As of today, New York is one of 13 states that allow terminally ill patients who want to end their lives to do so medically in consultation with a doctor. New York's law continues to face legal challenges, but in New Jersey, physician-assisted suicide has been legal since 2019. I spoke with a doctor there who works with patients who seek it out.
On a normal workday, Dr. Robin Plumer sits with her patients as they draw their final breaths.
"It seems like a great honor to me," she told me. "To be present with people at the time that they are leaving this world and to kind of facilitate them having a good death."
Plumer runs a practice called Compassionate Endings in Cherry Hill, New Jersey. She got interested in the work after spending decades as an emergency room doctor, where the emphasis was on maintaining life at all costs. "Everything was about resuscitation, resuscitation, resuscitation," said Plumer. "And yet, a lot of the people that came in maybe couldn't be resuscitated."
In those situations, Plumer says, when patients couldn't be saved, their deaths were often abrupt, traumatic, and painful - for them as well as their families. "When I look back at my ER days, most of those people were literally ripped out of their families' lives with no notice. And even people who were terminally ill, a lot of times it's not discussed. The families are literally stunned. And one of the worst things I had to do was go in and tell families, you know, that their loved one had just died when they had no preparation for it."
When she learned about medical aid in dying, a procedure where patients with a terminal diagnosis make a plan with a doctor to take medicine that will end their lives, she knew it was how she wanted to spend the next phase of her career.
Dr. Plumer works primarily with patients suffering from metastatic cancer and ALS, where the symptoms are so severe that many patients don't want to subject themselves to years of being bedridden, or losing the ability to move, speak, and eat. "Here's a person who, maybe, was living a pretty normal life," said Plumer. "And all of a sudden they get this diagnosis slapped on them, and they lose all control over which way their life is going. And now here's one thing, one important thing, that says okay, but you get to decide when the suffering is too great. And you get to say, 'That's enough.' As many of my patients will say to me, 'I want to still be me on the last day on this earth. I want my family to remember me saying goodbye to them, and I don't want them to remember me lying in a heap on the bed and unable to communicate.'"
To be clear, Dr. Plumer's patients seek her out. They call her up and they say they've heard about medically-assisted death. They ask what's involved. She explains how it works: on an agreed-upon date, she'll come to their house. When they're ready, she'll pour some medicine into a cup. Once they take it, they will fall asleep. Gradually, their breath will start to slow. After a few hours, they will pass away peacefully.
Many of her patients turn that final day into a kind of ceremony. Often, they're surrounded by friends and family. Dr. Plumer told me about one patient who'd been a professor. "He wrote this beautiful essay, and you know, he couldn't speak. He had written a whole thing about how lucky he felt about his life, and he had one of the family members read that before he took his medicine. So that was kind of like his last words."
But she says it's not always a solemn affair. "We had one gentleman who was a very extroverted man. He greeted us at the door, and he was wearing the loudest Hawaiian shirt you could imagine. And when I came in, he said in a very jovial voice, 'I want them to see me coming!' We're like, 'They will. They're going to see you coming.'"
Sometimes people question the ethics of medical aid in dying. They ask Dr. Plumer if it's consistent with the Hippocratic Oath. "People can sometimes say to me, 'Well, you took an oath that says do no harm.' In my mind, allowing people unnecessary suffering, or forcing them to have unnecessary suffering is doing harm. It's not always just about how long someone can live."
Some people also criticize medical aid in dying as tantamount to assisted suicide, but Dr. Plumer doesn't see it that way. "For the most part, the way we think about suicide is people who are not terminally ill, and who have the choice between living and dying, and they decide they don't want to live anymore. It's often done in a violent way. It's often done by people who are alone. It's so traumatizing to family members. Family members don't get the chance to say goodbye. It's a completely different scenario."
In fact, Dr. Plumer told me she sees medical aid in dying as an alternative to suicide. Some people take their own lives when they get a serious diagnosis, because they don't realize something like this is an option. And that, Dr. Plumer stresses, is ultimately what she's offering: a choice. "Medical aid in dying is only available to people who are already dying, right? If you have a chronic illness, and believe me, I get those calls, you don't qualify. You don't even get past step one. You have to have a terminal illness and be within a six-month prognostic window to even qualify. You have to be able to consent. I say to the patient, 'Can you please explain to me your understanding of what is medical aid in dying?' So that I'm clear that they understand it. They have to be really, really clear about it."
And even then, she says, right up until the day arrives, she describes her patients as "considering" the treatment. "We use the term 'consider' because I think everyone is considering it until the day they think it's right. And the big thing with medical aid in dying is it's got to be driven by the person in real time, right? On that day, the first thing I do when I go into a person's home, I sit down, take their hand, look them in the eyes, and say, 'Are you absolutely sure today is the day? Do you know that when you take this medication, it's going to cause you to fall asleep, and then you will die?' And I have to be sure that they understand and consent to that."
Dr. Plumer insists on staying with patients and their families until the patient passes away. Sometimes that can take as long as 15 hours. In those situations, she told me, sometimes she'll sit down with the family for a meal, or talk people through the feelings they're having as the medicine takes its course.
"It's a pretty intense type of relationship," she acknowledged. "It's a pretty intense kind of practice. But then I remind myself, it's not like working 12 hours in the emergency room. So those days are over for me."
