Today’s Topics: Nov. 18, 2020

1. Thaddeus Pope examines key variations among U.S. state MAID laws
 (Right To Die news list – FEN)
2. Thoughts on California’s MAID residency requirement
 (Right To Die news list – FEN)
3. MAID and the those who access it
 (Right To Die news list – FEN)

Message: 1

An essential read for those involved in MAID:

Thaddeus Mason Pope, Medical Aid in Dying: Key Variations Among U.S.

State Laws, J. Health and Life Sci. L., Oct. 2020, at 25. (c) American Health Law Association, journal. All rights reserved.

ABSTRACT: Medical aid in dying (MAID) is legal in eleven U.S.

jurisdictions representing one-fourth of the U.S. population, but despite its legality, MAID is practically available to only a subset of qualified patients in these states. MAID’s eligibility requirements and procedural safeguards may impede a patient’s access. In response, state legislatures have begun to craft more flexible rules as they recalibrate the balance between safety and access. There is already significant variability among U.S. MAID statutes in terms of eligibility requirements, procedural conditions, and other mandates.

While the Oregon Death with Dignity Act has served as the template for all subsequent MAID statutes, the states have not copied the Oregon law exactly. Furthermore, this nonconformity grows as states continue to engage in an earnest and profound debate about the practicality of MAID.

Message: 2

Thaddeus Pope’s article on the state differences of medical-aid-in-dying laws brought up a conversation about, in particular, California’s residency requirements. These are very specifically outlined in the law, and I’d like to point out a glaring deficiency in these requirements — one that all clinicians should be aware of and decide how to work with.

First, the residency requirement as stated in California’s End of Life Option Act.

3. The individual is a resident of California and is able to establish residency through at least one of the following means:

a. Possession of a California driver license or other identification issued by the State of California.
b. Registration to vote in California.
c. Evidence that the person owns or leases property in California.
This includes renting an apartment.
d. Filing of a California tax return for the most recent tax year.

The intent of this section of the End of Life Option Act is, understandably, to discourage “aid-in-dying tourism” where people move to California just to access aid-in-dying.  But in my experience, this is uncommon (although not absent). What is very common is the

following: Out-of-state patients who have close family members in California who come here to have that family member provide their end-of-life care, who also are considering medical aid in dying.

Example: A patient who lives in Arizona has pancreatic cancer.  Her daughter lives in California and wants to care for her mother at the end of her life. Mom moves in with daughter, does not pay rent, does not get a driver’s license, votes in Arizona, etc.  In my opinion, her residence in her daughter’s house qualifies her for the End of Life Option Act, and I have accepted these patients into my aid-in-dying practice.  But that’s not the letter of the law.  The law, then, allows for a man to rent a hotel room in California and come there just for an aid-in-dying death (aid-in-dying tourism), while excluding patients who have every good reason to come to California for end-of-life care by a family member.

Thaddeus suggested a remedy: Have these patients pay $1 in rent to the family member, thus fulfilling the legal requirement.  A note from the family member and/or the patient documenting this should suffice.

I bring this up since I believe that these originally out-of-state patients are entitled to access the End of Life Option Act, but some physicians might hesitate to participate.  The $1 rent payment, as well as chart documentation about why the patient has come to the state, should suffice, I believe, to quiet all concerns and provide needed care.

I welcome all thoughts and ideas — not just about how this works in California (which has the most specifically outlined proof-of-residency requirements), but in other states as well.

Lonny Shavelson, MD

Moderator, Listserve of the American Clinicians Academy on Medical Aid in Dying

Message: 3

In this article, published in August, one MAID provider shares thoughts about the process and the patients who access it.

August 24, 2020

Medical Aid in Living

JAMA Neurol. 2020;77(11):1349-1350. doi:10.1001/jamaneurol.2020.2915 By Benzi M. Kluger, MD, MS, August 24, 220

“People seeking MAID are vibrant, courageous, and thoughtful. They know who they are, define the rules of their life, and are clear on their values, including the meaning of living. My last visits with them are typically marked by a sense of clarity and peace.

“The use of MAID is a complex issue with many ethical, legal, and medical implications. In talking to experts on both sides of this issue, I find that there is also a strong moral thread, often unstated, that could be summed up by stating that MAID is for quitters and cowards. But we are all going to die, and we will all die in ways that are unique to our persons, our circumstances, and our illnesses.

What I learned from my patient was that MAID was not simply, or even mainly, about dying. It was about living. It was about hope. It was about stealing a victory from an illness that could not be cured…”

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