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Let’s debate allowing more end-of-life options


Wednesday, January 03, 2018

The Massachusetts Medical Society late last year ended its longstanding opposition to physician-assisted suicide, removing a key obstacle to the End of Life Options Act now being considered by the Legislature.

We urge legislators to move the bill out of the Joint Committee on Public Health early this year for debate. We hope that Massachusetts in 2018 becomes the seventh state in the nation, along with Washington, D.C., that allows doctors to prescribe medication for terminally ill patients who want to end their lives.

The emotionally charged issue, which supporters describe as “death with dignity,” has failed to win approval from Massachusetts legislators or voters in recent years. This is the fifth such bill filed by chief House sponsor, Rep. Louis Kafka, D-Stoughton. His most recent attempt in the last session did not get out of committee in 2016. Voters turned down a death with dignity ballot initiative in 2012 by a margin of 51 percent to 49 percent.

The Massachusetts Medical Society has been a formidable opponent to those past efforts, along with the Catholic Church. The medical society’s switch to a neutral stance is significant because death with dignity legislation was approved in California and Colorado only after similar action was taken by medical groups in those states.

After surveying its members this year, the Massachusetts Medical Society announced Dec. 2 that it had rescinded opposition to “the act of a physician writing a prescription for a lethal dose of medication to be used by an adult with a terminal illness at such time as the patient sees fit.”

At the same time, the society adopted a position of “neutral engagement, which allows the organization to serve as a medical and scientific resource as part of legislative efforts that will support shared decision-making between terminally ill patients and their trusted physicians.”

The society also stated that medical aid in dying should only be allowed by licensed doctors “in conformance with standards of good medical practice and statutory and/or legal authority,” and that physicians should not be required to prescribe lethal doses of medicine if that violates their ethical principles.

The bill in the Massachusetts Legislature, modeled on an Oregon law, would establish specific steps a patient must take before being prescribed lethal medication. They include medical certification of a terminal illness expected to cause death within six months, written and oral requests for the medication that must be approved by two doctors, as well as a psychological examination to determine if the patient is of sound mind. After a 15-day waiting period, the patient would be given the drugs. When — and if — the medication is used is up to the patient.

Roger Kligler, a retired doctor from Falmouth who was diagnosed with prostate cancer in 2002 and told five years later that it was incurable, is among the chief proponents of the End of Life Options Act. In October, he spoke in Northampton about the ethical issues surrounding end-of-life care. “I took care of people at the end of their lives and had many discussions and saw death in many ways at the hospital,” he says. “And I was thinking about me — I didn’t want to lose my license, I didn’t want to go to jail. But that’s not the decision I should be making. I should just be listening to the patient.”

We agree. It is time for Massachusetts to ease that decision-making process — for terminally ill patients and their doctors — by adding to their legal, end-of-life options.