Discussing the 'Death with Dignity' Law

With all the talk about the local Senate race and the epic contest between President Obama and Governor Romney, voters are not hearing much about a major ballot question that will be decided this November – whether Massachusetts should adopt a “right to die” law.

Question 2 will ask voters whether the Commonwealth should enact a “Death with Dignity” Law similar to those now existing in a handful of states such Washington and Oregon.

The law will permit a doctor to prescribe medication, at the request of a terminally ill patient, to end the patient’s life.  To quality, the patient must be an adult that is medically determined to be mentally capable of making a health care decision; (2) has been diagnosed as having an incurable, irreversible disease that will cause death within six months and (3) voluntarily makes clear that he or she wishes to die.  If the patient follows all the steps laid out in the Act, the patient may self-administer drugs that will end his or her life.

For a complete summary of the Act, prepared by the Attorney General’s office, read here.

Supporters of the proposed law include the Massachusetts Death with Dignity Coalition. According to the group’s web-site, “original petitioners” include doctors, lawyers and civil rights advocates. They contend that the proposed law contains numerous safeguards against abuse. Doctors must inform patients about all end-of-life care options, including palliative care, pain management, and hospice. Two physicians must verify the mental competence of the terminally ill patient, and three requests must be made by the patient for the prescription, two oral and one written. There also are required waiting periods, requirements that the requests be witnessed and a rule allowing the patient to change his or her mind at any time.

Steve Crawford, a spokesman for the group, states that "The act gives patients dignity, control, and peace of mind during their final days with their families and loved ones. These are very intimate personal choices that should remain in the hands of the individual not the government."  

Critics of the proposed ballot question include a group known as No on Question 2. The critics contend, among other things, that the law is subject to abuse.  The Disability Rights Education and Defense Fund, advocates for the disabled whose work is cited extensively on the former group’s website, is working to defeat the proposed law. Writing recently in the New York Times, its senior policy analyst, Marilyn Goldman, noted that physician-assisted suicide laws offer “no protection when family pressures, financial or emotional, distort patient choice.” And in another publication distributed by the same organization, the group claims that in other countries, such as the Netherlands, where suicide laws have been on the books for many years, over time to right to die has expanded to include persons not falling in the category of the terminally ill, and that medical care of the terminally or seriously ill also has eroded.

Another group, calling itself Mass Against Assisted Suicide, also sees potential for abuse. “The proposed act has significant gaps that put seniors at risk. The most obvious gap is the lack of witnesses when the lethal dose is administered. Without disinterested witnesses, an opportunity is created for the patient's heir, or someone else who will benefit from the patient's death, to administer the lethal dose to the patient without his consent. Even if he struggled, who would know?” 

Cardinal Sean O’Malley of the Archdiocese of Boston also has spoken out against such laws. “We hope that the citizens of the commonwealth will not be seduced by the language, ‘dignity, mercy, compassion,’ which are used to disguise the sheer brutality of helping someone to kill themselves,” said the archbishop last year.  

One possible explanation for the relatively little publicity this important ballot question has received lately is that the groups both supporting and opposing the measure lack the resources necessary to get their messages out to the broader public. Compare their efforts to those put forth, for example, by the various public employee unions, tax advocacy and business groups that weighed in, pro and con, when voters were given the chance to roll back the state income tax. 

Of course, careful contemplation of this ballot questions forces each of us to confront our own notions about individual freedom, our level trust in the medical profession, our feelings about the terminally ill and our views regarding the sanctity of human life. Our individual opinions about Question 2 often may seem contradictory in the light of our view on these weighty matters.

But there is a more practical consideration as well, and that is, just how reliable is a diagnosis of impending death? 

An old friend of mine relates the story of a doctor that told him six years ago that his mother had, at most, “six months to live.”  My friend, and his father, didn’t buy it. They changed doctors and moved the woman to a different facility.

Yesterday, my friend joined his mother for lunch over a plate of Chinese food.