Assisted Suicide Gets New Legislation

Kim Callinan on state expansions of end-of-life options

Ric Edelman: It's Friday, May 10th. On today's show, will AI be transformative? Plus, the latest developments in assisted suicide. Think about the development of the telephone. It was invented in 1876 by, of course, Alexander Graham Bell. It took 70 years for 50% of US households to get a telephone. We spent over a hundred years hardwiring phone lines all across the country. But in South America, they got 50% of the country using telephones in about a decade. Because they didn't spend decades and billions of dollars wiring the continent. Instead, they waited until there was cellular technology. 

Now, of course, they didn't wait out of choice. They simply didn't have the money, or the political, or economic, or social structure to lay phone wires everywhere. But when cell phones came out, everybody could buy one, and BAM! Suddenly, everybody's got a phone. We spend over a century getting phones into everyone's homes. They did it in a matter of years.  

Is this leap into the future going to happen again, thanks to AI? For you and me, AI might seem to be iterative. When we search online, AI makes our search easier and better. But for people in South America, Africa, India, Southeast Asia, this technology might just bring revolutionary improvements to their lives. 

Already, mobile devices have given 4 billion people in low-income countries quick and cheap access to information. They can engage in financial transactions without a bank account. This is helping a billion people rise out of abject poverty. A lot of experts say that AI is going to be just as transformational. The technology is getting really good, it can spread really fast, and it can replace the need for skilled workers. Now, that might sound like a negative for those living in first world countries, like the US, where AI might put a skilled worker out of work. But in a lot of places around the world, these countries don't have skilled workers in the first place. They don't have enough teachers and doctors and engineers or managers. AI can perform the work of those people. So countries that are right now being held back because of a shortage of skilled workers can now advance by using AI as a substitute.  

In Kenya, there's an app that lets elementary school children ask questions to a talking chatbot. You want to know how to convert fractions into percentages? The chatbot can explain it to you, step by step. And chatbots can give every child undivided attention, 24/7. It knows how to adapt to the different learning styles of each child. Some kids like to learn with numbers, others with stories. The chatbot is a chameleon. It can be for each child whatever each child needs it to be. 

There's also an app for teachers. It creates lesson plans for them, tells the teacher about the progress that each student is making on their assignments, which they do, by the way, on their smartphones. The companies behind all this figure that the tech will cost less than $4 a month per child. Others are starting to use AI to write textbooks in languages that commercial publishers won't because there are too few potential buyers.  

There's also a movement to use AI to provide health care services in poor countries. Medical kits that have handheld ultrasound devices. They're incorporating AI to read the data so that human health care professionals aren't needed. If there's a diagnosis, the data can be transmitted to doctors who work not just in a different city, but on an entirely different continent. This is a big deal, because here in America, we have one physician for about every 400 people. But in Kenya, they have one doctor for about every 4,000. But now there's an outfit that runs a virtual healthcare platform that serves 29,000 people. How many patients does your doctor handle?  

The site uses AI to talk to patients. It asks them for more information and sends that information, along with recommendations to a nurse. The human expert approves it and sends it to the patient. And check this out. McDonald's discovered that when it installed kiosks in their restaurants, sales of large orders of fries went up because people were too embarrassed to ask for a large order of fries when talking to a human clerk. But when using a digital kiosk, they felt free to order the large fries. Nobody would pass judgment on them.  

And they're discovering the same behavior in Africa. When people have an embarrassing illness, like a sexually transmitted disease, they often don't want to admit it to a doctor. But they are telling the AI chatbot because they know the chatbot won't judge them. The result is that more people are getting better treatment for their problems. One huge area of help is with pregnancies. There's a health facility in Kenya that serves 30,000 people, but has no doctor. So now, midwives are using an AI powered scanner to check out how the fetus is doing. It costs only a few bucks a day.  

And remember when we had no idea that a hurricane was coming? Now we have a week's heads up, but in poor countries, they don't have the benefit of advanced weather forecasts like we do. So now they're starting to use AI to make weather forecasts, to give people in rural areas time to seek shelter from coming storms. 

They're also using AI to get financial aid to people who didn't even know it was available. In India, there's a program to give money to farmers, but tens of millions of these farmers are illiterate. So when the government launched an AI app that let farmers ask questions verbally to a chatbot, they got half a million applications on the very first day. 

And all this is just the beginning. The race is on. In Saudi Arabia, the government is spending $40 billion on AI. That'll make Saudi Arabia the world's biggest investor in this new technology. Google, Microsoft, Meta, Alphabet, everybody's getting in on this. Meta, of course, the parent company of Facebook. Alphabet, a parent of Google. Both of them, along with Microsoft, have spent a combined $32 billion on AI in just the first three months of this year. They've all said that they have no intention of slowing down their spending on AI. Mark Zuckerberg said, quote, “We're going to go for it.” It's easy to see why there's so much interest in investing in all of this. 

