Is 'death with dignity' the only option?
Naga P. Raja  Your view  Maria is 52 years old diagnosed with advanced kidney cancer for the last three years. She received three distinct lines of treatments and is no longer responding to them. Because of her weakness and inability to walk, we do not consider clinical trials as an option. She lives alone and her sister is her primary caregiver. She does not want to burden her sister and depend on her for activities of daily living. Unfortunately, Marias story is not the only one for an oncologist taking care of terminally ill patients. New Mexico becomes the 10th state to pass a medically assisted suicide bill  The Elizabeth Whitfield End-of-Life Options Act named after the judge who supported the bill and eventually died of cancer in 2018. Over 70% of these requests come from cancer patients, so oncologists face the tough decision of whether to endorse or take part in this practice. While supporters of this bill argue that this will prevent terminally ill patients from suffering and pain, research has shown that in most of the cases this is not the predominant reason to opt for physician-assisted suicide. We need to distinguish between opting out of life-saving procedures or treatments versus actively taking medicines to end life. A patients autonomy to decide about their care and potentially refuse lifesaving procedures are part of the highest standard of care in medicine. For example, terminally ill patients can refuse potentially lifesaving procedures like cardiopulmonary resuscitation or being put on a ventilator. If the patient is required to be put on a ventilator and if he/she refuses the same, their terminal illness may progress and lead to death. Administering lethal medicine to a terminally ill patient makes medicine the immediate cause of death. American College of Physicians in its position statement published in 2017 continues to oppose physician-assisted suicide. ACP sites significant ethical and moral values against the practice of medicine. PAS is at odds with the physicians role as a trusted healer and caregiver. It affects the trust of society in medicine and the patient-physician relationship. ACP suggests improvements in access to hospice and palliative care, communication between the physicians and patients about palliative care early in treatments, and other measures to improve end-of-life care. Of note, 90% of the patients and families do not know what palliative or hospice care means. World Health Organization (WHO) describes palliative care as services designed to prevent and relieve suffering for patients and families facing life-threatening illness, through early management of pain and other physical, psychosocial, and spiritual problems. After discussing this option, most patients and families agree to take part in palliative care. Rather than promoting and improving the access to hospice and palliative care, passing this bill will expose the poor and less educated in taking a decision that might not be good for themselves or for their family. One provision in the bill that differs from similar bills from other states is that this bill puts the waiting period at only 48 hours compared to one week in other states. This one-week window might avoid hasty decisions taken out of anxiety and being a burden to family members. Naga P. Raja is a cancer specialist in the medical oncology/hematology unit at Memorial Medical Center Cancer Center