A policy mapping analysis of the U.S. Congressional approach to medical aid-in-dying

Oregon was the first state to legalize medical aid-in-dying (MAID), in 1994. Since then eight states and Washington, DC have legalized MAID through legislation. Despite literature exploring the legal and ethical aspects of MAID, very little research examines MAID policy at the federal level. This study aimed to 1) examine the objectives of MAID legislation introduced to the US Congress, and 2) investigate whether these bills increase or decrease access to MAID. This study used the congress.gov website to search for bills related to MAID introduced by the US Congress between 1994 and 2020. From the 98 bills identified, we excluded bills that were not directly related to MAID or were introduced in subsequent congresses. In total, 23 bills were retained and analyzed. The greatest number of bills aimed to restrict funds for MAID, followed by bills that sought to regulate the drugs used for MAID. Other bills prohibited the development of policies supporting MAID, regulated penalties for practitioners related to the drugs used for MAID, and restricted legal assistance for accessing MAID. These bills intended to block or limit patient access to MAID by restricting drugs, funds, health care services, legal assistance, policy, and research. These findings suggest that the federal approach is incongruous with the growing numbers of states that have legalized MAID. Federal policymakers must develop policies to 1) prevent discrimination against vulnerable groups, 2) support funds to study MAID, and 3) build a system to allows eligible individuals to access MAID equally.

Medicine against Suicide: Sustaining Solidarity with Those Diminished by Illness and Debility

The medical profession’s increasing acceptance of “physician aid-in-dying” indicates the ascendancy of what we call the provider-of-services model for medicine, in which medical “providers” offer services to help patients maximize their “well-being” according to the wishes of the patient. This model contrasts with and contradicts what we call the Way of Medicine, in which medicine is a moral practice oriented to the patient’s health. A steadfast refusal intentionally to harm or kill is a touchstone of the Way of Medicine, one unambiguously affirmed by Christians through the centuries. Moreover, physician aid-in-dying contradicts one of the distinctive contributions that the Christian era brought to medicine, namely, a taken-for-granted solidarity between medical practitioners and those suffering illness and disability. Insofar as medical practitioners cooperate in aid-in-dying, they contradict this solidarity and undermine the trust that patients need to allow themselves to be cared for by physicians when they are sick and debilitated.

Socioeconomic Status and Medical Assistance in Dying: A Regional Descriptive Study

Purpose Concerns that medical assistance in dying (MAiD) may harm vulnerable groups unable to access medical treatments and social supports have arisen since the legalization of MAiD on June 17, 2016; however, there is little research on the topic. The purpose of this study is to investigate the socioeconomic status (SES) of patients who request MAiD at the London Health Sciences Centre (LHSC). Methods A retrospective analysis of patients from the LHSC MAiD database between June 6, 2016 and December 20, 2019 was conducted. Patients were linked to income data from the 2016 Canadian Census, and their corresponding income quintile was a proxy for SES. Geographic information system (GIS) mapping software was used to visualize the distribution of income and MAiD requests. Results 39.4% of the LHSC catchment area was classified as low SES. Two hundred thirty-seven (58.1%) MAiD requests came from low SES patients and 171 (41.9%) requests came from high SES patients. Two hundred fifty-nine (63.5%) patients who requested a MAiD assessment did not receive MAiD following their request. Of the 237 lower SES patients, 150 (63.3% [95% CI 57.2-69.3]) did not receive MAiD. Of the 171 higher SES patients, 109 (63.7% [95% CI 56.5-70.9]) did not receive MAiD. Conclusion A disproportionate number of requests for a MAiD assessment at LHSC came from lower SES patients; however, similar proportions of patients who requested MAiD from each SES group received aid in dying. Future research should explore why a disproportionately high number of low SES patients request MAiD at LHSC.

Physician Aid in Dying for Dementia: The Problem With the Early vs. Late Disease Stage Distinction

Background: Physician aid in dying (PAD) based on dementia is a contentious, highly debated topic. Several countries are considering extending their existing laws to include requests in incompetent patients based on a previously written advance directive. Discussions about this issue often invoke a distinction based on disease stage. The Dutch practice uses this distinction in classifications of dementia PAD cases and in guidance for clinicians. This paper explores the problem with this distinction for assessments of persons at the margins of competence.The Problem: Dutch guidance for clinicians uses an early vs. late-stage disease distinction to refer to requests from competent and incompetent persons. However, the use of disease stages is problematic, both conceptually and empirically. Conceptually, because it goes against very functional model of competence that guidance recognizes. Empirically, because it creates problems for classifying and evaluating patients at the margins of competence.Possible Ways Forward: Classification of cases and guidance should be based on competence, not disease stage. This requires rethinking decision-making for patients with dementia. Several possibilities are described, ranging from redefining the scope and role of advance directives in this context to exploring different types of decision-making frameworks.