Compassion & Choices Arizona
Arizona

Advance Directive for Control of Suffering

This proposed act would create a new type of advance directive which allows a terminally ill person to have control of the administration of pain medication to ease their own pain and suffering.

Summary

  • The act establishes a new form of advance directive, the "Advance Directive for Control of Suffering", which contains the following or substantially similar wording: "If I am diagnosed with a terminal illness, I want to be able to control my own medication to lessen suffering and preserve my dignity and be in control of my own pain management."
  • Pursuant to existing Arizona law the Directive must be either notarized or witnessed. The Directive may be utilized only if two physicians diagnose the signer with a terminal disease expected to result in death within six months.
  • The Directive takes effect three months after signing. [Therefore, people who want this should sign one as soon as possible while still healthy. It is also recommended that such a Directive be executed separately from a Living Will or Power of Attorney for Health Care, because revising such documents might result in another three-month wait for this to become effective.]
  • A person who has such a Directive in effect, who is so diagnosed, who is competent, who has been fully informed of the diagnosis, prognosis, potential risks, probable results, and feasible alternatives, and who is a resident of Arizona, may make a written request for medication for patient control of suffering which is managed by the patient. Two persons must witness this written request. (There is some restriction on who those persons may be.)
  • The medication shall be as agreed on by the patient and the prescribing physician. Although medical professionals may provide assistance, the actual act of controlling the intake of the medication must be in the immediate control of the patient.

Talking Points

  1. People are dying in pain and suffering [1,2]. In a civilized society in the 21st Century it is intolerable that people are dying in pain and suffering. People do not want to die this way. We need to do something.
  2. HB 2564, the Patient Comfort and Control Act (PCCA), allows dying persons, who have indicated their wish in an advance directive, to maintain control over their own medication to ease pain and suffering. This puts control in the hands of the only person who can know how much pain and suffering is being experienced – the individual patient.
  3. Studies of patient-controlled analgesia (PCA)[3] indicate a high degree of patient satisfaction [4]. The primary factor in this satisfaction was due to the patient's ability to control the process [5].
  4. This is not an assisted suicide bill. The intent is rather to reduce any potential desire of dying patients to intentionally hasten death, by instead providing the degree of individual control needed to adequately alleviate pain and suffering. By placing control with the patient, any motive to hasten death is greatly reduced.
  5. Even if a secondary effect of pain medication were to hasten death, this is established medical practice accepted by the American Medical Association, whose policy is stated as follows: "Physicians have an obligation to relieve pain and suffering and to promote the dignity and autonomy of dying patients in their care. This includes providing effective palliative treatment even though it may foreseeably hasten death."[6]
  6. This bill is consistent with most religious doctrines. For example, the Catholic Church has taken the position that "medicines capable of alleviating or suppressing pain may be given to a dying person, even if this therapy may indirectly shorten the person's life so long as the intent is not to hasten death"[7].
  7. A large majority of people want this option. A 2003 poll in California and Florida showed that over three-fourths of people (79.6%) agreed with the statement "In the event I am diagnosed with a terminal illness, I want to be able to control my own medication to lessen suffering and preserve my dignity and be in control of my own pain management as I see fit, even to the point of hastening death"[8]. Significant majorities were in favor in every class tested (region of state, political party, age group, educational level, ethnic background, religion, ideology, gender, income level, and other variables).

References

  1. A controlled trial to improve care for seriously ill hospitalized patients: the study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). Journal of the American Medical Association, 1995 Nov 22-29;274(20):1591-8.
  2. Family Perspectives on End-of-Life Care at the Last Place of Care. Journal of the American Medical Association, 2004 Jan 7;291:88-93.
  3. Safety and efficacy of patient-controlled analgesia. British Journal of Anaesthesia, 2001, Vol. 87, No. 1 36-46.
  4. High Patient Satisfaction Achieved with Patient-Controlled Analgesia. Drugs & Therapy Perspectives, 2001:17(24). s
  5. Perceived control mediates the relationship between pain severity and patient satisfaction. Journal of Pain Symptom Management, 1998 Feb;15(2):110-6.
  6. AMA Policy H-140.966, Decisions Near the End of Life.
  7. Ethical and Religious Directives for Catholic Health Care Services, No. 61
  8. Zogby International poll commissioned by Compassion & Choices, Denver, CO.