The presidential and senatorial elections won’t be the only hotly contested issues on Election Day in Massachusetts this year. On Tuesday November 6th, Massachusetts residents will vote on a Death with Dignity Law; if the ballot measure passes, Massachusetts will join Oregon and Washington in legalizing physician assisted suicide. Physician assisted suicide was made legal in Montana in 2009 by a state Supreme Court ruling.
Last fall, Dignity 2012, the group that penned the proposed law, gained over 85,000 signatures to send the proposal to the state legislature. But because the state legislature did not act on the proposal before May 1st, the decision will now be left up to Massachusetts voters.
The proposed law would permit a physician to write a prescription, at the request of a terminally ill patient, for self-administered life-ending drugs. While a long series of case law—beginning with the Quinlan case in 1976—established the legality of “allowing to die” by withholding or withdrawing treatment or artificial nutrition and hydration, physician participation in intentional suicide remains illegal in all states but Oregon, Washington, and Montana.
The legislation includes a number of safeguards to protect against abuse and violation. Only a patient who has been determined to be terminally ill and has “voluntarily expressed his or her wish to die” may apply for physician assisted suicide. Two doctors—the patient’s own physician and an additional consulting physician—must confirm that the patient is expected to die within six months. The patient must file two requests, spaced 15 days apart, in the presence of two witnesses, one of whom cannot be a relation. The patient must wait an additional 48 hours to fill the prescription. Violation of the law, including coercion and forgery, would result in the physician’s imprisonment. Under the law, active euthanasia is illegal; the drugs must be self-administered by the patient. Physicians who are opposed to the practice would be in no way obligated to write a lethal prescription for a patient.
Support of and opposition to physician assisted suicide transcends political and religious lines. Advocates contend that physician assisted suicide preserves dignity and autonomy until the last moments of life, ending the suffering of the terminally ill on their own terms. Opponents fear that although the law includes psychiatric evaluations and other safeguards against manipulation, families, especially those encumbered by soaring medical bills, will take advantage of the law and encourage suicide. Others feel that we are “playing God” and unnaturally interfering with the natural course of life. Many groups, including disability rights activists, believe that death with dignity laws devalue the lives of sick and disabled people who are capable of leading productive and fulfilling lives. These activists are particularly troubled by what they perceive to be euphemistic language—words such as “choice,” “empowerment,” and “self determination”—used by assisted suicide proponents.
The number of people who pursue physician assisted suicide and meet Death with Dignity criteria is actually quite small: last year in Oregon and Washington, just over 200 people filled prescriptions for lethal drugs, and about 2/3 of those people followed through with suicide.
It is unclear which way the Bay State will vote in November. On the one hand, Massachusetts is home to one of the largest Catholic populations in the nation (by some estimates, the state is over 50% Catholic). Catholic Bishops in Massachusetts have denounced Death with Dignity, suggesting that it not only goes against Catholic doctrine but that it also violates the Hippocratic Oath. The Catholic Church teaches “Life is to be nurtured and cherished until natural death. Not self-administered death. Not assisted death.” The Massachusetts Medical Society also opposes the proposal. On the other hand, Massachusetts hosts a long tradition of liberal Democratic politics, and is a bastion of medical education and scientific innovation. Among the 15 originalauthors of the petition are four Harvard Medical School Professors, two former editors of the New England Journal of Medicine, and the executive director of the Massachusetts ACLU.
The fact that so few states have approved Death with Dignity laws is evidence of the highly controversial nature of physician assisted suicide. As expected, the proposed legislation in Massachusetts has inspired emotional reactions from across the nation. But this November, it’s up to the people of Massachusetts to decide: near the end of life, should we have the ability to choose exactly when the time comes?
Katrina Hacker is a summer intern at the Montefiore-Einstein Center for Bioethics. She is a rising senior at Princeton University, where she studies the History of Science. After graduation, she plans to complete a post-baccalaureate pre-med program and attend medical school.