Linda Jarrett

Linda Jarrett reads through notes at Dying with Dignity's offices in Toronto on Friday, Feb. 6, 2015, the day Canada's highest court unanimously struck down a ban on doctor-assisted suicide for mentally competent patients with terminal illnesses. New York lawmakers have introduced bills to legalize physician-assisted suicide in New York.

((AP Photo/The Canadian Press, Chris Young))

SYRACUSE, N.Y. - Dr. Timothy Quill helped a friend and long-time patient end her life.



Dr. Timothy Quill, at his office in Rochester, in an April 1996 file photograph, is once again playing a quiet but central role as he pushes to legalize doctor-assisted suicide for terminally ill patients.

A deadly form of leukemia afflicted Diane, a Rochester-area woman whose last name Quill still protects 24 years after her death became famous and put the doctor in front of a Monroe County grand jury.

Her pain was under control, Quill says now. But her disease was on track to leave her delirious and diminished, Quill says. The two talked about her death months before it came, he says.

With the understanding of her family, Diane got life-ending drugs from Quill. She administered them herself.

"She wanted to live but she wanted to live on her own terms," said Quill, who is still practicing palliative care medicine at the University of Rochester's medical center. "She was going to go through a phase of dying that she wanted to skip."

Quill wrote about Diane's wishes and his actions in the New England Journal of Medicine in 1991, an outing meant to stir debate about physician-assisted suicide. A Monroe County grand jury investigated his actions, but Quill was never charged in Diane's death. In a subsequent case, the U.S. Supreme Court took the opposite view and upheld New York's existing law against assisted suicide.

That's where the issue sat, fairly quiet, for years. Currently, just four states (Oregon, Washington, Vermont and Montana) allow physician-assisted suicide. Assisted suicide, whether by a doctor or anyone else, remains a felony in New York.

Now advocates are pushing state lawmakers in New York and across the country to take up the issue. At least two versions of legislation have been introduced this session in Albany to give terminal patients the ability to end their lives sooner than their diseases would.

"I want to give New Yorkers a choice," said Sen. Brad Hoylman, D-Manhattan, who along with Sen. Diane Savino, D-Staten Island, introduced legislation this week on physician-assisted suicide. "I think that's something that will be valued, to reduce suffering and give people who have been given a terminal illness some modicum of control."

The Roman Catholic Church, many disability advocacy groups and the American Medical Association oppose physician-assisted suicide. New York's archbishop, Cardinal Timothy Dolan, vowed this month to fight the effort to legalize it.

Diane Coleman, who heads a disability advocacy group out of Rochester, puts the argument in more stark terms.

"We don't think the safeguards have the ability to work," Coleman said. "We compare this to the death penalty. Even with the courts dotting their i's and crossing their t's, injustice occurs."

How it would work



Three years ago, voters in Massachusetts rejected a physician-assisted suicide referendum.

But the "death by dignity" advocacy is spreading across the nation, spurred by the death of Brittany Maynard, a young California woman with brain cancer who last year advocated for the ability to end her own life. With a robust media campaign, she led advocates and opponents to Oregon, where she ended her life late last year using drugs prescribed by a doctor.



Brittany Maynard, a 29-year-old terminally ill woman with advanced brain cancer, took her own life under Oregon's death with dignity law in 2014.

Earlier this month, Canada's highest court struck down a ban on doctor-assisted suicide and gave the country's lawmakers a year to draft a new law to govern the practice. The current ban on doctor-assisted suicide in Canada stands until then, the Associated Press reported.

New York would be the fifth and largest state to allow physician-assisted suicide. Here, advocates are suing the state to change the law. A lawsuit was filed earlier this month in state Supreme Court in Manhattan on behalf of Quill, other providers and three patients who want assistance from doctors to end their lives early.

Assemblywoman Linda Rosenthal, D-Manhattan, already has introduced a bill to allow doctors to prescribe drugs to end lives of terminally ill patients. Hoylman and Savino's legislation came out this week.

