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    Oregon the model

    Most state measures are modeled on Oregon’s law, which outlines steps for patients who want assistance in death: The person must be a state resident, at least 18 years old, still able to communicate, and diagnosed with a terminal illness with a prognosis of six months or less.

    Patients must make two separate oral and one written request to their physician. The prescribing physician and a consulting physician must confirm the diagnosis and prognosis and determine whether the patient is capable of making a decision and isn’t impaired by a mental disorder. And the prescribing physician must inform the patient of feasible alternatives to medical aid-in-dying, including hospice care and pain control.

    Oregon closely tracks how the law is used. Since the measure took effect in 1997, 1,967 people have received prescriptions under the law, and 1,275 have ingested the medication. Oregon data shows the median age for people who took this option in 2017 was 74.

    Byock said he believes doctors who provide aid-in-dying are violating the most sacred stricture in medicine. He also believes that in most cases, it is possible to provide pain relief to dying patients and that the real problem is that quality palliative care is not universally available or embraced by the medical profession.

    Byock also points out that the biggest concern of Oregon patients who used the law was not escape from pain, but their decreasing ability to enjoy their lives, loss of autonomy and loss of dignity, according to an Oregon report on its use. “Plenty of other people face those same conditions,” said Byock, including those with severe arthritis, depression or failing eyesight. “Once we go down this road, it’s a slippery slope.”

    In Oregon, however, patients didn’t turn to aid-in-dying because they couldn’t get end-of-life services. About 90 percent were enrolled in hospice at the time of death, according to the most recent state data, published this year.

    Byock acknowledges palliative care can’t always take away pain. It didn’t for T.J. Baudanza Jr., a onetime marketing manager who in 2015 died of colon cancer at age 32 in New Seabury, Mass. “T.J. died the way he feared he would,” said Amanda Baudanza, his widow, in an interview. “He suffered a prolonged, painful death because Massachusetts denied him the option of medical aid-in-dying.” He was in hospice in the last portion of his life.

    T.J. had been a big supporter of an aid-in-dying referendum that narrowly missed passage in Massachusetts in 2012, not long after his diagnosis. Now Amanda is championing aid-in-dying in the state legislature.

    “I’m Catholic, and so was T.J.,” Baudanza said, “but he and I both believed that God wouldn’t want anyone to suffer needlessly.”

    In New Jersey, Susan Boyce says her lungs are doing well enough that she believes her death is still off in the distance. She doesn’t know whether she actually would take medicine that would end her life. But she knows one thing: “I want the option.”

    Ollove is a reporter for Stateline, an initiative of the Pew Charitable Trusts.