About the Law
The Medical Aid in Dying for the Terminally Ill Act allows qualified terminally ill adults to voluntarily request and receive prescription medications to hasten their death in a peaceful and dignified manner if their suffering becomes intolerable
Governor Phil Murphy signed this legislation into law on April 12, 2019
This law became active in New Jersey on August 1, 2019
The Medical Aid in Dying for the Terminally Ill Act clearly outlines the process by which qualified individuals may obtain life-ending medication
You, your loved ones, and your physicians are protected from criminal prosecution
Participation in the law is voluntary, for both physicians and patients alike
There are no published lists of physicians who prescribe MAID medications
The laws stipulate waiting periods; generally, it may take at least 3-4 weeks to go through the process from the first oral request to filling the prescription
To legally obtain a prescription medication to end your life in a peaceful, humane, and dignified manner under medical- aid-in-dying statutes, you must first become a qualified patient, meeting a set of stringent requirements
Eligibility
To qualify for a prescription under the law, you must meet all of the following criteria:
resident of New Jersey
18 years of age or older
mentally competent, i.e., capable of making, communicating, and understanding your healthcare decisions
diagnosed with a terminal illness that will, within reasonable medical judgment, lead to death within six months
able to self-administer the prescribed medication
All of these requirements must be met without exception.
Two physicians must determine whether all these criteria have been met.
Proving Residency
Legal state residency is a requirement for accessing medical aid in dying. Proof of residency can be provided in the form of:
a state issued identification card or driver’s license or
a state voter registration card or
a recent state tax return
There is no minimum length of residency requirement. You must simply be able to prove that you are a current bona fide resident of New Jersey.
Talking With Your Physician
It is important to discuss your end-of-life wishes with your physician as early as possible, as the process can take several weeks . Early discussions can identify your physician’s willingness to support your end-of-life choices. Otherwise it may be necessary to seek out another physician.
This discussion can be easily timed with any discussions of your advanced directive or the use of a POLST (Practitioner Orders for Life Sustaining Treatment) form.
You may wish to approach this as follows…
“I wish to have the option to advance the time of my death if my suffering becomes unbearable. Am I eligible? If yes, will you write a prescription for medical-aid-in-dying medication? If you will not write the prescription, will you record my request in my chart and refer me to a physician who is able and willing to honor my request?”
Even if you are not terminally ill, you may wish to have this preemptive discussion by stating…
“I value quality of life. If I am no longer able to find dignity in my life and I meet the legal requirements, I would like to have the option of using the Medical Aid in Dying for the Terminally Ill Act.
I hope you will honor my decisions and respect my values, as I respect yours. Will you write me a prescription for aid-in-dying medication if I am eligible? If you will not honor my request, please tell me now.”
If your physician does not feel comfortable honoring your request and if she is unable to refer you to one who can, we will do our best to find a physician for you. Find your care here.
Talking to Your Loved Ones
Every family is different, some have strained relationships. However, even if there has been little communication for years, the months or weeks before death is a time when many people attempt to open up to each other. It is amazing how many loved ones come around to establish communication and offer support, as they learn what their loved one is struggling with.
It is truly in the best interest of those who will be left behind that you tell your loved ones what you are planning and give them the option to accept or reject it, or to work out personal past differences. This helps them cope better after you die, as they have some positive memories.
Even if your loved ones cannot support you or what you are choosing to do, by starting the dialogue you have at least given them the chance to understand and grow. And most families rise to the occasion of help, support, and understanding.
Process of Obtaining Aid-in-Dying Prescriptions
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You may make the initial verbal request for medical aid in dying at the time of your choosing; many people make the request when discussing their end-of-life options with their physician.
The physician to whom you make your request must be licensed in New Jersey and the request must take place in New Jersey. This includes telemedicine visits.
Your physician must confirm you meet all of the eligibility criteria. Your physician must also inform you of alternatives, including palliative care, hospice and pain management options, and ask that you notify your next-of-kin of the prescription request.
The first verbal request must be documented in the medical chart. Having the conversation without documentation does not start the waiting period.
If your physician determines that your judgment is impaired in any way, e.g., by a mental illness or early cognitive difficulties, they must refer you for a psychological or psychiatric evaluation.
