jerseyans to gently end unbearable suffering. Since the law took effect, I have evaluated 112 people who were requesting medical aid in dying and authorized aid-in-dying prescriptions for 71 terminally ill patients, 46 of whom decided to take the medication. Whether they took the medication or not, these patients got immediate peace of mind once they received the prescription, knowing they would have the option to end their life if their suffering became intolerable. This comfort enabled them to enjoy their remaining days as worry-free as possible with their loved ones.
The bad news: 26 of my eligible patients (25%) who requested medical aid in dying either died during or became incapable of completing the 15-day waiting period. Tragically, many of them died with needless suffering. Terminally ill patients who opt for medical aid in dying typically contemplate this end-of-life option for weeks or months before they formally request it, so sometimes they run out of time.
In reality, the 15-day waiting period is not a safeguard; it’s a huge hurdle to accessing the law.
This is why I urge New Jersey lawmakers to amend and improve the medical aid-in-dying law by reducing the 15-day waiting period and/or allowing physicians to waive it if the patient isn’t expected to survive it. There are precedents for making these critically important improvements.
In recent years, several states have reduced or allowed waivers of the 15-day waiting period after a 2018 study by Kaiser Permanente Southern California showed that 21% of its terminally ill patients who requested medical aid in dying either died during its 15-day waiting period or were too ill to complete it.
In 2019, Oregon lawmakers amended their medical aid-in-dying law to allow physicians to waive its 15-day waiting period if the patient wasn’t expected to survive it. In 2020, the first year the amended Oregon law went into effect, physicians waived the 15-day waiting period for 75 of the patients (20%) who received aid-in-dying medication.
In 2021, New Mexico passed its first medical aid-in-dying law with a 48-hour waiting period but allowed clinicians to waive it if the patient wasn’t expected to survive it. Last fall, California lawmakers amended their medical aid-in-dying law to reduce its waiting period from 15 days to 48 hours.
In addition, I have had four neighboring out-of-state patients, who requested medical aid in dying but I had to advise them that I could not help them because of the New Jersey law’s residency requirement. I deeply regret that I could not meet their needs. It stands to reason that there are other terminally ill patients from nearby states who would request this option were it not for the New Jersey state residency requirement.
Our lawmakers can address this problem by eliminating our medical aid-in-dying law’s residency requirement. Oregon agreed to a settlement in a federal lawsuit filed by Compassion & Choices on behalf of a physician asserting that the residency requirement in its medical aid-in-dying law violates the U.S. Constitution’s guarantee of equal treatment. The settlement requires Oregon officials to 1) issue directives halting enforcement of the unconstitutional residency provision of the law, and 2) initiate a legislative request to permanently remove the residency language from the law.
It’s worth noting that New Mexico enacted a 48-hour waiting period to obtain a prescription with a waiver allowance based on many years of evidence and experience with medical aid in dying from other states. After just three years of experience with New Jersey’s medical aid-in-dying law, we already have enough evidence to make similar improvements to ease the suffering of terminally ill patients.
Deborah Pasik, M.D. FACR is a physician in Cedar Knolls.
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