In the US alone, we spend $5 trillion a year on health care. A third of that is on administrative expenses. With this much money involved, the profit potential is enormous. And everyone's going to benefit. Not just us wealthy people in the US, but all people worldwide.  

Coming up next, a conversation with Kim Callanan, the president and CEO of Compassion & Choices. Stay with us for more here on The Truth About Your Future. 

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Ric Edelman: You're listening to The Truth About Your Future, and I think maybe you're watching it, too, or maybe you're reading it. I don't know how you're digesting this program, but any way you wish, we make it available to you. One thing that we talk about often on this program, because it is about the future, is the inevitability of your future. Sorry to remind you of this, but you're going to die one day. That is so far an inevitability for everybody. Although there are a lot of folks, as we've talked about often on this podcast, people trying really hard to extend life ultimately to immortality. It remains a pipe dream. For now, we have to recognize the fact that we are, good news, living longer than ever, but bad news, many of us are becoming infirm long before we die. And the issue is that medical science has gotten pretty darn good at keeping us alive. It hasn't yet achieved that holy grail of keeping us alive healthy until the day we die. And this is creating a bit of a challenge for an awful lot of folks, and has raised the issue of medical aid in the death process. And we've talked about this on the show in the past. We need to talk about it again, not only because it's an ever-present issue, but because there are new developments from a legislative perspective in this area. So, I'm happy to bring back onto the podcast my good friend Kim Callinan, she is President and CEO of Compassion & Choices. Kim, welcome back to the podcast.  

Kim Callinan: Thanks so much, Ric. It's great to be here today. 

Ric Edelman: So, I use the phrase medical aid in dying, that might come off to some as jargon, so talk, first, before we delve into this, explain to everybody what exactly we're talking about here. 

Kim Callinan: Sure. So, medical aid in dying, quite simply, is a medical option that is available in 10 states and Washington, DC that gives a person who is terminally ill, and has the ability to make their own health care decisions, the option to request from their doctor a prescription medication that they have the option to take if their suffering becomes too great. It is entirely optional for both the doctor and the patient, and it's patient-directed from start to finish.  

Ric Edelman: That's presuming that the patient has the capacity to instruct the doctor and to make that choice. So are you suggesting that this is only for such patients as opposed to those who are mentally incompetent or not, you know, able to make such decisions? 

Kim Callinan: Yeah, that's correct. So the option of medical aid in dying is only for someone who is mentally competent. People do have the option to document their care preferences, if they can no longer speak for themselves and have a healthcare proxy carry out those wishes, but you wouldn't be able to use the option of medical aid in dying. You'd be able to forego treatments. You'd be able to not get more treatments for care, but the option of medically aided dying is not available if you don't have capacity. 

Ric Edelman: And you mentioned getting a prescription. Describe that.  

Kim Callinan: Sure. So, under the laws, there are very strict regulatory requirements that protect vulnerable populations. And that requires you to request, from two different physicians, the prescription medication, the prescription is a number, it's a compound that's a number of barbiturates that are compounded together by a pharmacy, and then you mix it with four ounces of typically orange juice, and you drink the medication when you decide that the time is right. 

Ric Edelman: And, you just go to sleep and your heart ultimately stops? 

Kim Callinan: Heart rate starts to slow down. And typically, for the average person, within about 30 minutes, you've fallen asleep. And, on average, normally within about two hours, you've died.  

Ric Edelman: This is legal, you said, in 10 states plus the District of Columbia. That's a bigger number than the last time you and I chatted here on the podcast. Talk about the advances, I'm not sure if advances is the right word, but the development, the increased frequency with which state legislatures are saying yes to this.  

Kim Callinan: Yeah, so really a couple of things is happening. First, as you noted, medical science has been phenomenal in extending life, but many of the treatments that extend life result in very, very challenging ends. And so, more people are recognizing as they are watching their caring for their aging parents and then contemplating their own mortality that there is an imbalance in the way we care for people at the end of life. So you're seeing increased consumers demanding a voice and choice in the kind of care they receive and actually it impacts lawmakers too because they too are caring for elderly parents and watching unnecessary suffering at the end of life. So between those things and lots of advocates coming together, the work that we and others are doing, you're seeing an increased momentum in states. So this year, we have 18 states that are currently considering the legislation. Over the past eight years, we've had at least one state authorize a new bill or authorize a bill to improve an existing law. So, there are 18 states right now that have introduced legislation to authorize medical aid in dying. And the momentum is just incredible. You have more people that are demanding that they have a voice and choice in the kind of care they receive. And we've seen that progress over the past eight years. We've had at least one state authorize or improve medical aid in dying legislation every year. So we anticipate that that will continue in the coming years.  

