New Jersey now has a right to die law.  Formally, the law is known as the “Medical Aid in Dying for the Terminally Ill Act.”  The law permits a qualified terminally ill patient to self-administer a medication that will hasten his death.

A “qualified terminally ill patient” is a defined term in the law.  The patient must be capable of making the request himself.  In other words, a guardian or healthcare representative named in an advanced healthcare directive (what I frequently call a living will) could not make the request for the patient.

This is an important provision in my opinion and could limit the law’s impact quite a bit.  The patient must be capable of requesting the life-ending medication himself.  Many ill people lose their cognitive functions.  For instance, a terminally ill patient with severe dementia could not avail himself of this law because such a patient would not be capable of making the request himself.

While the requirement that that patient be “capable” does limit the effectiveness of the law as to many terminally ill patients, I believe such a limitation is necessary.  Causing a person’s death is not something we can delegate to surrogate decision-makers, such as guardians or healthcare agents.  Actively ending your life is about as personal of a decision as can be made.

It is one thing to withdraw extraordinary life-sustaining measures.  For instance, if a person is only being kept alive because they are on a ventilator and they have no reasonable hope of ever recovering (say, they are permanently unconscious), withdrawing that ventilator is not the same thing as administering a pill to a person that will actively and directly cause them to die.  For this reason, I believe that only a capable (or competent) person should be able to make the request himself.

The qualified terminally ill patient must also be capable of self-administering the medication.  This is another limitation.  For instance, someone with ALS or Lou Gehrig’s disease may be incapable of self-administering a medication because their muscles may have atrophied to such a point that they cannot put a pill in their mouth or swallow the medication once the medication finds its way to their mouth.  Under the law, the life-ending medication must be self-administered.

Now, since someone with ALS is likely to be wholly competent and to be capable of freely consenting to the administration of the medication, I’m unsure how this law will work in such situations given the fact that the law says that medication must be self-administered.  The phrase “self-administered” is actually defined in the law to mean “a qualified terminally ill patient’s act of physically administering, to the patient’s own self, medication that has been prescribed ….”  That definition is unequivocal—the patient has to give himself the life-ending drug.

I can see the wisdom in this provision.  It would be extremely difficult to ask a loved one to administer a drug that is directly and actively going to result in the patient’s death.  Most people find it extremely difficult to withdraw life-sustaining treatment to a patient who is clearly all but deceased in heartbeat only, for instance, someone who is “brain dead.”  To permit another person to administer a poison to someone seems a bit too far.

But I am uncertain how some terminally ill patients will benefit from this law, and once again, I think about the ALS patient.  Essentially, such a patient would have to avail himself of the law before he got so bad that he couldn’t administer the drug himself.

Yet, the definition of “terminally ill” is defined to mean an expectation of death within six months, so a qualified terminally ill patient cannot avail himself of the law too early because he wouldn’t be “terminally ill.”  This law is a great step forward for New Jersey.  We’ll have to see how it plays out though.