Medical Aid in Dying

Position

Alaska End-of-Life Alliance (AKEOLA) supports individuals’ rights to exercise

autonomy as is legal in their communities. Medical Aid in Dying (MAiD) is

understood to be the most efficacious use of already available means, for the

sole purpose of allowing a terminally ill, mentally capable individual with six or

fewer months to live to request from their provider a prescription for medication

they can decide to self-administer to advance the time of their death.

AKEOLA acknowledges that a range of views exist on the subject of MAiD. The

Alliance respects each person’s right to hold any belief and view dictated by their

conscience. Taking into account these considerations, AKEOLA holds the

following positions regarding end-of-life care and MAiD.

1. AKEOLA supports the right of mentally capable, terminally ill individuals to

have the freedom to make the decision regarding the time of their death

when it may otherwise be a protracted, undignified, or extremely painful

death.

2. AKEOLA also supports the following practices in the care of terminally ill

individuals and maintains that these practices are not forms of MAiD.

(1,2,3,4)

     a. The provision of palliative care measures to alleviate pain even if the

individual’s death is a possible side effect of the treatment.

     b. The withdrawal or withholding of life-sustaining measures as

requested by an individual or surrogate, thereby allowing the

individual to die as a direct result of their illness.

     c. Providing only supportive, compassionate care to individuals who

voluntarily stop eating and drinking.

3. AKEOLA supports the appropriate and timely utilization of all end-of-life

planning conversations including advance directives, palliative care, and

hospice services to terminally ill individuals. (5,6,7,8)

4. AKEOLA supports transparent communication, free from coercion,

between the medical provider and individual or agent regarding all possible

end-of-life care options for the terminally ill individual. (5,6,7,8)

5. AKEOLA supports legislation that empowers and protects terminally ill

persons with decision-making capacity and medical providers with regard

to MAiD. (9,10)

Conclusion

AKEOLA supports individual autonomy and the right of terminally ill Alaskans to

request MAiD. In addition, AKEOLA strongly supports the timely provision of

palliative, hospice, and compassionate care to all Alaskans.

Glossary of Terms

● Withholding or Withdrawing Life-sustaining Measures

     ○ When a medical intervention is either not given, or the ongoing use

of the intervention is discontinued, allowing natural progression of the

underlying disease state.

● Voluntary Stopping of Eating and Drinking

     ○ Voluntary refusal of nutrition and hydration with the understanding

that such actions will result in death.

● Terminally Ill

     ○ A person that has a life expectancy of less than one year, in the

opinion of the person's primary physician due to an incurable, irreversible

life disease.

References

1. Quill TE, Lo B, Brock DW. Palliative options of last resort: a comparison of

voluntarily stopping eating and drinking, terminal sedation, physician-assisted

suicide, and voluntary active euthanasia. JAMA. 1997. 278:2099-2104

2. Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990)

3. Gillick MR. Advance care planning. New England Journal of Medicine. 2004.

350(1):7-8.

4. Quill TE, Byock IR. Responding to intractable terminal suffering: the role of

terminal sedation and voluntary refusal of food and fluids. Ann Intern Med.

2000;132:408-14.

5. The SUPPORT Principal Investigators. A controlled trial to improve care for

seriously ill hospitalized patients: the study to understand prognoses and

preferences for outcomes and risks of treatments (SUPPORT). JAMA.

1995;274:1591–1598.

6. Collins LG. Parks SM. Winter L. The state of advance care planning: one

decade after SUPPORT. American Journal of Hospice & Palliative Care. 2006.

23(5):378-84.

7. Morrison RS. Meier DE. Clinical practice. Palliative care. New England Journal

of Medicine. 2004. 350(25):2582-90.

8. Quill TE. Dying and decision making--evolution of end-of-life options. New

England Journal of Medicine. 2004. 350(20):2029-32.

9. Okie, Susan. Physician Assisted Suicide: Oregon and Beyond. NEJM. 2005.

352: 1627-1630.

10. Gonzales v. Oregon, 546 U.S. 243 (2006)