Compassion and Support
SEPTEMBER 2017
Physician Assisted Suicide: Not a Constitutional Right

On September 8, 2017, the NY Court of Appeals ruled that terminally ill people do not have a fundamental state constitutional right to physician-assisted suicide. The decision stated, “Aid-in-dying falls squarely within the ordinary meaning of the statutory prohibition on assisting a suicide.” The court added that state law is clear in prohibiting anyone, including doctors, from assisting in suicide. To date, no state has recognized assisted suicide as a fundamental right.

The court ruled “that state lawmakers had a rational reason for passing a ban on assisted suicide and that the ban doesn’t violate the state constitution.” In addition, the court ruled that it would not block the NY Legislature from passing legislation banning physician-assisted death.

New York’s Catholic Conference hailed the decision as a “significant victory.” "The decision is a significant victory for those who would be most at risk of abuse and most susceptible to pressure to take their own lives, including the isolated elderly, persons with disabilities and those who are depressed and overcome with hopelessness,” said Kathleen M. Gallagher of the Catholic Conference, which represents the church’s bishops in the state.

The court pointed out that New York law does allow terminally ill patients to decline life-sustaining medical assistance, but, it does not permit anyone to assist in ending patients’ lives. There are specific laws that govern end-of-life decisions in New York, including Health Care Proxy, Family Health Care Decisions Act (FHCDA), Medical Orders for Life-Sustaining Treatment (MOLST) and Surrogate Court Proceedings Act §1750-b. These laws include patient protections to ensure these end-of-life decisions are person-centered and grounded in ethical principles.

The MOLST program helps seriously ill patients who might die in the next year ensure they receive care reflecting their values, beliefs, goals for care and their end-of-life treatment preferences will be honored. Using a standardized process, completion of the MOLST includes conversations between the patient/family/loved ones and their physician/care team to define the patient’s goals for end-of-life care and review possible treatment options using shared decision-making that is well informed. Once completed, the MOLST is a set of medical orders that clearly set forth the patient’s preferences for life-sustaining treatment. A palliative care plan must support the MOLST. These medical orders must be followed by all healthcare professionals, including EMS, in all settings. New York's Catholic Conference supports appropriate use of the MOLST.

eMOLST, the secure web-based application for MOLST – found at NYSeMOLSTregistry.com – serves as New York’s eMOLST Registry. The completion process adds an additional layer of structure and quality assurance to MOLST. eMOLST is essential to be sure the process is done correctly.

MOLST is a key pillar of palliative care. The time is now to move towards universal access to high-quality palliative care for persons with serious illness and statewide eMOLST implementation.

Featured Resource: Spring 2017 Generations Journal

The Spring 2017 issue of Generations is dedicated to ensuring all Americans with advanced illness receive comprehensive, high-quality, and person-and-family-centered care consistent with their values. The issue provides a solid perspective on critical issues and a map of the terrain ahead. It can be read in full here.

ASA invites you to join a special Roundtable event to learn more. Download the agenda and register today!

MOLST FAQ: Is MOLST the same as Physician Assisted Suicide?

No. The MOLST program does not allow for active euthanasia or physician assisted suicide. Allowing natural death is not the same. There is no ethical obligation to prolong the dying process by using every medical treatment available.

Making medical decisions can be guided by asking ethical questions:
1. Will treatment make a difference?
2. What are the benefits and burdens?
3. Is there hope of getting better with the treatment? If so, what will life be like afterwards?
4. What are the person’s values, beliefs & goals?

Stopping medical treatment that is burdensome, dangerous, extraordinary, or disproportionate to the expected outcome often represents the refusal of “over-zealous” treatment.


eMOLST Champion:
Carolyn Kazdan, MHSA, NHA

Carolyn Kazdan, MHSA, NHA serves as the Assistant Director, Health Care Quality Improvement for IPRO. For the past two years, Ms. Kazdan has been responsible for coordinating the implementation of the CMS Special Innovation Project, “Transforming End-Of-Life Care” which has focused on increasing the utilization of MOLST and eMOLST in the Long Island region and education of healthcare providers and Medicare beneficiaries on the importance of meaningful End-Of-Life conversations and Advance Care Planning (ACP). Ms. Kazdan also coordinates IPRO’s work on the NYS Partnership for Patients initiative in collaboration with HANYS and GNYHA.

Ms. Kazdan is an active member of the MOLST Executive Committee and is an advocate for ACP and NY’s MOLST program. As a Licensed Nursing Home Administrator, Ms. Kazdan recognizes the value of well-informed, well-documented shared medical decision making for both patients and healthcare providers dedicated to patient centric culture change.

Through the CMS Special Innovation Project, Ms. Kazdan worked with Dr. Pat Bomba and Katie Orem to provide educational programs attended by almost 2000 healthcare professionals and with Patient Advocate Beth van Bladel to educate approximately 1800 Medicare Beneficiaries on the importance of ACP. As a result of the training provided, the number of healthcare facilities enrolled in eMOLST tripled and there are now 100s of NY Elders whose wishes related to life sustaining treatment are now documented and accessible through the eMOLST registry.

According to Ms. Kazdan, “it is important for the elders we serve in NY that the work of implementing MOLST and eMOLST continue and be recognized as an important public health initiative”.

Construction Ahead! CompassionAndSupport.org Website Revision

This fall we will be working on a significant revision to CompassionAndSupport.org, our community website that houses public educational materials and resources on advance care planning, MOLST, palliative care and end-of-life care. As part of this project we plan to extract the rich resources about New York’s MOLST program on to a new sister site, MOLST.org. We believe that separating out information and resources on MOLST will allow for improved navigation for both consumers and professionals.

We are approaching this project with a few key goals in mind including:

• Improved usability, including better navigation and simplified website architecture so that the information people want and need can be found quickly and efficiently. Separating the MOLST content on to MOLST.org and storing other advance care planning, palliative care and pain management content on CompassionAndSupport.org will assist with simplifying the site’s architecture.

• Visually distinguishing MOLST content from other content given that we are New York’s hub for all MOLST information. This is consistent with the approach taken by other endorsed POLST Paradigm Programs. To maintain consistency, our MOLST site will complement the content and user experience found on CompassionAndSupport.org.

• A modern look and feel. Our current website is a decade old and web standards have changed significantly in that time. Our new site will be responsive and mobile friendly. This means that the site content will adjust in size to fit the screens’ that our visitors are using. We expect an improved user experience and better search performance.

• Simplified maintenance. As many of you know, we are a small team without a dedicated communications staff member. We need our content manager to be intuitive and easy to maintain so that we optimize the use of our limited time.

• A strong foundation with flexibility for future growth. We need our website to be secure and stable, while maintaining flexibility for both constantly evolving technology and demands from consumers and professionals. Being able to adapt to change is critical for our team as we continue our work on public health programs and meet the communication requirements of the future.

We appreciate your patience as our entire team undertakes this massive project. Suggestions on improvements or items that we should consider during this transition can be sent to Meg Greco, Geriatrics & Palliative Care Coordinator, at meg.greco@excellus.com.

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