Ideas

EDITORIAL

As doctors rethink assisted dying, Mass. should too

Waltham, MA -- 12/2/2016 - Dr. Roger Kligler testifies in front of the Mass Medical Society as during a hearing to ask the Society to consider conducting a Medical Aid-in-Dying Survey as Dr. Barbara Rockett looks on. (Jessica Rinaldi/Globe Staff) Topic: Death Reporter: Patricia Wen

JESSICA RINALDI/GLOBE STAFF/FILE

Dr. Roger Kligler testified last month in front of the Massachusetts Medical Society.

FIVE YEARS AGO, the Massachusetts Medical Society helped defeat a “death with dignity” ballot measure that would have allowed terminally ill patients to end their lives with medication prescribed by physicians. Now, the doctors’ group is carefully reexamining its long-held position on the issue. The rest of the state would be wise to follow its lead.

Last month, the society’s policy-making body voted to authorize a survey of members’ attitudes toward “medical aid in dying.”

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A poll may seem a small step. But it’s actually a significant one. Similar surveys in Colorado and Maryland helped steer medical societies in those states toward a neutral position on the issue. And in Colorado, that neutrality played a role in voter approval of a physician-assisted dying ballot measure in November.

Massachusetts doctors are not Colorado doctors. And they may, in the end, declare their opposition to the idea. If they do, policy makers and voters should take that opposition seriously. But all signs are pointing toward an evolution on the issue.

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A national doctors’ survey by Medscape, an online news site, showed 46 percent supported physician-assisted dying policies in 2010. By 2014, the figure was at 54 percent. And last fall, 57 percent were in support, with just 29 percent opposed and 14 percent saying “it depends.”

Polls also show public support for physician-assisted dying. And several state legislatures are considering bills to allow it. It’s hard to say what, precisely, is driving the reexamination. The accumulation of surveys by itself seems to be generating momentum — suggesting that more doctors are open to the idea than expected.

Dr. James Gessner, president of the Massachusetts Medical Society, argues that it’s part of a broader realization that end-of-life issues require more attention, from palliative care to patient declarations of end-of-life wishes.

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But the stories of individual patients have also played a role. A few years ago, Brittany Maynard, a young California woman with brain cancer, made compelling online videos that won millions of views and thrust her story into the national media. And here in Massachusetts, Roger Kligler, a retired Falmouth
physician with metastatic prostate cancer, has emerged as a key spokesman. Before his own diagnosis, he says, he would decline to help patients who wanted aid in dying, worried about the professional and legal ramifications. Now he calls that decision selfish.

“As a physician, you’re supposed to put your patients first,” Kligler says. “And in this case, I can’t say that I did. Their need was clear. They’re saying, ‘I’m suffering,’ and I’m saying, ‘Well, no, you’re not suffering enough.’ ”

Assisted death, Kligler says, can be “more beautiful than traumatic.” And he wants the chance to choose beautiful when the time comes.

The testimony of Kligler and Maynard, however
eloquent, does not erase the difficult ethical issues
involved with a doctor helping a patient take his or her own life. And a reasonable argument can be made that the focus on “death with dignity” distracts from the larger task of improving a flawed system for end-of-life care.

A state study released this fall showed that nearly one in four Massachusetts residents dies in a hospital — suggesting a hesitation, by the medical establishment, to refer patientsto hospice or palliative care. The same study showed that the state ranks last in the country for the number of days residents spend in their homes during their final six months of life.

There are national problems to tackle, too. Under Medicare rules, for instance, a patient must give up
curative care before entering hospice — a decision that can be difficult to make. The federal government, though, has launched a pilot allowing patients to
receive curative and hospice care at the same time. It has also begun paying for doctor-patient conversations about end-of-life care.

Those measures alone will not fix the system. But they make it clear that policy makers can work on pieces of the bigger end-of-life problem, even amid the divisive debate over the narrower issue of physician-assisted dying. That debate, difficult as it may be, should move forward. Give Massachusetts doctors credit for nudging it ahead.

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