Ric Edelman: So, at present, only ten states plus DC, what if you don't live in one of those states?  

Kim Callinan: Fortunately, through our efforts, we have been able to, convince two states, Oregon and Vermont, to remove their residency requirement. It is our belief in all of the states when they were passed, the states had a residency requirement that said you had to live in that state in order to be able to access the option. We believe this is unconstitutional and it violates a person's right to travel to another state and access medical care. And fortunately, we were successful at convincing two states, Oregon and Vermont, to drop that residency requirement. And we hope that more states will follow suit and do just that. So you can right now access the option in either Oregon or Vermont. If you live in a state that does not authorize medical aid in dying, and we would encourage you to reach out to us if you need help navigating the process, it is difficult. So you would want to plan in advance. It's not something you want to wait till the last minute if this is an option you might want to take advantage of for yourself.  

Ric Edelman: When you say it's difficult, are you talking legally, medically, logistically? You know, just getting the patient from one place to another?  

Kim Callinan: Logistically, it's difficult. So, because lawmakers understandably want to protect vulnerable populations, there is a very specific set of requirements that someone has to go through in order to access the law that requires meeting with two doctors and you have to be physically in the state to do that and when someone's at the very end of their life, the idea of traveling to another state, being there long enough to be able to see two doctors in Vermont, there's a 15-day waiting period. Oregon has a waiting period too, but they do have the ability for it to be waived by a doctor. So just finding a doctor can be a challenge. And so getting through that whole process while you're terminally ill is not easy, and that's why we really do need to bring this option to every single state. It's only going to help a small number of people who know in advance that this is the option they want who set things up. If you're at the very end of your life and you decide at the last minute that this is an option you want and you live in a state that's not authorized, you're not going to have the wherewithal or the ability to be able to travel to another state. 

Ric Edelman: Let's talk about the ethical, moral, religious concerns that inevitably, people raise when talking about this.  

Kim Callinan: Yeah, and that's why the law has been so carefully crafted, in the states and made entirely patient-directed and you have to be mentally capable in order to be able to access the option. It requires a patient to ask two different providers, on their own, whether or not to access the law. A person has to, do something in writing, and you have to actually be able to take the medication yourself And there are multiple different ways you can do this. So it could be pushing a plunger or sipping out of a straw in a cup. But it is so patient-directed from start to finish and so highly regulated – many people who oppose abortion do also oppose this – but there all are a group of people who see this very differently because this is an instance where the person is making the decision entirely themselves. There are people who are able to separate out their own religious beliefs from, I personally would not choose this for myself, but recognize that our country is about freedom for people to practice their own religion and to have their own decisions. So for those people who do want this option, they respect that they should be able to have this as an option. 

Ric Edelman: Are you collecting any data on who is availing themselves of this opportunity? I'm wondering if people are more likely to be in one socio economic strata than another.  

Kim Callinan: Yeah, that's a great question. So across the authorized states, it's primarily, wealthy, educated, white people that are availing themselves of their option, equally men and women, the question really exists as to, why African Americans, Latinos are not using the option, is it because it's against their personal preferences, which is perfectly fine, or is it because, there's an access issue? 

Ric Edelman: What about the cause of death? What kind of medical conditions are you generally finding that people are suffering from that are leading them to this decision?  

Kim Callinan: Yeah, the two biggest are cancer, and neurodegenerative diseases like ALS are the two biggest. And ALS is actually the second largest group of people who choose the option, and it's really a small percentage of people who die, so it really is an indication of just how hard death can be for some of those neurodegenerative diseases like ALS. In cancer what we often see is, people try all kinds of clinical trials and we of course have incredible lifesaving cancer treatments, but some of those treatments are super debilitating. And so people find after going through, you know, hundreds of rounds of chemotherapy and stripping their body away of all, you know, immunities that, it's just too much. It just becomes unbearable. And so the option of medical aid and dying balances out all of the extensive life prolonging treatments they've tried. For most people with dementia, the only way that you're likely to qualify is if you have something else.  

Ric Edelman: And so that's the key. You've got to be within six months, according to the two physicians. 

Kim Callinan: I think that there is a misunderstanding that there's nothing that you can do if you have Alzheimer's or Dementia in order to plan for, prepare for the death and shorten the length of time that you live with it. If you look at how people died 50 years ago, people didn't die from Dementia, people died from disease, from diabetes, from dehydration, and medical science has gotten really, really good, and so we know how to extend life. And the default mode in our medical system is to extend life. So even when somebody gets Dementia, what typically happens is that we are automatically treating all of the other diseases, and we are artificially prolonging people's lives. And that's why you have people who are 80 and 90 who live for several years with Dementia, beyond the point that most people say they would want to live. But actually, they have choices. You can document the point at which you would want to forego treatments. Or not end up getting life prolonging treatments and, a healthcare proxy can carry out your wishes and you can cut years off of the length of time that you live with Dementia. So we do have a tool on our website called the Dementia Values and Priorities tool, that I would encourage everybody to fill out as, a part of their end-of-life planning work. And that could really change the experience that you have at the end of life.  

