House Bill 1157, filed on Jan. 8 in the Indiana General Assembly by Rep. Matt Pierce, D-Bloomington, would legalize "medical aid in dying" for competent individuals with a terminal illness, making Indiana the sixth state with physician-assisted dying (PAD) legislation if passed.
The Editorial Board supports the bill insofar as it produces conversations between patients, physicians and families about end-of-life expectations, and acknowledges that the bodily integrity and autonomy of patients must be maintained during these difficult decisions.
“Indiana wants me to die a tortuous death in front of my children and my sweetheart,” said Cory Polen, an Indiana father diagnosed with amyotrophic lateral sclerosis who joined Pierce at the bill’s unveiling.
By changing how individuals like Polen may die, the bill can greatly improve their final months of life and make the emotional burden of their death easier for families to bear.
In Oregon, where PAD has been legal since 1997, the primary end-of-life concerns reported by those considering physician-assisted death included loss of dignity, loss of autonomy and loss of the ability “to participate in activities that made life enjoyable.” As these individuals become incontinent, bedridden and unable to communicate with their loved ones, families and physicians must consider these concerns as the individual decides how to proceed with treatment or palliative care.
Oregon’s Death With Dignity Act, however, is far from flawless. A long-term analysis of the act published in the Journal of the American Medical Association shows that 3.1 percent of patients requesting the self-administered lethal drug cocktail did so at least partially because the cost of chemotherapy or other treatments was too high, and only 5 percent of patients in Oregon received any form of psychological consultation prior.
Another 25 percent reported inadequate pain control as the primary reason why they were making the decision to pursue PAD.
Indiana physicians must continue to do everything in their power to ensure that pain is reduced through other means before PAD is discussed. But in cases where modern medicine is truly unable to reduce pain to a bearable level, PAD may be the best option for the comfort of the patient.
Still, further barriers to physician-assisted dying must be put in place to ensure that patients are not electing to die solely because of high treatment costs or improper pain management that palliative care may be able to assist in, and the Editorial Board worries about the potential for a PAD system to be abused.
Other Hoosiers, such as Glenn Trebbe, executive director of the Indiana Catholic Conference, have taken a stronger stance against the bill.
"There are ways to assist people facing great pain and to assist with the last stages of life that offer dignity to that patient, but killing them is not one of them," said Trebbe in a Chicago Tribune interview.
Trebbe is correct that these other ways exist. One issue with end-of-life care is that many Hoosiers don't know about them.
According to research published in the Annals of Internal Medicine in 2017, “90 percent of U.S. adults do not know what palliative care is; however, when told the definition, more than 90 percent say they would want it for themselves or family members if severely ill.”
U.S. healthcare does need honest, empathetic and patient-driven end-of-life care, but physician-assisted death should always remain an option of last resort. The Editorial Board hopes that Pierce's bill brings greater awareness to how death can be made dignified and free of suffering.
