Giving Compass' Take:

• Paul Duberstein and Elissa Kozlov explain the logistical and ethical implications of New Jersey's aid-in-dying law which went into effect on August 1st. 

• Should individuals have a right to die? How can funders help to overcome the logistical obstacles to the practice? 

• Read an argument against assisted suicide.

How does the law determine who can be prescribed this medication?

Duberstein: The law states that patients must have a prognosis, based upon reasonable medical certainty, of six months or less to live and are able to administer medicine themselves.

Two witnesses must attest that the individual is capable and that their decision to die is voluntary. At least one of the witnesses must be disinterested, meaning that they cannot be perceived to benefit from the individual’s death. A second “consulting” physician must verify eligibility.

There are other safeguards, such as the person must make two oral requests within 15 days and a written request.

The treating physician must refer the patient to a qualified health care professional to discuss care options, including pain relief, palliative care, and hospice.

If either the treating physician or consulting physician is uncertain about the patient’s mental capability, they may refer the patient to a qualified mental health professional.

What makes a mental health professional qualified to determine if a person has the capacity to decide to die?

Kozlov: Under the law, psychologists, psychiatrists, and social workers can complete the evaluation, however it’s important to note that very few of these providers have specific training with end-of-life issues.

Studies done in Oregon, which passed the first such law in 1994, have shown that mental health professionals may lack the experience, training, knowledge, and confidence to ethically participate in consultations surrounding physician aid in dying.

Also, research shows that mental health practitioners with moral opposition to physician aid in dying were more likely to support stricter standards for competence and were less likely to believe that certain patients would ever be deemed competent to consent to physician aid in dying.

New Jersey might want to follow the lead of Washington and California, which have issued guidelines for mental health professionals participating in physician aid-in-dying laws to ensure that specialists apply the same standards to all patients.

What challenges might New Jersey experience in implementing this law?

Duberstein: The demand for this service might outstrip the supply of health care professionals who are willing and trained to participate.

Even though there is no criminal or civil liability or professional disciplinary action for good faith compliance with the provisions of this law, some physicians, hospice providers, or nursing home administrators will not want to participate.

There are also practical and ethical challenges. Currently, there is a shortage of Seconal, a drug that is frequently prescribed. And there is concern that some might wish to monetize aid in dying. After California passed an aid-in-dying law in 2016, a pharmaceutical company doubled the price of the drug.

Read the full article about New Jersey’s aid-in-dying law by Patti Verbanas at Futurity.