Debby Waldman
KFF News
Originally posted 20 Aug 24
In the 18 months after Francine Milano was diagnosed with a recurrence of the ovarian cancer she thought she’d beaten 20 years ago, she traveled twice from her home in Pennsylvania to Vermont. She went not to ski, hike, or leaf-peep, but to arrange to die.
“I really wanted to take control over how I left this world,” said the 61-year-old who lives in Lancaster. “I decided that this was an option for me.”
Dying with medical assistance wasn’t an option when Milano learned in early 2023 that her disease was incurable. At that point, she would have had to travel to Switzerland — or live in the District of Columbia or one of the 10 states where medical aid in dying was legal.
But Vermont lifted its residency requirement in May 2023, followed by Oregon two months later. (Montana effectively allows aid in dying through a 2009 court decision, but that ruling doesn’t spell out rules around residency. And though New York and California recently considered legislation that would allow out-of-staters to secure aid in dying, neither provision passed.)
Despite the limited options and the challenges — such as finding doctors in a new state, figuring out where to die, and traveling when too sick to walk to the next room, let alone climb into a car — dozens have made the trek to the two states that have opened their doors to terminally ill nonresidents seeking aid in dying.
Here are some thoughts:
This article delves into the complex ethical and psychological dimensions of medical aid in dying, highlighting several key issues. At its core, the story of Francine Milano underscores the importance of personal autonomy in end-of-life decisions, with many terminally ill patients finding empowerment and dignity in having control over their final moments.
The legal requirement of a six-month prognosis reflects the ongoing ethical debate surrounding quality versus quantity of life. However, the logistical challenges and travel burdens placed on patients seeking this option raise questions about equitable access and the ethics of imposing additional stress on those already suffering.
The article also touches on the impact on family dynamics, with out-of-state patients often having fewer loved ones present during their final moments. Safeguards such as mental capacity assessments and waiting periods attempt to balance patient autonomy with societal protections, addressing concerns about vulnerable individuals being coerced.
The article acknowledges moral and religious objections, illustrating the ongoing ethical debate in society. Interestingly, the observation that a third of approved patients don't follow through suggests that for some, the mere option provides psychological comfort.
The geographic inequity in access to aid in dying based on state laws raises further ethical concerns.
Lastly, the gradual expansion of these laws points to evolving societal attitudes towards death and dying, which has profound implications for how we approach end-of-life care psychologically and ethically. These multifaceted issues highlight the intricate interplay between individual rights, societal values, and the psychological needs of terminally ill patients and their families in the context of assisted dying.
