To the editor:

Mr. Miller’s letter “Improve end-of-life care” (March 20) in response to my guest commentary (“New York’s Medical Aid in Dying Act,” March 6) contains numerous inaccuracies and distortions which unnecessarily confuses this important issue. Suicide, assisted suicide and Medical Aid in Dying are conflated. Many people do this, including the organization he cites “Patients’ Rights Action.”

Those who contemplate or commit suicide are generally severely distraught, depressed or have other serious psychiatric problems which if adequately addressed would allow them to live, often quite happily and productively, for many years. Their condition is reversible or can be improved. Individuals who request MAiD desperately want to live, have often undergone long and arduous treatments to do so, but are faced with impending, unavoidable death. More than 90% are receiving hospice and palliative care. To meet MAiD criteria, their disease must be incurable and irreversible with a life expectancy of less than 6 months. Often they are actively dying with only weeks or days to live. Physicians are not infallible in predicting time of death, but data show they tend to overestimate that time not underestimate it.

Differentiating suicide from MAiD is not merely a semantic distinction any more than discontinuing a ventilator (in a patient who has no chance of coming off it and wishes to die) is considered murder. The impact of suicide vs. MAiD on families is dramatic. Suicide is traumatic and devastating often leaving lasting scars. MAiD is usually healing and comforting, bringing families together. Their final memories are often positive and joyful considering their painful loss.

There also appears to be confusion between being disabled and having a terminal illness. Miller, citing PRA, conflates the fact that people with disabilities who as a group receive lower quality medical care and therefore might be pressured into seeking an early death. Having a disability, in and of itself, does not in any way qualify one for MAiD. There certainly is tremendous room for improvement in care for the disabled, as is the case with others disadvantaged in our society. Denying MAiD does not improve care for anyone.

The disadvantaged and minorities are not being pressured into accepting aid in dying. Abundant data shows the opposite to be the case. In every state where MAiD is legal a much greater percentage of those who are better off avail themselves to MAiD than the disadvantaged.

I strongly advocate for better availability and quality of medical care for those who are less well-off, regardless of the reason. Quality universal healthcare would go a long way in correcting our present disparities. Inclusive healthcare for everyone and MAiD are not mutually exclusive but, in fact, complementary.

Hospice and palliation are wonderful for people with terminal illness but are not sufficient for all. Individuals should have the peace of mind to know they can have the control to end their suffering on their own terms when they choose.

Note the spelling of my name.

Jay S. Federman

Saranac Lake