Question 2 asks voters to decide on right-to-die
Massachusetts ballot Question 2 asks voters to approve or nix legislation that would allow terminally ill patients to end their own lives legally with a lethal dose of medication. Purchase photo reprints »
Called “death with dignity” by its supporters and “physician-assisted suicide” by its opponents, a yes vote on Question 2 would allow Massachusetts doctors to prescribe lethal medication to terminally-ill patients.
In order to qualify for the medication, the patient must be a Massachusetts resident with a terminal diagnosis of six months or less. The medication is ingested orally by the patient — typically by breaking about 100 Secobarbital pill capsules and letting them dissolve into a glass of water.
If the question is approved, Massachusetts would become the third state to adopt a Death With Dignity Act. A similar law has existed in Oregon since 1997 and in Washington for the past four years.
In 2011, 165 people from the two states died from the medication, with 52 others receiving prescriptions but ultimately deciding not to ingest it. In the history of both acts, 837 people have ingested medication — roughly 70 percent of the 1,190 total prescriptions.
“People all around the country are watching to see what happens here,” said Terry Gaberson, executive director of Hospice of Franklin County. “Americans don’t easily discuss matters related to end of life. … This legislation is loaded with issues related to belief systems, morals, religious and political issues and the emotions of grief and loss.”
For Death With Dignity supporters, the question is about providing a basic human right for suffering individuals to choose the manner of their death.
“It’s an issue of giving the terminally-ill patient the control over their lives,” said Randee Laikind, a Shelburne Falls resident who helped found Hampshire County Hospice in the late 1970s.
“When I’ve worked with dying patients, they seem to reach a point where they make that decision,” she said. “It’s a deeper level of pain or tiredness. They reach a point where it’s like, ‘OK, I’m here now. I’m at this point.’”
But opponents of the act — a group that includes the Hospice and Palliative Care Federation of Massachusetts, the Massachusetts Medical Society, the Western Massachusetts Pharmacists Association and a coalition of religious organizations, among others — say it will cause more harm than good.
They argue that there are flaws in the legislation and a lack of proper patient protections. With this new freedom to choose end-of-life medication, they fear the dying patient will not thoroughly consider his or her alternative options.
A debate over safeguards
Supporters and opponents have focused their debate on the language of the ballot question — specifically if the act’s safeguards are strong enough to protect the patient’s best interests.
When giving a patient news of the terminal diagnosis, a physician must let the patient know about alternative end-of-life treatments and programs, including hospice care. The doctor will also advise the patient to contact family members for help in making an end-of-life decision.
Before a patient can receive lethal medication, the law requires a second doctor to confirm the terminal diagnosis. Opponents, including some medical officials, said that even with this safeguard, it is impossible to always be accurate with medical diagnoses.
Both doctors must also make sure that the patient is mentally capable of making an informed decision about how to die.
After orally requesting the prescription, the patient must wait 15 days before making a written request and second oral request to his or her physician. The written request is then signed by two witnesses — one of whom must not be a relative, beneficiary or health care provider of the patient.
Supporters of the question believe the proposed law protects the dying patient’s rights while also preventing abuses in the system. The presence of the second non-affiliated witness prevents people from coercing a patient to make a decision in order to obtain inheritance earlier.
But even more than possible abuse, opponents are mostly concerned that a patient’s judgment will be clouded and lead them to make a terrible mistake.
They argue that a patient will become depressed when learning about the terminal diagnosis. And in their despair and loneliness — without a required psychiatric evaluation, hospital consultation or contact with family members — that person may make a rash decision to end his or her life, opponents said.
“A person can get a lethal prescription without ever having talked to a mental health professional,” said Mark Horan, spokesman for the Committee Against Physician Assisted Suicide.
“There’s a difference between being down and sad and actually being clinically depressed and having thought patterns distorted and not being able to see any hope in the real world,” he said. “When they are vulnerable and have the means to commit suicide, they sometimes act on that.”
According to the Oregon and Washington departments of public health, 6 percent of the people who ingested the lethal medication were referred for psychiatric evaluations.
Joel Feinman, president of the local Valley Medical Group, said he believes that as long as a person does not have a psychiatric history, an evaluation is not necessary.
“Death happens to everyone, it’s not a psychiatric condition,” he said. “I don’t think it’s a psychiatric matter as much as it’s a human matter. ... Being involved in a relationship with a wise doctor is probably more than enough.”
A dignified death
The issue has divided those in the medical community — some of whom believe that prescribing lethal medication is a direct violation of their oath to always protect the lives of their patients.
Others argue that their job to relieve patients’ suffering includes respecting the individual’s end-of-life decision.
“It’s a personal choice and I don’t think anyone has the right to tell you how you want to die,” said Donna Stern, a psychiatric nurse at Baystate Franklin Medical Center.
“If they want to have every known medication and life support system attached to them to keep them alive ... I respect that choice,” she said. “But if someone says, ‘You know what, I don’t want to be hooked up to tubes and be given all these medications and go through incredibly difficult treatments’ ... that’s their choice.”
But with palliative care options like hospice — and with the ability to clarify future medical intentions through wills and health proxies — there are already ways to ensure that a person dies with dignity, said Richard Aghababian, president of the Massachusetts Medical Society.
“In most cases you should know if your disease is likely to be terminal (and) you should have a family doctor for a while who knows your wishes who connects you with hospice and palliative care,” he said. “We should have the care teams that have been caring for the patient involved in coordinating this, not someone from outside.”
Gaberson said her hospice organization can provide end-of-life support and pain relief in ways not a lot of people are aware of.
“We often see a shift to people who want to live as opposed to people who are just waiting to die, because of the support and the dignity that they find in their lives again when they’re not overwhelmed,” she said.
Still, some argue that at times even hospice isn’t enough to stop the suffering.
According to the states’ departments of public health, about 80 percent of Washington patients and 90 percent of Oregon patients were enrolled in hospice care when they ingested the lethal medication.
Ed Porter, executive director of United Arc, said he can never thank hospice enough for the end-of-life care they provided for his wife, Sharon Lea Porter, in 1998.
But even with hospice care, the end of his wife’s three-year battle with metastatic breast cancer was anything but pain-free.
“The pleasant deathbed scene was not part of my experience,” he said. “It was god awful. It was hideous.”
Porter, who was speaking on his own and not as a spokesman for the Arc, said he will never know for sure what his wife would have done had she been given the option to end her suffering on her own terms.
“I don’t know what the decision would have been,” he said, “but I know I would have totally supported her.”
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