Ric Edelman: Talk about that tool.  

Kim Callinan: Yeah, so the tool has a number of different markers that are common for someone who has Dementia. Things like, I can no longer feed or dress myself, I can no longer recognize my loved ones, so it's, the things that typically happen to somebody as you go through the progression of Dementia. And then there's different levels of care. So, you can choose, do you want life prolonging, like here, if you go to the hospital, do you want to be resuscitated at that point? You can choose, do you want to start looking for ways to be a gentle exit for you? Like, don't treat my pneumonia. Do you want to be taken off of medications that you might be taking, like for diabetes or heart disease? Or do you want all available care and to continue to live your life? And so you go through that and you choose the level of care that you want and it creates for you a customized advanced directive that serves as a care plan for your health care proxy. And it really takes the guilt and guesswork out of how to care for somebody when they have Dementia. I will just say it's so important though that you pick the right health care proxy because you're going to be up against a system where the default mode is life extending treatments and that person has to be able to be strong enough to stand up to, the pressure of treatment and care to extend life. 

Ric Edelman: We have a link to the Dementia Values and Priorities tool from Compassion & Choices here in the show notes, so you can access that right away. The tool is free, is it not, Kim?  

Kim Callinan: It is free, yep.  

Ric Edelman: So, be sure to access that yourself, and financial advisors should certainly share this information with their clients, all of whom are ultimately going to be facing this, if not for themselves, for their loved ones. We are talking with Kim Callinan, the President and CEO of Compassion & Choices. Talk about the other initiatives that you're engaging in.  

Kim Callinan: Absolutely. So our mission is to improve care, expand options and empower everyone to chart their own end of life journey. And what we choose to do is to focus on the initiatives that we believe is going to result in patients having a greater voice and choice in the kind of care they receive. So medical aid in dying is a huge initiative. Our Dementia program is a huge initiative. We also do a lot of work around addressing inequities in end-of-life care, because unfortunately, there are groups and communities that don't have access to the same level of care that other people do, either because there's a lack of information or a lack of access. And so we have programs that focus on education to African Americans, Latinos, Asian American Pacific Islanders, and those are run by staff from the communities who work in conjunction with leadership councils from the communities that guide and direct those programs. And then we have a whole empower everybody effort where it's really about bringing the tools and the information and the know-how to help people accept the inevitability of their death and plan for the kind of end they want. And this work is near and dear to me because what I have seen, and you alluded to it in the very beginning of your show, is that when someone gets to the point where they can truly accept the inevitability of their death, they begin to live life in a really different way. And I have the benefit of watching our terminally ill advocates teach me every day of what it means to really recognize that your time is finite. And so through our advanced care planning program, we're not just helping people for the planning for the very end, but I think what many people find is it teaches them how to have courage now to live. So you find people, you know, being more grateful for those they care about. Making amends with people that they, had, you know, fights with. You know, having courage to step in and do something that they were afraid of. Because if you realize that life is short and that, like, really we're all just visiting this earth for a period of time, things that seem important to you no longer seem important to you in the same way. And so that for me is what our work around accepting the inevitability of death is all about. It's really about living life to the fullest.  

Ric Edelman: If you'd like to learn more about the work that Compassion & Choices is doing, we have a link to their website here in the show notes for you. Compassion & Choices is a nonprofit organization. Your support through volunteerism or financial support, as well as lobbying the state legislatures as they debate these bills, is something that Compassion & Choices would be very happy to have your assistance with. That's Kim Callinan, the president and CEO of Compassion & Choices. Thank you, Kim, for joining us again on the show.  

Kim Callinan: Thanks for having me, Ric. I really appreciate being here. 

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Ric Edelman: On Monday's show, I’m going to respond to your questions and comments. If you like what you're hearing, be sure to follow and subscribe to the show, wherever you get your podcasts – Apple, Spotify, YouTube – and remember leave a review on Apple podcasts. I read them all. Never miss an episode of The Truth About Your Future. Follow and subscribe on your favorite podcast app. 

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Links from today’s show: 

VISION – Register Now: https://dacfp.com/2024-dacfp-vision/  

Compassion & Choices: https://www.compassionandchoices.org/  

Dementia Values and Priorities tool from Compassion & Choices: https://www.compassionandchoices.org/dementia-values-tool  

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