Dying Right NC supports end-of-life autonomy, through what’s known as medical aid in dying.
“[That's] an end of life option, where someone who was cognitively able and has a terminal illness, meaning less than six months of life projected that they can self administer a medication prescribed to them," according to Dying Right NC board member and general counsel Joan Keston.
Keston, who practiced elder law and estate planning before joining the organization, is quick to say this is not assisted suicide — the practice once associated with Dr. Jack Kevorkian, who was convicted of second-degree murder in the late 1990s.
“Assisted suicide is what is referred to when a physician or a third-party administers, usually, an injection to end someone's life. There is no state in the United States that allows that. Every state, including Oregon, which was the first state to legislate in favor of this back in 1997, requires the self-administration of the medication, [the patient to be] cognitively able, [and to have a] terminal illness. So when you hear of things like assisted suicide, physician-assisted suicide, that's not what we're trying to get here in North Carolina," Keston said.
Keston says medical aid in dying, as it’s been legalized in ten states and Washington, D.C., has strict rules: patients must be able to physically take the medication themselves, they have a terminal diagnosis, meaning less than six months left to live, and they must be mentally competent (including being free of clinical depression). Patients must provide two witnessed written requests, and two doctors have to sign off on it.
The current bill, HB410, isn’t about legalization, though; instead, it asks the House to commission a fund a study.
"Effective July 1, 2025, there is appropriated from the General Fund to the Department of Health and Human Services the sum of one hundred fifty thousand dollars ($150,000) in nonrecurring funds for the 2025-2026 fiscal year to be allocated to the North Carolina Institute of Medicine to fund the study authorized by Section 1 of this act," the bill reads, in part.
That would look at why patients might pursue medical aid in dying, what other options there are, and what it means for patients who don’t have other options. It would also look at data suggesting that about a third of people who go through the process and actually end up with the life-ending drugs, decide not to take them.
“The argument against this was, 'oh, everyone's going to flock to this and use it, abuse it, die.' Oregon and California have a lot of studies [...] and what they find that 30% of the people, a third of the people who get the medication, never use it, and the resulting conclusion is that they want control. Some individuals want control of their life, and they feel comforted by having that available, and then don't seem to need it. Let like nature take its course," Keston said.
Keston noted disability advocates have vehemently objected to the bill, but said there’s no evidence of this type of law being abused: “Nothing, not one case of abuse, not one."
And, in general, there hasn't been any real political, medical, or religious pushback.
“We did a survey a couple of years ago among Republicans — I always said this is not a divide, and we found that it's not — even most Catholics are in favor of it. The only group that is a little bit opposed, maybe some Christians, not so much majority against, but maybe not as much in favor. So we can't really say that there's any kind of group or dynamic that vitally opposes this in our terms of the general population," Keston said, noting they hadn't heard pushback from the medical establishment either. (One feature of future legislation, she said, would be removing liability from anyone involved in the medical aid in dying process.)
In fact, this year’s House study bill has bipartisan support, with two Republican and two Democratic primary sponsors, and 16 co-sponsors, including Wilmington-based Democrat Deb Butler. Still, it’s been difficult for Dying Right NC to get traction — they’ve filed bills every two years for a decade, starting in 2015.
Keston said part of the struggle hasn't been pushback as much as a general hesitancy to dwell on a difficult issue like the end of life.
“No one wants to spend political capital on it, because there's other issues, and there's not been enough of an outcry that people are demanding," Keston said. "And, coming from estate planning, you know, people don't like to talk about end-of-life things they, really don't.”
Keston hopes more awareness will move the needle of public opinion — to help prevent people from being convinced in more personal, tragic ways.
“You know what we always say is that when someone, it's your one bad death away — either a loved one or somebody — from being in favor of something like this,” Keston said.
It's not clear if HB410 will survive crossover day, the deadline for most bills to make it out of their originating chamber (Thursday, May 8, this year). But, Keston said Dying Right NC has no intention of stopping, even if they're not successful this year.
