Page 12 - Delaware Medical Journal - April 2018
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TABLE 1:
SAFEGUARDS PLACED IN DELAWARE HOUSE BILL 160
1. Patient must be diagnosed with a terminal disease with a prognosis of 6 months or less.
2. Physician must confirm patient’s mental health and that patient is making an informed decision free from pressuring or coercion.
3. The bill requires a second consulting physician to confirm terminal diagnosis, mental health and informed decision.
4. If either physician has concerns about the individual’s ability to make a rational informed health care decision or believes he/she may be suffering from impaired judgement, the patient must be referred to a mental health professional for further evaluation.
5. No sooner than 15 days after the first oral request, patients must repeat their request for the medication again from their attending physician.
6. After the two oral requests, patients must submit a written request to their attending physician. The request is made via a template set forth in the legislation, and must be signed by two witnesses.
7. Once each of these steps has been completed and documented, the physician sends the request to the pharmacy, which will make the medication available only after a 48- hour time period has passed.
Why I Support the End of Life Options Act, HB 160
Robert J. Varipapa, Sr., MD
Sam was a healthy and vibrant 42- year-old patient of mine who came
weakness and loss of endurance over the prior months (name changed for patient and family noted a change in his speech. Neurologic evaluation revealed that he had ALS or amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease).
Over the ensuing months, Sam became weaker and had to use a wheelchair to get around. He began having trouble forming words and spoke in a whisper. He was choking on his food (now pureed, like baby saliva. He was rapidly losing weight, both in muscle bulk and in overall body mass.
Sam and I had heartfelt conversations on his disease state and prognosis. His mind was clear throughout the course of his disease (ALS does not affect memory or cognitive function). He didn’t want a stomach tube for feeding or a tracheostomy to help him breathe. Sam wanted a choice on how he would die, something that was not available to him then and still is not available now
in our state. One day, I got a call from his wife. Sam had developed severe shortness of breath and a high grade fever. He passed away because the food he attempted to swallow went into his lungs, causing aspiration pneumonia.
This is just one story among many I have experienced during my practice of
medicine in Delaware over 33 years. As
a physician, I try to do my best to help
my patients make decisions about their health every day. Educating patients
and discussing diagnosis and treatment options may be the most important thing
I do. Sometimes decisions are easy, like recommending that one exercise more, lose
weight, or take a prescribed medication. And many times, the decisions are much
Patients with terminal illness, where there is no cure, are extra-special in my eyes as they are facing something for which none of us are ready. I always want to ensure that I respect the patient’s wishes and try to carefully listen to what they and their family tell me. It is very important for
me to be empathetic and sensitive so that honest conversations about how people want to be cared for at the end of their lives can take place.
Patients should be allowed to make decisions regarding diagnostic testing
and treatment, based on their personal values and beliefs. It is for this reason
that I have made the decision to support Representative Baumbach’s bill, HB 160, which is positioned to deliver to terminally ill Delawareans the freedom to live out authorizing an additional end-of-life care option known as medical aid in dying.
Medical aid in dying is an end-of-life practice where a terminally ill, mentally capable adult who has a prognosis of six months or less to live requests, obtains
and — if his or her suffering becomes unbearable — may self-ingest a physician- prescribed medication that brings about a peaceful death. Representative Baumbach’s bill has many safeguards (Table 1). The patient must have a terminal illness with less than six months to live and two physicians must be involved with the approval. Two oral and one written request separated by time must be made by the patient and there is a 48-hour time delay
This issue has been extensively discussed in the medical community. A 2017 Medscape
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Del Med J | April 2018 | Vol. 90 | No. 4
