MAID a Mistake
by Dr. Paul S. Aijian, M.D.
Medical Assistance in Dying is MAID
Many years ago, I was seeing a patient on weekend hospital call for another doctor. She had advanced lung cancer and was being discharged home. As we discussed her discharge plan, she asked me if I could help her by having drugs administered in the hospital to kill her. This was a startling question, and after a brief gulp, I replied that she was in the wrong hospital (St. Francis, which is now gone) and had asked the wrong doctor. I suggested we refer her to hospice. She wanted something more immediate. I declined, and she had to take up that discussion with her regular doctor after she got home. This was over 30 years ago, and I had never been asked something like that before. I have placed a fair number of patients on hospice over the years, but never participated in medically assisted suicide.
The End-of-Life Option
Fast forward to 2024, and things have really changed in California, and around the world. The California End of Life Option Act (EOLA) allows terminally ill California residents to request and self-administer lethal drugs to end their life. This law went into effect June 9, 2016. To qualify, a patient must be at least 18 years old, have a terminal illness with a life expectancy of 6 months or less, and be able to make an independent decision to request the medication. I remember when it passed, and wondered if any doctors in Santa Barbara would step up and offer this service. It did not take long, and someone did.
How often this is actually practiced in Santa Barbara is not clear to me, but the law exists, and doctors are willing to act on it. In fact, there has been a recent proposal to loosen the regulations and broaden the criteria for medical assistance in dying (MAID). Catherine Blakespear, an estate planning attorney and a first term California lawmaker, has proposed legislation (Senate Bill 1196) that “would enable people without a specific terminal prognosis to request life-ending drugs, a lower threshold than any of the other 10 states that currently allow some form of aid in dying (•).
California: Destination State To Die In
An even more controversial aspect of this proposal is that it “would allow early and mid-stage dementia patients to request the medication while they still have the faculties to do so.” The article referenced here suggests that California could become a destination state for people coming here to legally have doctors help them end their own life. People have been fleeing this state for reasons we all know. This would be a strange reason for them to come here, albeit briefly. Death tourism could become a thing.
Some states have set themselves up as magnets for people seeking to terminate their unborn children’s lives, so this is not so surprising in that context. California could become the state not just known for liberal politics, but for assisted death at both ends of the age spectrum. There is plenty of opposition to EOLA, and even more opposition to this expanded program. Those who object include those with religious issues with this practice, disability rights groups, and many doctors who still see it as a violation of the Hippocratic Oath.
Worldwide Expansion of MAID Legislation
On November 29, the British Parliament voted to advance a bill legalizing assisted dying for the terminally ill with a prognosis of six months or less. This trend is spreading around the globe, and our neighbors to the north, Canada, have used MAID to such an extent that it is the fifth leading cause of death in that country.
You don’t need to search far to find stories suggesting that Canada may not be the safest place to go to the doctor in a state of depression, and state that you feel that life is burdensome and not worth it any longer. The doctor may well suggest there is a solution to that besides Prozac. One huge issue is that the amount of money spent on health care during the last year of life is often massive, compared to all the years leading up to this point. In 2017, one year after Canada legalized assisted suicide, a report estimated the procedure could save the country between $34.7 million and $138.8 million annually.
Money-Saving Option for Offspring… or Government
Governments around the globe are providing health care at enormous cost, and many countries are in deep red ink. Medicare is not technically nationalized health care, as it is in Britain and Canada, but you can be sure that someone has already calculated the financial savings of a broad implementation of MAID here in the USA. A patient might reasonably feel suspicious when they realize that the doctor or the hospital may be motivated or pressured to suggest MAID instead of expensive late-in-life care, and the main motive for the advice is cost savings. It is a generally good idea to spend as much time with a family member who is hospitalized as you can, for a variety of reasons. You want to be aware of all the critical decisions being made regarding intensity of care and CPR status.
Another troubling aspect of all of this is that some people feel guilty for living so long that they expend a huge amount of money on end-of-life care. This can be an issue whether the money is theirs or the insurance plan’s. They may feel like they are doing a big favor by ending it all and avoiding the expense. A sad fact is that in some situations, families may be swayed by the motivation to convince grandma or grandpa to end it all, realizing the financial gain of their earlier demise. This sounds dark but is not as uncommon as you might like to think.
Nazi Doctors There “To Help”
I will end by referring to a book I read some years ago called “The Nazi Doctors,” by psychiatrist Jay Lifton. It describes how the doctors in Nazi Germany were used by the government as agents of death, instead of life. Initially, they were sent into the baby nurseries to kill the deformed and terribly retarded children, They told the parents it was for the best, and with the war, the resources consumed by their child took away from the war effort. After the nurseries were cleared out, the doctors were directed to start killing others less severely impaired. This included children with Down syndrome, for example.
Finally, once the concentration-death camps were operating, doctors were placed on the platform, greeting Jews and other “undesirables” as they got off the trains. They posed as public health professionals and told people everything would be ok. They just needed a shower, and some of them would be assigned work duties. Their job was to look over the people going by and sort out those strong enough to be worked to death, and to send the rest to the gas chambers. Some of the twins and others were directed to the dormitory housing people to be research subjects for Dr Mengele.
“Never Again?”
The doctors were in two general camps regarding the morality of what they were doing. Some were true Nazi believers and thought that ridding the world of these people was a good thing. Many of them did not actually believe this, and drank themselves into a stuporous sleep every night, thinking about the horror of what they were being asked to do. The option was to be sent to the Eastern front as medics in the frozen war with Russia, or worse. The Nuremberg trials put Nazis, including doctors, on trial and the result was the promise, “never again.” The question for us today is whether medicine could be harnessed for evil in the name of saving the state money, or helping those whose life is no longer worth much to them or their families exit this earth a little sooner.
Further resources:
Politico: “For Terminal patients, dying in California may get easier”
The Free Press: “Should a Government Help People Die?” By Madeleine Kearns Nov 27, 2024
The Nazi Doctors: Medical Killing and the Psychology of Genocide
Great article.
I don’t know Dr. Aijian but I believe that he is probably a Christian and any devout Christian knows that they are a Christian before they are ANYTHING else.
My primary care doctor is a believer and it makes such a difference!
This world is very lost and ignorance is no excuse.
The devil is the greatest liar of all time.
God bless you Dr.
This is where I go off the reservation with conservative dictum. Having taken care of thousands of critically ill patients over the course of 40+ years, I stand resolute with the right to die with dignity. Patients should have a right to choose their end based on well defined, medically supervised and legally sanctioned laws, with strictly applied guidelines, checks and balances to prevent fraud and abuse.
Sad how our society is more
humane with our pets end of life, than we are for our loved ones during their final days. Conservatives constantly remind us of our God given rights of freedom, until it comes to the right to end our lives! The ultimate freedom is that of our own destiny!
Yes, the final weeks or months of life can be not only painful, but extremely expensive as well. The majority of cost for Medicare is typically during the last 30 days of life, leaving many families paying for the 20% of a multi million dollar bill left by caring for their loved ones. Often, families are left with difficult choices, sometimes left with having to liquidate their parent’s home in order to pay for care.
I reject fully, the use of Nazi analogies in terms of right to die legitimacy.
Give terminally ill patients the freedom of choice now!