New Mexico’s End-Of-Life Options Journey (Trek)

(The author has lived in New Mexico since 1975 enjoying a career in rural health, EMS, trauma systems, and was director of the statewide Public Health Division of the New Mexico Department of Health. Since his 2004 retirement, he has served as an analyst for the Senate Health and Public Affairs Committee, and is now board chair of End of Life Options New Mexico. For the last decade, Barak and wife Leah have been deeply involved with EOL issues. – Jay Niver, editor)

 

A year ago, the Elizabeth Whitefield End-of-Life Options Act was in the middle of its successful journey through the New Mexico House Health and Human Services Committee, the House Judiciary Committee, the House Floor, the Senate Health and Public Affairs Committee, the Senate Judiciary Committee, and finally to a vote of the Full Senate. On April 8, Governor Grisham signed HB 47, and on June 18, 2021, Medical Aid in Dying (MAiD) went into effect, affording New Mexicans an additional end-of-life option and extending compassion and peace of mind to many living with or suffering from life-threatening conditions.

Nine years of advocacy and outreach for the New Mexico End of Life Options Coalition and their partners were culminated in 2022. It took four years in the courts and three sessions of the state legislature over a five-year period to authorize MAiD. Going into the session, we were blessed to have passionate, deeply committed, and expertly knowledgeable legislative champions, excellent and active grassroots supporters, compelling storytellers, a well-vetted and progressive bill, and an unusually favorable political wind at our back.

And yet, to shepherd the bill through the gauntlet of organized and strident opposition, many other important issues competing for legislative attention, and the demands of a mere 60 days to navigate successfully through both the House and Senate, was a heavy lift.

The HB 47 signing ceremony was a full Zoom event with ceremony, recognitions, appreciations, and a viewing audience from all over the state of almost 100 supporters. It was a fine moment – and a fitting capstone to our years of advocacy.

And then, very quickly,  the “What’s Next?” question arose for our relatively small group of core coalition organizers. Do we really have the energy and the wherewithal to incorporate as a nonprofit, and commit to the work of helping implement our new law? Or should we declare victory and leave it to the vagaries of clinicians, agencies, institutions, and the public to figure out the law and begin to make it work?

We knew there was a range of approaches in the other states that preceded ours in authorizing MAiD. Some had taken a laissez-fair approach, while others had developed robust, volunteer-driven, nonprofit service organizations working tirelessly on public education, professional training, and a spectrum of individual support services.

We really didn’t know which way we would go. Although we had had some informal discussions about it in the past, we felt that we already had more than enough to do, and we didn’t want to jinx our advocacy efforts by getting out “ahead of our skis” and planning for an uncertain future. However, it was now time to decide.

Ultimately, I was one of four from our core group of about 20 who said we were willing to lead the effort and submitted our resumes and statements of interest to join a board of directors. No surprise, the larger group supported us all and seemed pleased and perhaps relieved to have us step forward.   Although it was a smaller group than we would have liked, we had an informal organizational meeting the following week to discuss where we go next.

In the next few weeks, we added one more to our initial board, but one dropped out. A few weeks later, another pulled back, so we’ve ended up with only three board members and a group of some 20 other capable folks we knew would participate fully, help us flesh out our vision, mission, planning objectives, etc., and provide a variety of volunteer services going forward. It was heady stuff, a bit daunting, and even a little scary – all at the same time.

The next four-five months were a whirlwind of nitty-gritty organizational activities and nonstop decision-making. The best news was that right from the get-go we had amazing and generous support from our two national partners (Compassion & Choices and Death with Dignity) and a New Mexico-based company, the Delta Management Group (owned by our legislative champion, Debbie Armstrong) that provides a wide range of back-office support, training, and executive leadership functions to a variety of nonprofit organizations and professional associations. They knew the ropes and helped us move forward quickly and efficiently on a pro-bono basis.

So, we named ourselves End of Life Options New Mexico (EOLONM). From there we:

• accomplished our initial strategic planning;
• adopted mission, vision, and values statements;
• submitted our paperwork to obtain state and federal certifications and our tax exempt status;
• developed a logo and brand;
• shifted our website from one of advocacy to our new role as a service and information provider;
• created a system where the public and healthcare professionals could reach us through our website or call us and get a knowledgeable response;
• identified and appointed official advisors to the board;
• developed our initial brochure;
• partnered with state and national organizations to conduct zoom sessions about our new law; and, • generally started the work.

It’s been a bit of a wild ride, but for the most part, very encouraging. Medical Aid in Dying is now available as an end-of-life option here in New Mexico. Since July, we are aware of more than 50 ingestions, with almost all of those clients enrolled in hospice and most attended at the bedside by their prescribing clinicians.

We have had several private physicians and a few hospice agencies fully incorporate MAiD into their scope of services. Several of our large health systems have developed clear policies supporting clinicians who wish to participate. Other agencies/hospitals have been just as clear about supporting patients’ end-of-life options, except choosing to refer out those who request MAiD support. We have distributed thousands of our EOLONM brochures to help ensure that clinicians and patients know where they can get accurate information and caring support regarding MAiD and/or other end-of-life options. It has been a good start, but as always, there is so much more to do and much hard work ahead to sustain our progress and help ensure access and support for all New Mexicans.

In late November the board began working on our first annual report with a sense of pride and humility, which is now available here (https://endoflifeoptionsnm.org/2021-first-annual-report/).

To have this opportunity to share with our fellow citizens the power of their right to self-determination, the importance of advance care planning to identify one’s values and preferences over time, and to help improve our end-of-life care, services, and options, including medical aid in dying, is a blessing.

So, friends and colleagues, check out our website (https://endoflifeoptionsnm.org), download our brochure, request a copy of our report, and maybe make a donation (board members have to learn how to make the “ask”). Good luck with your end-of-life options journey – it’s a compelling and righteous cause.