Both versions of legislation would require second opinions by physicians and a mental health screening before prescriptions for life-ending drugs would be written. The proposals also require waiting times between the patient's request and the dispensing of drugs, which are usually barbiturates.

Participation by doctors would be voluntary. Patients would have to administer the lethal doses themselves.

All patients would have to be 18 or older and New York residents to qualify.

"I think people must be empowered at the end of their life," Rosenthal said this week. "Some people opt for treatment no matter the odds against them. Some people want to keep trying or just keep living until they die by themselves. Others do not want to suffer and make their families suffer."

Opponents fear 'outright abuse'



Coleman heads Not Dead Yet, a disability rights group that rallied at Rosenthal's Albany office this week, demanding that she rethink her proposal. Coleman said Rosenthal has agreed to meet with the group next month.

"We're concerned that between medical mistakes and various forms of coercion and neglect and outright abuse, old ill and disabled people are going to have their lives ended without actual, informed consent," Coleman said.

People with disabilities, she said, face many of the same challenges as people with terminal illnesses: loss of control, dependence on caregivers, expensive treatments, chronic discomfort and pain. None of that, according to Coleman, is a justification for death.

Plus, she says, the assisted-suicide laws set up a double standard.

"If you are healthy, and you want to kill yourself, you get suicide prevention," Coleman says. "But if you are older or disabled, you are considered rational. You get the means to carry it out and complete it."

Bishop Robert Cunningham

The Roman Catholic Church would agree. "We look upon all life as very valuable," Bishop Robert Cunningham, head of the Diocese of Syracuse, said this week. "All life is a gift from God, from conception to natural death."

Cunningham agrees the situations for sick people and their families are not easy. He also believes that palliative care and pain management can assuage much suffering. The church, he says, doesn't argue for extraordinary means to keep sick people living. But purposefully ending life is against the church's teachings, he says.

So far, the New York State Catholic Conference is watching the issue, Cunningham said. He's sent out no letters to parishioners in the diocese's seven-county region, a move the church sometimes employs during political debates.

Very few people use it



Where the practice is legal, very few people actually use it.

Oregon legalized "death with dignity" in 1997. Since then, 1,173 people diagnosed with terminal illnesses have requested prescriptions that would kill them. Only 752 took the drugs and died.

The majority of people who opt for physician-assisted suicide are white, older and have some form of cancer, according to 13 years of Oregon health records. More than half went to college and have private insurance. Almost all die at home.

In Washington State, 173 people requested deadly drugs from doctors in 2013. Only 119 took the drugs, according to state records. That same year, 11,812 people diagnosed with cancer died in the state.

So why raise such an emotional and complicated debate for so few patients? Quill has two answers.

One, the option of controlling death gives reassurance, even when most don't use it, he said. Two: "We don't turn our back on the most severe cases," he says, no matter how few there ultimately are.

Dr. Joel Potash, a former head of Hospice of Central New York, would add a third.

"There are cases when people are dying where we as doctors are unable to control their pain and suffering," said Potash, of Cazenovia, who is retired, but sits on medical ethics boards around the state.

Quill and Potash both believe doctors in New York secretly assist dying people with suicide. If the state regulated it, then both doctors and patients would be able to more easily seek second opinions and guidance before asking for lethal prescriptions, they say.

"We're not talking about killing people prematurely," Potash says. "We're talking about people who are going to die."

Legalization could take years



Lawmakers supporting the effort say legalizing physician-assisted suicide will likely take years, much like allowing same-sex marriage and medical marijuana did. A spokesman for Gov. Andrew Cuomo did not respond to an inquiry about where the Democrat stands on physician-assisted suicide.



Dr. Joel Potash

For now, Hoylman and Rosenthal say their legislation is meant to start the conversation. "I have no illusions this is going to become law this year," Rosenthal said. "This is something to ponder."

In the meantime, dying patients have two options, according to Potash. Those in severe enough pain can enter "palliative sedation," akin to a coma. Others, he says, can starve themselves.

"The only thing that's legally available to you is to stop eating," Potash said. "No one can force you...even in a hospital. They can't force you to have an IV."

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