Medical Aid in Dying law for New York State: Shelter Islander David Hoffman will help implement it 

For nearly 10 years, a bill to allow physicians to help terminally ill patients receive medications to peacefully end their lives has been considered by legislators in New York. In June the measure got enough support in the State Legislature to be adopted, and it now awaits final approval by Gov. Kathy Hochul (D).

In April, the Assembly voted to pass the bill and this month the Senate followed with an affirmative vote of 35-27.

When Gov. Hochul signs the bill, as she is expected to do, Shelter Island resident David Hoffman, who is an expert in law, healthcare ethics, and policy implementation, will lead the effort to roll out an important new tool in patient rights, and end-of-life care in New York state.

Mr. Hoffman says he decided to become a lawyer when he was in the 7th grade. In his college years, he became interested in health care and then came a life-changing course in medical ethics. He found his calling in the intersection of healthcare, ethics and the law, and became a clinical ethicist. He’s now a professor of Bioethics in the Columbia University School of Professional Studies. 

“I’ve been advocating for legalization of medical assistance in dying for 15 years,” he said. “I get to help people at a time when they don’t even know what the questions are, never mind what the answers are.”

Mr. Hoffman was a vocal proponent of medical aid in dying during the years of debate in New York state because he sees it as a moral issue. “Doctors are the gatekeepers of medicine,” he said.  “Only doctors can give access, and if we are not going to give access to medicines for terminally ill that are safe, certain and painless, it is immoral to require people to use methods that are not safe, certain and painless.”

The Medical Aid in Dying legislation allows terminally ill patients with a prognosis of six months or less to request a prescription for medication that will enable them to end their lives peacefully and on their terms. According to Mr. Hoffman, the law’s implementation must navigate logistical, ethical, and emotional complexity, but there’s a solid track record from other states to follow.

Currently 10 countries and 11 U.S. states, as well as Washington, D.C., have legalized medical assistance in dying. 

Mr. Hoffman has studied these precedents, to ensure that the education of New York’s medical professionals, and the implementation of this newly granted right for terminal patients, is seamless and respectful.

Mr. Hoffman says the need for medical assistance in dying is partly an outcome of advancements in saving and extending life.  “Because we are able to treat conditions that would otherwise kill people, we now have to confront the situations where there is no treatment,” he said.  “Patients can sometimes decide to discontinue a medication to end their own lives. Medical aid in dying helps those who suffer but can’t end their treatment to stop their lives.”

The New York law ensures that when a terminal patient requests aid in dying, the process is deliberate and careful.  Two doctors must be convinced that there are no other ways of addressing the patient’s pain. There is a mental health evaluation, and the patient’s death must be imminent.

The debate in the New York legislature was emotional, with lawmakers citing examples from their own experience with loved ones facing end-of-life decisions. A representative of State Senator Anthony Palumbo (R-New Suffolk) said Mr. Palumbo voted against the bill because of a lack of safeguards, calling it, ‘deeply troubling.” Mr. Hoffman countered that response by saying it “evidences a profound disrespect for, and distrust of, physicians’ ability to exercise medical judgment.”  

Now that the bill seems likely to become law, physicians will require training to ensure they can have sensitive, informed discussions with patients, Mr. Hoffman noted. Pharmacists, visiting nurses, legal advisers, and social workers will also need to be educated and trained.

Mr. Hoffman will lead the roll out of educational programs to train medical professionals on the technical aspects of the law and its ethical implications, and for patients and their families, a centralized resource hub, where they can get information and support as they navigate their decisions.

As for a medical directive, health care proxy, or living will, Mr. Hoffman says everyone should have such formal instructions to guide their doctors and family in case they are not able to express their wishes.  The need for a medical directive is not lessened by the advent of medical aid in dying.  

The new Medical Aid in Dying legislation is for patients who have faced the certainty of imminent death, who can express their wishes clearly, and undergo evaluation to ensure that they are eligible for a safe, certain and painless end of life experience.

Speaking with Mr. Hoffman, one can come to realize that there is a strange comfort in accepting the fact of death, which binds us to every other living creature.