You can rescind the request at any time in the process.
If your first verbal request is authorized, you must wait a minimum of 15 days to make the second verbal request.
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A second, consulting physician must confirm the diagnosis, prognosis, and your mental capacity to make healthcare decisions. This consultation is scheduled before your second verbal request visit. Again, a capacity evaluation will be requested if your consulting physician feels that your judgment is impaired.
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You may make your second verbal request at any time after the 15-day waiting period. Again, you may rescind this request at any time.
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You can make the written request to your physician at any time following the first verbal request, using the Request for Medication to End my Life in a Humane and Dignified Manner form. The written request must be witnessed by two individuals, at least one of whom is not related to you, not entitled to any portion of your estate, or an employee of the healthcare facility caring for you. Your attending or consulting physician is not eligible to be a witness.
As with both oral requests, you can rescind the written request at any time.
Keep a copy of the written request for your records.
Your attending physician must wait 48 hours from the time of receiving the written request before writing the prescription.
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After the above steps are completed and you are ready to fill the prescription, your physician will write the prescription and send it to the pharmacy either in person, by mail, or by electronic delivery. You, your physician, or your chosen designee may pick up the medications from the pharmacy.
Alternatively, you may decide not to fill the prescription at all.
Enrolling in a Supportive Hospice Program
When considering medical and in dying, it is important to be enrolled in a supportive hospice program. A supportive hospice program can help with medical aid in dying and, most importantly, serves as the entity that is called to pronounce death, eliminating the requirement to call emergency services. A phone call to the hospice nurse is all that is necessary.
Planning Your Death
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As long as the proper steps required for medical aid in dying are taken, your life insurance benefits should be unaffected. The cause of death on the death certificate is listed as your underlying terminal disease.
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After the prescription is written, you have a choice to fill the prescription or not to fill it. You can leave the prescription at the pharmacy until you decide that you want to make this choice, at the time that is right for you.
If you do obtain the medication, you can decide to use the medicine at any time or to never use it. The aid-in-dying law is all about giving you this choice.
About one third of qualified terminally ill people decide that they do not want to hasten their death using the medication. The prescription provides them with peace of mind, knowing that if their suffering becomes intolerable, they can choose to take the medication.
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You are the only person who can decide if and when you want to take the prescribed medication. This is a decision that is often made by conferring with your loved ones, as they are also aware of the changes happening to you as your disease progresses.
You will know when the time is right; if the time is never right, that is fine, too. A significant number of patients qualify for the life-ending medication but never use it.
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There are three scenarios in which you may be unable to take the medication after it has been prescribed:
Your disease progresses to coma or death.
You are experiencing increasing confusion and you have lost the capacity to understand and make decisions. This may be due to tumors in your brain or certain metabolic problems that affect your brain function. In this scenario, you will no longer qualify to take the medication. On the day you take the prescribed medication, you need to be able to ask for it and be cognizant of what it is for.
You are unable to swallow the medication or unable to push the plunger of a syringe to administer the medication through a feeding or rectal tube. This might occur with progressive overwhelming weakness from end-stage illness or from a neurologic disease like ALS.
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The prescribed medicine is a combination of several medications in lethal dosages. These are dispensed in powder form and are mixed with about 2 ounces of liquid before you drink it. The full amount needs to be ingested within two minutes. Most patients fall asleep peacefully within 10 minutes after drinking the life-ending medication and die in 1-3 hours. In about 5 percent of patients, it takes longer than 6 hours to die, but they sleep comfortably the whole time, until death ensues.
This information was adapted from the original content of Death with Dignity National Center and Compassion & Choices
Grief and Medical Aid in Dying
Grief is the natural way we cope with loss. It is the sum of everything you feel when something or someone important to you is no longer in your life.
Medical aid in dying reflects a different way for individuals to manage the end of their life during a terminal illness and focuses on the patient’s self-determination. However, the loved ones who are left behind still experience grief.
