MAIDCancer Support NOW 2022

1. End-of-Life OptionsAct
MedicalAid-in-DyingUpdate
Representative Debbie Armstrong

2. www.endoflifeoptionsnm.org
Right to Self-Determination
• Guaranteed by the NM Uniform Health Care Decisions Act
• We decide what health care to startand if/whento stop it
• We can appoint a surrogate or proxy to act on our behalf if
we lose capacity
• Gives us the “opportunity” for a good death

3. www.endoflifeoptionsnm.org
End-of-Life Options
•Let nature take its course
•Pursue Life-Sustaining Treatments
•Refuse Treatment
•Discontinue Treatment
•Palliative Care/Hospice…when ready for “comfort care”
•Voluntarily Stopping Eating and Drinking (VSED)…hasten death
•Continuous Deep Sedation…physician initiated
•Medical Aid in Dying…our newest option here in NM

4. Elizabeth Whitefield
End-of-Life Options Act
New Mexico’s End-of-Life Options Act
provides for “medical aid in
dying”(MAID) which is the medical
practice wherein a health care
provider prescribes medication to a
qualified individual who may self-
administer that medication to bring
about a peaceful death.
The law went into effect June 18, 2021

5. www.endoflifeoptionsnm.org
Qualified Individuals
• The individual must be an ADULT at least 18 years old and a resident of NM.
• The prescribingprovidermust determine that the individual has:
• TERMINALILLNESSwhich is a diseaseor condition that is incurable and irreversibleand that,in
accordance with reasonablemedical judgement,will resultin deathwithin 6 months
• CAPACITYto understandand appreciatehealth care options available, including significant
benefits andrisks,and to make and communicatean informeddecision.
• VOLUNTARY so that the requestfor MAID is not underduressor undueinfluence.
• ABILITYTOSELF-ADMINISTERthe MAID medicationby taking an affirmative,conscious, voluntary
action to ingestthe medications.(Injectionor IV administrationare NOT allowed.)

6. www.endoflifeoptionsnm.org
Healthcare Providers
• Any of the followingindividualslicensedin New Mexicoand authorized
under NM law to prescribe a medication to be used in MAID:
1. Allopathic Physician (MD)
2. Osteopathic Physician (DO)
3. Advanced Practice Nurse (APRN)
4. Physician Assistant (PA)
• At least one physician (MD/DO) mustdetermine, after conductingan
appropriate examination, that the individualis qualified. That can be the
”prescribing”provider, a “consulting”providerOR affirmation the individual
is enrolled in Hospice.If the individualis notenrolledin hospice,then two
providers mustaffirm qualifications,one of whichmust be an MD/DO.

7. www.endoflifeoptionsnm.org
Capacity
• A determination of capacity shall be made only according to professional standards of care
and the provisions of the NM Uniform Health Care Decisions Act, which has an underlying
presumptionthatanindividualhasthecapacityto makeahealthcaredecision.
• If the prescribing or a consulting provider believes the individual may lack decisional
capacity or if the individual has a current or recent history of mental illness or disability
that could impair capacity for end-of-life decision-making, the individual must be referred
to a mental health professional and MAID cannot proceed until such professional
determines the individual has capacity to make end-of-life decisions.
• A Mental Health Professional is a NM-licensed psychiatrist, psychologist, master social
worker, psychiatric nurse practitioner or professional clinical mental health counselor.

8. www.endoflifeoptionsnm.org
Prescribing
• Prior to prescribing, the provider must inform the individual of all available end-of-life care
options, including palliative care and hospice.
• The prescribing provider must document all qualifications. The individual’s enrollment in
hospice or, if necessary, affirmation of terminal illness by a consulting provider must also be
included.
• The “Request to End My Life in a Peaceful Manner” form is required by law. It should be
discussed with the prescribing clinician, completed, signed, and witnessed by two persons, one
of which must be a disinterested party. The prescriber will include it in the individual’s health
record.
• The prescription, once written, has a 48-hour hold before it can be filled UNLESS the prescriber
affirms that, within reasonable medical judgement, the individual will not survive 48 hours.
• Sleep usually occurs within minutes of ingestion and death within hours.

9. www.endoflifeoptionsnm.org
Other Provisions
• “Right to Know” …terminal patients should understand all their options
• “Medical Aid in Dying” is NOT “suicide” …language is critical, no naming or
shaming
• Strong Immunity Protections and Conscience Clauses…no one has to
utilize or participate in MAID…voluntary for all
• Healthcare Entities that don’t participate must post that information
publicly and must provide a referral and medical records if requested
• Patient-centered…so the patient is in control

10. www.endoflifeoptionsnm.org
The Uniqueness of EWEOLO Act
• Prescribercan be a Nurse Practitioneror a PhysicianAssistant
• A Consultant Physician must affirm terminal diagnosis, decisional capacity and
ability to self-administer the medications
• Enrollment in Hospiceis automaticconfirmationof terminal diagnosis
• If not in Hospice, a physician must affirm terminal diagnosis
• The onlywaiting periodis 48 hoursbetween prescriptionbeing written and
whenit can be filled…may be waived if patient might die
• Capacity is assumed,unless provider questionsor there is disability or recent
mental illness that might impact end-of-life decisionalcapacity
• Can refer to a wide variety of mental health providers to ensure access
• Ingestion(self-administration)does not require physical independence
• Non-participatingproviders mustrefer to anotherprovider or entity that will
assistin findinga provider

11. www.endoflifeoptionsnm.org
So, How’s It Going?
• Lots of interest and inquiries. There have already been a good number of
ingestions that we know about with patients and familiesbeing well-served and
peaceful deaths resulting.
• Several hospice agencies are fully incorporating MAID, including prescribing;
others are providing supportiveservices during ingestions. Some have decided not
to participate at this time
• Both UNM Health Sciences Center and Presbyterian Healthcare Services are
supportive and have developed systems for approvaland participation. There are
also a number of private practice physicians who are supportive and prescribing.
• End of Life Options NM (EOLONM) is incorporated as a nonprofit and building our
programsof public and clinical outreach, education and individual
support/referrals.

12. www.endoflifeoptionsnm.org
End of Life Options New Mexico

13. www.endoflifeoptionsnm.org
In Summary
• Medical aid in dying is not a failure of palliative care or hospice care; it
can be complementary when requested
• Having a conversation about all end-of-life options, including medical
aid in dying, is palliative in and of itself, and it is empowering
• Medical aid in dying is person-centered and patient-controlled
• Patient autonomy and professional integrity are standards of care

14. www.endoflifeoptionsnm.org
Resources
• END-OF-LIFEOPTIONSNEWMEXICO https://endoflifeoptionsnm.org. (505) 393-1321
Non-profit entity formed to serve as MAID information clearinghouse and referral source for providers
and patients; and to educate and support individuals, healthcare providers, organizationsand
communities regarding the full range of end-of-life options for all New Mexicans.
• COMPASSION&CHOICES https://compassionandchoices.org/in-your-state/new-mexico/
• DEATHWITHDIGNITYNATIONALCENTERhttps://deathwithdignity.org
• AMERICAN CLINICIANSACADEMY ONMEDICALAIDINDYING(ACAMAID) https://www.acamaid.org
• THECONVERSATIONPROJECT:The Conversation Project - Have You Had The Conversation?
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