NJ Right-To-Die Law Takes Effect Now: 16 Things You Need To Know

The right-to-die law takes effect on Thursday in New Jersey. But the legislation has a number of components that, officials say, will ensure that the law is utilized properly.

And it's not coming without backlash. At least one Catholic leader has vocally opposed the new law, saying the legislation "follows a dangerous and frightening trend and is a brazen attack against the sanctity of human life."

Gov. Phil Murphy signed legislation in the spring that, he says, will allow terminally ill New Jersey adults to end their lives peacefully, with dignity, and at their own discretion.

The bill, which was sponsored by Democratic Assemblyman John Burzichelli and Senator Nick Scutari, makes New Jersey the eighth state to allow such end-of-life decisions with the assistance of medical professionals.

“Allowing residents with terminal illnesses to make end-of-life choices for themselves is the right thing to do,” said Murphy. “By signing this bill, we are providing terminally ill patients and their families with the humanity, dignity, and respect that they so richly deserve at the most difficult times any of us will face."

Here's what it will do:

• The “Medical Aid in Dying for the Terminally Ill Act” permits terminally ill, adult patients residing in New Jersey to obtain and self-administer medication to end their lives peacefully and humanely, Murphy said.
• A patient’s attending and consulting physicians must determine that the patient has a life expectancy of six months or less, has the capacity to make health care decisions, and is acting voluntarily, in order for the patient to obtain the medication, according to the Murphy administration.
• The bill defines a "terminal disease" as an irreversible illness that has been medically confirmed and will result in a patient's death within six months.
• It would cover: an adult resident of New Jersey who is capable and has been determined by the patient's attending physician and consulting physician to be suffering from a terminal disease, and has voluntarily expressed a wish to die.
• The bill would require patients suffering from a terminal disease to first verbally request a prescription from their attending physician, followed by a second verbal request at least 15 days later.
• The attending physician would have to offer the patient a chance to rescind the request.
• A consulting physician would then be called upon to certify the original diagnosis and reaffirm the patient is capable of making a decision.
• It would also require one request in writing signed by two witnesses. A valid request for medication must be signed and dated by the patient and witnessed by at least two individuals who, in the patient's presence, attest that the patient is capable and is acting voluntarily to sign the request.
• Only the patient would be permitted to administer the drug to themselves. At least one of the witnesses must be a person who is not: 1) a relative of the patient; 2) entitled to any portion of the estate of the patient; 3) an owner, operator, or employee of a health care facility where the patient is receiving treatment, or 4) the patient's physician.
• The bill requires that the patient's attending physician recommend that the patient participate in a consultation concerning additional treatment opportunities, palliative care, comfort care, hospice care, and pain control options, and provide the patient with a referral to a health care professional qualified to discuss these options.
• The attending physician would be required to document the recommendation in the patient's medical record, and indicate whether the patient chose to participate in the consultation, and whether the patient is receiving palliative, comfort or hospice care.

Rutgers School of Public Health palliative care experts Paul Duberstein and Elissa Kozlov discussed the ethical questions involved and what New Jersey can learn from other states with similar laws.

How does the law determine who can be prescribed this medication?

Duberstein: The law states that patients must have a prognosis, based upon reasonable medical certainty, of six months or less to live and are able to administer medicine themselves. Two witnesses must attest that the individual is capable and that their decision to die is voluntary. At least one of the witnesses must be disinterested, meaning that they cannot be perceived to benefit from the individual’s death. A second “consulting” physician must verify eligibility.

There are other safeguards, such as the person must make two oral requests within 15 days and a written request. The treating physician must refer the patient to a qualified health care professional to discuss care options, including pain relief, palliative care and hospice. If either the treating physician or consulting physician is uncertain about the patient’s mental capability, they may refer the patient to a qualified mental health professional.

What makes a mental health professional qualified to determine if a person has the capacity to decide to die?

Kozlov: Under the law, psychologists, psychiatrists and social workers can complete the evaluation, however it’s important to note that very few of these providers have specific training with end-of-life issues. Studies done in Oregon, which passed the first such law in 1994, have shown that mental health professionals may lack the experience, training, knowledge and confidence to ethically participate in consultations surrounding physician aid in dying. Also, research shows that mental health practitioners with moral opposition to physician aid in dying were more likely to support stricter standards for competence and were less likely to believe that certain patients would ever be deemed competent to consent to physician aid in dying.

New Jersey might want to follow the lead of Washington and California, which have issued guidelines for mental health professionals participating in physician aid-in-dying laws to ensure that specialists apply the same standards to all patients.

What challenges might New Jersey experience in implementing this law?

Duberstein: The demand for this service might outstrip the supply of health care professionals who are willing and trained to participate. Even though there is no criminal or civil liability or professional disciplinary action for good faith compliance with the provisions of this law, some physicians, hospice providers or nursing home administrators will not want to participate.

There are also practical and ethical challenges. Currently, there is a shortage of Seconal, a drug that is frequently prescribed. And there is concern that some might wish to monetize aid-in-dying. After California passed an aid-in-dying law in 2016, a pharmaceutical company doubled the price of the drug.

What ethical considerations does this law raise?

Duberstein: The medical community has taken a neutral stance on such laws, but there is an ethical debate that is particularly relevant to New Jersey. The Governor’s Advisory Council on End-of-Life Care reported that dying New Jerseyans receive the most aggressive medical care in the nation, and other groups have equated aggressive care at the end of life with worse care. Access to hospice and palliative care here is relatively limited. Across the nation, there are too few home health aides, social workers’ case loads are exploding and employees in both fields are underpaid. I would feel better about the law if it was accompanied by a robust effort to improve the flagging aging, health and social services infrastructure.

The data from other states show that many people rescind their request for physician aid in dying after they have met with specialists to better manage their symptoms of pain, depression and anxiety, which speaks for the need to complement this bill with better access to high-quality end-of-life care.

There also are social justice and equity concerns. The medication costs from $4,000 to $5,000, but Medicare and VA benefits cannot be used. Not every family will have $5,000 at their disposal.

What can New Jersey learn from states that have passed similar laws?

Duberstein: One-third of the prescriptions written since Oregon passed its law have not been used. This implies that just having a prescription is helpful. There is also reason to believe that the law has helped individuals have conversations with their clinicians and family members about their care preferences.

The law has been helpful in other ways. For example, most people want to die at home, but too many die in hospitals and other care settings. In Oregon, 93 percent of people who used the law died at home, as that likely was their ultimate wish.

Bishop James F. Checchio of the Metuchen Archdiocese, meanwhile, issued the following statement on the passage of the Medical Aid in Dying for the Terminally Ill Act, which was signed into law by Murphy on April 12:

"The passage of the Medical Aid in Dying for the Terminally Ill Act was a sad day for our diocese and the Church in New Jersey, which has battled against its passage since 2012, when the bill was first introduced. The passage of this legislation follows a dangerous and frightening trend and is a brazen attack against the sanctity of human life. While we are facing dark times, we will not stop from advocating for the sanctity of human life, in all stages, and we will continue to educate our legislators, our fellow Catholics and the general public about the dangers of legalized physician-assisted suicide. We look to Our Blessed Mother in our fight to end the threats to human beings and a growing culture of death. She is our model and our example of how every human being should be treated as a gift at the beginning and end of life. Easter Sunday comes after the darkness of Good Friday, we know, so we will continue to work for Easter light to pervade our society."