There have been some studies looking at the grieving experience of those who have lost loved ones through medical aid in dying and if it differs from other deaths experienced. The studies suggest that experiencing the death of a loved one from medical aid in dying did not negatively impact family members and, in many cases, allowed them to feel more prepared and accepting of the death. Themes that emerged from the studies revealed that medical aid in dying allows for the opportunity to say goodbye to one's loved one, and to plan and prepare for the death. Grief was eased by knowing that medical aid in dying was the loved one's choice, that the mode of death was legal, and that love one avoided prolonged suffering. Personal and family agreement with the loved one’s decision to use medical aid in dying also eased grief. Unfortunately, some studies also suggest that loved ones who are hesitant to disclose the manner of death to others because of fear of judgment or social estrangement can experience increased levels of personal stress during their natural grieving process.
Regardless of the circumstances surrounding the death of a loved one, being able to find support and a compassionate community in which to help you grieve can be important for many people.
Consider the following resources if you are looking for help with the grief process:
New Jersey Death with Dignity has partnered with Grief to Hope Counseling create a bereavement program to address the unique aspects of loss and grief associated with the loss of loved ones that utilized MAiD (Medical Aid in Dying). The initial offering of this program will be group support. The first group available is the MAiD Bereavement Support Group – this is an 8-week group designed to both educate and support. The second group, Living with Hope, is a 6-week support group for those that have attended the initial support group and wish to continue with group support. All groups are facilitated by certified grief counselors. For more information and/or enrollment, contact us.
Your hospice agency (if enrolled) provides up to 13 months of bereavement counselling/support after the death of your loved one.
Studies:
Gamondi C, Pott M, Forbes K, Payne S. Exploring the experiences of bereaved families involved in assisted suicide in Southern Switzerland: A qualitative study. BMJ Supportive & Palliative Care. 2015;5(2):146-52. Family Caregivers' Reflections on Experiences of Assisted Suicide in Switzerland: A Qualitative Interview Study - Journal of Pain and Symptom Management (jpsmjournal.com)
Ganzini L, Goy ER, Dobscha SK, Prigerson H. Mental health outcomes of family members of Oregonians who request physician aid in dying. Journal of Pain and Symptom Management. 2009;38(6):807-15. Mental Health Outcomes of Family Members of Oregonians Who Request Physician Aid in Dying (jpsmjournal.com)
End-of-Life Resources
Exploring and Recording What is Important to You
Having the Conversation
While 92% of Americans say it’s important to discuss their wishes for end-of-life care, only 32% have had such a conversation. 95% of Americans say they would be willing to talk about their wishes, and 53% even say they’d be relieved to discuss it (The Conversation Project National Survey, 2018).
We know that no single conversation can cover all the decisions that you and your family may face. What a conversation can do is provide a shared understanding of what matters most to you and your loved ones. This can make it easier to make decisions when the time comes and find the support you may need.
Conversation Project – Resources and tools to help you have a conversation about your end-of-life wishes with the important people in your life.
Advance Directives
In the event you should be unable to make decisions regarding your healthcare in the future, you may want to complete an advance directive. An advance directive is a written document that provides instructions to your medical team regarding your personal healthcare wishes in the event you develop an irreversible or end-of-life condition.
An advance directive includes specific directions regarding organ sustaining treatments and the conditions under which you would or would not want such treatments to be provided. You should discuss the details of your advance directive with a relative or close friend.
In addition, completing a “Durable Power of Attorney for Healthcare” is very helpful. The person you designate is sometimes referred to as a healthcare agent, proxy, or representative. This is a person you choose to make healthcare decisions for you if you’re too sick to make them for yourself. Your proxy can talk with your doctors, consult your medical records, and make decisions about tests, procedures, and other treatments. If you do have an advance directive as well, the role of the proxy is to advocate for your wishes as you have outlined them in your advance directive.
Keep the original advance directive in a place known to your family and provide a copy to your proxy. You may also choose to give a copy to your physician and clergy.
Prepare for Your Care - An online step-by-step guide to making an advance directive
New Jersey Standard Advance Directive & Proxy Document
Now’s the time to get started. Emergencies can happen at any time, leaving you too injured or ill to communicate decisions about your medical treatment. MyDirectives helps you create your own advance-care plan for your family and doctors so they can make decisions on your behalf.
Five Wishes is changing the way we talk about advance-care planning. It's more than just a document. Five Wishes is a complete approach to discussing and documenting your care and comfort choices. It's about connecting families, communicating with healthcare providers, and showing your community what it means to care for one another.
