Terminal patients sometimes find themselves across state lines. Some are transported across state lines with a traveling nurse — a tactic popularized when politicians and health care officials worried that timely hospital care for terminally ill patients could be denied by the practice of “right-to-die.” Just this month, those patients were represented by the ACLU at a landmark Senate hearing about physician aid in dying.
These terminally ill patients can also end up on the other side of the country, sometimes ending up in states where hospitals will not provide care. As a nurse, I can attest to this. When I worked in a high-profile, unincorporated town in the California coastal rainforest, I transported terminal patients across state lines several times a week. I have seen the likes of a young adult with a colorectal cancer diagnosis unable to get medical help to end his life, because he was from Oregon, a state that, although it allows physician aid in dying, prohibits such help for terminally ill patients beyond the first two weeks of their disease — and nurses can be fined for authorizing aid in dying for an adult patient outside of this time frame. That teen was sent to a family member in the nearby town, with nothing in-between but hospital and hospice care.
Terminal patients can be sent anywhere, and even have difficulty getting assistance from medical professionals. One terminally ill patient (in fact, the first patient I read about) recently told a hospital psychologist that her grandmother had been hospitalized and was dying. His grandmother eventually died, but the security officer at the hospital threatened to take her to an “institution” when the security sergeant recognized the grandmother from the TV show “Orange is the New Black,” telling her that the medical staff would not help her and “very likely … wouldn’t report her back” if she tried to administer the lethal dose to her grandmother herself.
Terminal patients often have to rely on their families for care — many patients are not comfortable talking to the staff about their advanced illness. Often, families accompany these terminally ill patients to the offices of a hospice, who then ask for written permission from the patients and their families to administer the assistance provided by the dying patient. Sometimes, the patient and his or her loved ones will decide that, rather than allow it, they would prefer an in-person, “surprise” visit from the hospice, with or without the aid in dying application.
Other patients with terminal illnesses are sent to out-of-state “accompaniers” — trained by and paid for by the company Hospice Helpers — who will assist in death-related activities such as travel to “suicide sites,” body removal by visiting a funeral home and scattering of ashes.
In accordance with the wishes of the patient, or even to reach out to the assisted suicide provider at a later date, these assisted deaths are often documented. Sometimes, I have seen families sign a “death declaration form” and are sent an altered version of the form: it has been shortened, some of the information has been omitted.
Even so, some states still do not have law specifically prohibiting assisted suicide. For example, under current law in Maine, for which I still live, assisted suicide is only prohibited if assisted suicide takes place in your home or where you are a close relative.
Lately, I have seen some hospice leaders in hospice admit they do not understand the new law in Oregon and the similarities of its prohibition to the prohibition in Maine. This is especially true with other states that do not expressly prohibit assisted suicide. In this interim, the state parties to many of the state aid-in-dying lawsuits have been working with state legislators and the state courts to modify their state statutes in ways that clarify, and in most cases, more closely mirror, the prohibition in Oregon.
Terminal patients face a range of end-of-life issues in their last days and weeks, from their understanding of how best to die, to their final wishes for themselves and their families. This end-of-life care is often complicated, not easy, and can be tough to navigate for patients and their loved ones. This new law in Oregon — and that of other states that allow physician aid in dying — can help bridge this coverage gap for terminally ill patients in those states that do not explicitly prohibit it.
Meryl Ain, M.D., is the chief medical officer of the hospice nonprofit Dignity Health.