One of the most contentious issues in medicine today is medical aid in dying, which allows terminally ill patients to take control of their last moments. In the United States, the practice is hotly contested. Ten states and the District of Columbia support this end-of-life option. In Rhode Island, it is not yet legal and the subject of much debate.
Legalized in Oregon in 1997, the “Death with Dignity” Act paved the way for terminally ill patients to decide the time and manner of their passing, with several states modeling their own state legislation after the bill.
In Rhode Island, a legislative proposal known as The Lila Manfield Sapinsley Compassionate Care Act would authorize a terminally ill and mentally capable adult with less than six months to live to voluntarily request medical aid in dying from their physician. Under the bill, patients would undergo a rigorous approval process, consisting of several requests, physician consultations, written affirmations, a psychological evaluation, and multiple confirmations of prognosis, all aimed at protecting patient autonomy and voluntary decision-making.
Before heading to medical school, I earned a master’s degree in bioethics from Columbia University, to learn how to navigate ethical issues at the center of health care. Today, as a physician in training at the Warren Alpert Medical School of Brown University, I try to put this into practice. I recently became aware of the proposed Sapinsley Act legislation in Rhode Island, and shared my testimony at the Rhode Island State House in favor of the bill.
In my testimony, I emphasized how supporters of medical aid in dying center on its nuanced understanding of bioethical principles, acknowledging a patient’s autonomy over their own life and over what happens to their own body. Supporters of this practice grasp that a patient’s voluntary request is a conscious and informed decision, reserved for patients who are dying and distinct from euthanasia or physician-assisted suicide.
Control over one’s last day is not the only reason medical aid in dying is valuable. In the months prior, terminally ill patients suffer. They experience a loss of functionality and independence, increasingly unable to control their illness. Medical aid in dying protects patient dignity by granting agency to those that would not have it otherwise.
Those who oppose this practice cite the ethical principle of nonmaleficence, or “do no harm,” invoking a cut and dried interpretation of the Hippocratic Oath. But we cannot ignore the harm imposed by denying dying patients access to a peaceful passing, instead forcing patients to endure the afflictions of their illness.
Consider the alternative: Withholding medical aid in dying condemns patients to a slow, agonizing decline as they waste away from dehydration and organ failure. Loved ones wait and watch. Contrast this with patients being able to bid farewell on their own terms, surrounded by loved ones.
As a physician in training, I understand that suffering and harm are not black and white. It can be a challenge to navigate through the sea of gray, aiming for ethical compassion. I implore Rhode Island to recognize medical aid in dying for what it truly is: a humane and principled option.
Fiona S. Griffin (she/her) is an M.D. candidate at the Warren Alpert Medical School of Brown University.
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