Plan for everything that matters. Organize all your wishes in one place with Cake's free planning tool.
While advance directives are “statements of patient intention,” POLST is a set of medical orders, designed specifically for those who are seriously ill and with a life expectancy of less than one year. Produced on a distinctive green form and signed by both doctor (or advance practice nurse or physician assistant) and the individual or their surrogate, POLST specifies the types of medical treatment an individual wishes to receive at the end of life. Information included in a POLST form consists of:
1. Goals of care for the individual – this is ideally specified in a heart-to-heart conversation with your healthcare provider
2. Preferences regarding cardiopulmonary resuscitation attempts, use of intubation and ventilation for respiratory failure, artificially administered nutrition and hydration, and other medical interventions
POLST was developed in response to seriously ill patients receiving medical treatments that were not consistent with their wishes, usually due to a lack of clear communication between the patient, family members, and the healthcare providers. The goal of POLST is to provide a framework for healthcare professionals so they can provide the treatments patients do want and avoid those treatments that patients do not want.
POLST (Practitioner Orders for Life Sustaining Treatment)
Palliative Care
Palliative care is a multidisciplinary medical service designed to enhance the quality of life for patients who suffer from serious illnesses. This is accomplished by not only relieving symptoms, but by also ensuring that all treatments are aligned with individual preferences and values.
A palliative care team is made up of physicians, advanced practice nurses, registered nurses, chaplains, consulting psychiatrists, dieticians and social workers. They maintain close contact with the patient’s primary care doctor and specialists to ensure a seamless continuum of care.
Palliative care is appropriate for people of any age or stage of illness, whether it’s curable, chronic or life-threatening. Some patients may even make a full recovery. In contrast, those who have a life expectancy of six months or less and wish to forgo curative treatments may benefit more from hospice care.
Hospice
Hospice practice is based on the premise that the last days of life should be dignified, comfortable and peaceful, helping to enhance patients' quality of life and support their family members and caregivers in private homes, assisted living facilities and nursing homes. When you and your primary physician determine that aggressive curative treatment is no longer appropriate or desired, you may be referred to hospice.
The hospice team includes medical directors who can collaborate with your physician or assume responsibility for your care. Hospice certified nurses, social workers, home health aides, spiritual counselors and volunteers focus on your comfort and individual needs. Bereavement professionals work with family and friends for a year through support groups and individual counseling.
For a comprehensive review:
https://compassionandchoices.org/resource/hospice-care/
End-of-Life Doulas
From the time of a terminal diagnosis forward, end-of-life doulas play a critical role in supporting, guiding and advocating for a person who is dying. They work with a dying person and, if desired, their loved ones to assist them emotionally, physically and spiritually. Navigating the end-of-life journey is difficult, and doulas are non-medical professionals who are trained to help. Doulas encourage individual exploration about what is wanted and needed, facilitate open and honest discussions, help with decision-making, and assist in creating memories that will live on forever.
The doula role in medical aid in dying is invaluable. Traversing the landscape of a medical-aid-in-dying death can be cumbersome: the timing of the medications, the mixing of the medications, education about the dying process, and making phone calls to hospice and the funeral home following a death. Doulas are well equipped to handle all the specifics, and do so in a calm, supportive manner. This frees you and your family to spend all your time together in a peaceful , meaningful way, without having the stress of navigating the process.
Spiritual Support
When you are ill, you often experience spiritual or emotional upheaval, stress, life-changing questions and choices. Spiritual and pastoral care can also be an opportunity to discover different dimensions of hope, and to find opportunities to celebrate the small things in life.
Chaplains are able to foster spiritual wholeness. They can listen to you and your loved ones with compassion and understanding. They make no assumptions about your personal convictions or life orientations. There can be a spiritual as well as physical benefit from engaging in a listening and supportive presence. Whatever one is feeling, a chaplain can be present to listen to concerns. Chaplains support patients, families, loved ones and staff through emotional and spiritual journeys with complete confidentiality.
Medical Social Work
Social workers provide individual assessments and counseling, as well as referrals to community resources that help with the financial and emotional aspects of illness.