Opponents of Medical Aid in Dying (MAID) cite its potential for abuse. Compassion and Choices, a pro-MAID advocacy group, claims there has not been a single case of a person being coerced into ending their life using MAID or MAID being used by someone who was suicidal but not terminally ill. But if someone had been coerced into using MAID, would we know? On the other hand, is the potential for abuse a reason to reject MAID outright?
MAID is available to terminally ill patients competent to make informed decisions. Opponents of MAID say an incompetent person could be pressured into using MAID via “doctor shopping.” In support of that argument, MAID opponents cite the case of Kate Cheney, an 85-year-old Oregonian woman with dementia, who was denied MAID after a psychiatrist found her incompetent. Whether Cheney’s daughter pressured her to pursue MAID is disputed. The daughter sought opinions from other health professionals, who found Cheney competent and approved MAID. The law assumes that professionals will act professionally and they risk loss of licensure, and potential criminal charges, for violating professional obligations. Is that enough, when the consequences of misuse of MAID laws are deadly?
Another objection to MAID is that it will be used to reduce healthcare costs. The infamous case of Barbara Wagner is often cited to support that argument. Wagner was an indigent Oregonian with advanced lung cancer. Oregon’s Medicaid program declined to cover chemotherapy that offered Wagner a chance to live an additional year. The letter denying coverage included information about end-of-life options that were covered, including palliative care and MAID. Wagner had not asked about MAID and was offended. When the case was publicized, the drug manufacturer provided Wagner’s treatment at no cost. As a matter of public policy, insurers and other healthcare payers should be precluded from providing patients with information about MAID. Like other important healthcare choices, a decision about MAID should be made by a patient in consultation with their doctor.
There is great concern that MAID is a slippery slope that will be used by people who are not terminally ill but who are suffering from a mental health crisis. For example, three countries where MAID is legal – Belgium, the Netherlands, and Luxembourg – have expanded the criteria used to authorize MAID and patients who suffer from depression, dementia, or being “tired of life” may choose MAID. This development is contrary to the original purpose of MAID: to aid the terminally ill in their final days. At a time when many Americans have unmet mental healthcare needs, we must write MAID laws to restrict their use to the terminally ill.
MAID laws can be carefully written to protect the most vulnerable from abuse. If we are going to make MAID safe, we need to acknowledge the very real potential for abuse. Let’s talk about dying.