N.J.’s right-to-die proposal debated at Rutgers-Camden

Posted: March 28, 2013

If a doctor tells a patient that he has six months to live, should that patient be legally permitted to end his life with pills?

Should those who have suffered life-altering injuries - like paralysis - or have a degenerative but not immediately terminal disease be afforded the same right to die?

And should doctors and nurses, who are tasked with saving lives, also be an active part of a person's death?

These were some of the questions raised at a panel discussion Wednesday night concerning a bill that could make New Jersey the third state to let terminally ill patients end their lives with medical assistance.

The bill's sponsor, Assemblyman John Burzichelli (D., Gloucester), said he hoped the forum, which drew about 60 people to Rutgers-Camden Law School, is the first of many.

"People seem to want to be in control of their circumstances, and they're looking to the law," he said. "Does the state law as presently structured adequately serve the people it governs? Should it change?"

Lawmakers favorably moved the bill, called the New Jersey Death With Dignity Act, from an Assembly committee last month. Burzichelli said he did not expect a vote in the full Assembly or Senate until after the fall elections.

The current bill is modeled after laws in Washington and Oregon. A terminally ill adult given a prognosis of six months or less to live would have to request a lethal dose from his or her attending physician on two occasions, the second request coming at least 15 days after the first. A second doctor would also have to approve the request.

In addition, the patient would submit a written request signed by two witnesses who believe the person is "capable" and "acting voluntarily." At least one of the witnesses would be forbidden from having any family or medical connection to the patient or any stake in the patient's estate.

Only the dying person could administer the lethal dose, under the bill's current language, which led some at Wednesday's discussion to ask about those suffering from a disease like amyotrophic lateral sclerosis, a degenerative neuromuscular disease that causes a person to progressively lose the ability to move, speak, and breathe.

A person with ALS might not be able to self-administer a dose, which Burzichelli said bore further discussion.

"It may be that we may want to think about how we use the term terminal and how it relates to their ability to self-administer," Burzichelli said, adding that he had lost five friends to ALS.

Joseph F. Fennelly, a doctor who has practiced medicine for 50 years and spoke against the bill, said that doctors use palliative care and pain management to help those who are suffering and near death. He said that he had seen patients with advanced ALS ask doctors to help them die, and that doctors had responded by using heavy morphine doses to ease the person's death.

But what goes on in the "sacred" space between a well-acquainted doctor and patient should not be dictated by state government, he said. Some patients hardly know their doctors. Should a primary-care physician agree to help someone die in the course of a five-minute visit, he asked.

"Save lives and stamp out disease: It's a mantra," he said of the message drilled into the heads of physicians.

The bill does not force doctors to participate, said David Leven, an expert on advance directives and end-of-life policy. The bill would simply give people the option, one that many do not take. About one-third of those in Oregon and Washington who obtained lethal drug doses never took them, he said.

Kathleen M. Gialanella, a registered nurse and a lawyer who spoke against the bill, said she supported withholding care at the request of a patient or his family. But doctors and nurses should not cross the line into actively helping a person to die, she said.

She questioned whether it was fair to let a person with terminal cancer choose when he or she would die when a person who is paralyzed from the neck down, for example, would not receive the same right under the bill.

"With any law, you can have unintended consequences. You do have to be concerned about the expansion of these type of societal changes," she said.

Burzichelli said he was not ready to contemplate allowing lethal drug doses to anyone except those who met the terminally-ill criteria of the bill.

"We're not ready for that," he said. "That is a slippery slope that has been salted."

Contact Joelle Farrell at 856-779-3237, jfarrell@phillynews.com, or follow on Twitter at @joellefarrell.

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