Janet Colbert made talking about death, a taboo topic, a normal part of her life.
When the retired oncology nurse received her own diagnosis — it was a rare form of liver cancer — in 2013, she began advocating that doctors should be allowed to prescribe lethal medication to terminally ill patients.
It was an option she wanted for herself.
"I feel that it would just give me so much more peace of mind," Colbert said in 2015, just months before her death.
Today, four years later,it becomes legal for New Jersey doctors to prescribe lethal medicationto patients with less than six months to live. New Jersey is one of eight states that allow what is called medically assisted suicide or medical aid in dying, depending on what side of the controversial issue you are on.
Even as advocates welcome the law for which they've fought for years,and declarevictory for patients' rights,there remains uncertainty within the medical profession about carrying it out.
The state boards that license doctors, pharmacists, mental health professionals and others have yet to implement regulations called for in the law. It wasn't until late Wednesday afternoon that the New Jersey Department of Healthpublished requirements for doctors, who must report information such aswhen prescriptions are issued and when patients die from them.
“It is a life-or-death issue," said Larry Downs, chief executive officer of the Medical Society of New Jersey, which opposed the law on ethical grounds. "Physicians would probably be wise to wait for thatregulatoryguidance beforedeciding to engage in it.”
Supporters say the law is detailed enough to allow doctors to proceed, and there are doctors who are on board, but that doesn't mean prescriptions will be written today. The New Jersey Attorney General's Office, which oversees the regulatory boards, says rule-making isn't required before the law goes into effect. Meanwhile, multiple hospital and medical associations have published extensive guidance for health care professionals.
“There are going to be doctors ready to practice on Day One, and there are going to bedoctorswho—it may take a patient who they’ve treated foralongtime to present a compelling case for them to use this law," said Corinne Carey, who led advocacy for the New Jersey law and works for Compassion & Choices.
Other doctors, she said, may wait for additional guidance from state agencies.
What the law says
Formally called the Medical Aid in Dying for the Terminally Ill Act, the law comes with extensive rules and a waiting period meant to ensure that patients make informed, voluntary decisions about ending their lives.
The law stalled at least twice before in the Legislature. Supporters say sick people should have a right to end their suffering on their own terms, while opponents worry over what they say is a lack of safeguards to protect vulnerable residents. There is debate within the medical community over ethical implications of helping patients die, and religious leaders have also opposed the law.
"I think some leaders in religious communities want to paint this as patients are giving up hope,"said Susan Boyce, a 56-year-old Rumson resident and supporter of the law. Boyce suffers from an auto-immune disease that reduces her lung function.
"We are all fighting and living our lives as full as we can," she said. "This isn’t hopelessness;this is just the desire to not suffer that last little bit that we don’t want to suffer through.
"It’s a very narrow bill.It has tight rails on it to keep it from being abused."
Which patients qualify
Patients with less than six months to live can request the medication. According to the law, two doctors must confirm the diagnosis of a terminal illness and that patients are capable of making a sound decision to end their lives.
Patients must be residents of New Jersey. They have to make two requests for life-ending medication at least 15 days apart, and also submit a written request that includes witness signatures.
Behind-the-scenes preparation
When Gov. Phil Murphy put pen to paper and signed the law, he also cued state agencies and health care associations and companies to roll out guidance on how to implement it.
“We knew there was a relatively short windowuntil the enactment date," said Theresa Edelstein, vice president of post-acute care policy and special initiatives for the New Jersey Hospital Association. "It’s been a process where we started with some basics, the explanation of the law, the summary of the law, and just started to build upon it.”
Now the hospitalassociation has extensive resources online, including sample forms for doctors and patientsand draft policies for health care professionals who opt out. The new law does not obligate doctors to prescribe lethal medication.
It's uncertain how many doctors will act on the law — no prescriptions can be issued for at least 15 days — and it's up to the Department of Health to collect reports from doctors about prescriptions that are issued and the number of deaths that result.
Doctors themselves are divided. A group of more than two dozenwrote in support of the law in a post on NJ.comearlier this year. Other doctors are vocal opponents.
"Assisted suicidedeeplyundermines the physician/patient relationship and runs counter to the physician’soathas a healer," Dr. Matthew Suh, a general surgery specialist in Newton, said in a statement.
Following others' lead
New Jersey joins seven other states and Washington, D.C.,in allowing doctors to write deadly prescriptions. Maine is the most recent state to approve a law, and Oregon was first, according to theDeath with Dignity National Center, an Oregon-based advocacy group.
In July, the Oregon law was amended and the 15-day waiting periodwas removed over concern that it caused patients in deteriorating condition to suffer for longer. Over time, states have seen increasing participation, but the number of people who take lethal medication remains minuscule. Check out the chart below to learn more.
Enduring controversy
Oregon's law has been challenged twice before the U.S. Supreme Court since it was enacted in 1994.
READ MORE:22 years of medically assisted suicide: A brief history as NJ prepares for the new law
While other states have seen court action, none has been taken in New Jersey. Instead, opposition is coming from inside the Statehouse, where lawmakers in both the Senate and Assembly eked out —by one vote — enough support to pass the bill in March.
Four Republican assemblymen are backinga bill that would repeal the law.
Assemblyman Robert Auth, R-Bergen, introduced the bill in June alongside co-sponsors Parker Space, R-Sussex; Ronald Dancer, R-Ocean; and John DiMaio, R-Warren. Auth expressed concern that nefarious individuals would exploit the law and encourage patients to take the medication for their own gain, even though the new law includes rulesto prevent that.
Garden State lawmakers, however, are off for the summer, and with Democratic majorities in the Legislature, it is unlikely the effort to repeal will go anywhere soon.
Auth raised concern that oversight bodies such as the Board of Medical Examiners haven't yet issued guidance on complying with the law.
"There's no protocol in place by the state," Auth said. "It’s kind of like the wildwildwest.”
Law comes after years of advocacy
Colbert, of Lakewood,supported the law while juggling a fierce crafting hobby and passion for sipping margaritas and watching Yankees games with her son.
She went to Trenton once and testified in support of one of the bill's earlier versions.
But months later, in late 2015, Colbert's cancer overpowered her chemotherapy treatments. She was in home hospice care for about a week as her liver and body began shutting down.
Her son, Damon DeSio, was by her bedside.
“Hopefullyshe wasn’t in pain those few days," he said, his voice shaking. One day at her Lakewood home, Colbert told DeSio it would have been "a good day" to take lethal medication, he recalled.
"Would sheactually havedone it if she had it in her hand?" DeSio said. "I don’t know. She would have been much more comfortable having it there."
Colbert died on Sept. 8, 2015. She was 69.
From the archive: NJ fighting to die, Christie mum
Her obituary ends: "Raise your margarita glass for one last toast to Janet Colbert."
That's what Colbert would be doing today.
"She'd be thrilled ... this is finally getting passed," said DeSio, who now lives in Maryland. "She would be happy that all thatworkand talk had paid off."
Stacey Barchenger: @sbarchenger; 732-427-0114; sbarchenger@gannettnj.com
