Congratulations on a courageous stand on an important issue. Your words are infused with the wisdom that can only come from having struggled with this decision in real life. This decision is too complex to be decided by a ballot question.

None of these arguments stand up to much scrutiny. 1. Although occasionally doctors are wrong about prognosis, they are usually right and there are many patients for whom prognosis is quite certain. The standard is "reasonable medical certainty", not absolute certainty. 2. Yes, patients could choose to end their lives without talking to family. But that's a choice--maybe a choice you and I wouldn't make, but a choice nonetheless. Should we force people to consult their families about all their health care choices? In Oregon, more than 95% of patients do notify and involve family. 3. Patients cannot obtain the drug without being evaluated for depression. The two physicians who must be involved are mandated by the law to evaluate for depression or other psychiatric conditions, and to refer for counseling if appropriate. You may wish that the law mandated that a psychiatrist do the evaluating, but this is an unreasonable hurdle. Non-psychiatrist physicians are capable of 'evaluating for depression'--we do it all the time. 4. Patients can obtain the drug without talking to pain/palliative care professionals, it's true, but the law mandates that they be offered this as an option. 5. The fact that patients with dementia would not qualify should reassure you if you're concerned about vulnerable patients--it's hardly an argument against the bill. 6. Do you really think it's unfair to make doctors contemplate--just contemplate--participating? The law is clear in stating that no physician will be required to participate. 7. The principle of "do no harm" means that we should not do more harm than good. If it literally meant never do any harm, we could never use medications with harmful side effects (e.g. chemotherapy). In practice, the principle is really "do no [net] harm" or "do more good than harm". And from the perspective of a dying patient who wants control over the manner and timing of their death, this bill is a net good.

First you have an issue that many people think is important. Proponents try lobbying the legislature, sometimes for years, and when that fails, they use our initiative petition process. Then opponents say that the issue may have some validity but the ballot question is flawed and/or ballot questions are no way to decide complicated issues. Sometimes the only way to get something done is for the voters to demand it, in the only way available to them.

Dear Liz, Let's try not to be sensationalist. To say "physicians — encouraging suicide", it's doubtful that would happen. And regarding "There are better ways to address end-of-life issues. As a start, the Commonwealth should.... ". Well the Commonwealth hasn't! Why hasn't the Commonwealth done anything. Why has this come down to a ballot question?

Interesting - the reasons you cite are the very reasons why I intend to vote for it. Why should I(or anyone else) have to vet such a personal decision with anyone - especially not clergy, hospice workers or other quacks.

Even more problems with this bill: doctors are unable to diagnose depression, and almost no one gets referred for psychological consultation. In the last two years in Oregon, 2/136 people were referred.

If you get a no from your own Dr., you just go doctor shopping. So much for a carefully decided decision "between you and your doctor."

This is a social policy for EVERYONE in the state. 19,000 Massachusetts elders are abused, most frequently by their spouse or an adult child, who is often also a caregiver. With no witness required, with the pills in the house, there is no way to prevent foul play, and maybe even worse, no way to find out about it. Last year, 80% of Oregon's suicides had no medical professional at the death.

An heir, someone who is in line to inherit money, can help sign you up, go pick up the pills at the pharmacy, and bring them home. The law takes no interest in the drugs after they leave the pharmacy.

And before we start legislating "Death with Dignity," first can we at least have a discussion about what "dignity" is?

For more information, and why local and national disability rights organizations are opposed to Question 2, please visit www.second-thoughts.org

It's a personal choice issue. If you want out, who am I to tell you can't go? True there are some loose "regulatory" ends in this legislation but those can get cleared up after it passes. I'd rather regret the peaceful passing of a person than regret a potentially traumatic one that may unwittingly involve others.

This is the same poor rational the religous right uses to try to ban abortion. There is a difference between giving some the right to do somthing and actually going through with it. No one is telling liz she needs to engage in this activity, but the government should not prohibit it. Get back to reading the tele-prompter and stop telling others how to live and vote.

There are many complex issues that should not be decided by popular vote. This is another one of those issues that should be deliberated in the legislature, not the voting booth.

In principle, Liz has some good points. The law as written requires a lot of good faith on the part of those involved in facilitating the person in question. I remember the coroner from L.A. commenting last year that all deaths should be autopsied because he is quite sure that many helpless seniors are murdered every year. BUT:

1. I fear that a comprehensive law that covers all situations would be far too complex - and burdensome - to administer. People struggling to interpret such laws tend to get confused and discouraged pretty fast. I think it says a lot that your critique does not include an alternative to the proposed law. 

2. Furthermore, a cleverly written complex law that would appear to cover all situations would still leave many murders undiscovered even with autopsies because they leave no trace for coroners to find. Recognizing this truth is not pleasant, but constructing unenforceable laws won't solve a problem that in fact already exists - as the L.A. coroner no doubt knows. 

I think it's highly doubtful we could write an airtight law that would eliminate foul play. After all, the many knowledgeable Oregonians evidently couldn't, so why should we think we are any different. If you and others think it's possible, a logical way to start would be to ask the Oregonians who spent several long years trying to fashion a law that solves the problems you raise. After all, they are known to be at least as logical and educated as the people of this state. 

Sometimes we have to rely on the good will of people, and while people may have moral lapses, I think it's safe to say that most people recoil in horror at the thought of actually murdering someone. The major exception, of course, is the psychopath, thought to be about 1% of the population. But no law, no matter how comprehensive or complex, could stop those who have murder in their hearts.

I applaud Liz Walker's article. As a physician who takes care of many patients near the end of life, and a Democrat, I am deeply concerned about the implications of Question 2, on multiple levels: too many to discuss in a brief comment. I would plead with voters, however, to consider this question carefully, and not to vote based on prejudice, knee-jerk reaction, or propaganda. Two points I must make: 1. Some of the strongest opposition to Question 2 has come, not from religious groups, but from disability rights activists. I urge everyone, before voting, to investigate what makes these forward-thinking individuals so concerned. 2. Question 2 is NOT about increasing patients' rights, or choices. Roughly 40,000 people commit suicide every year in the US: there is clearly no need for new legislation to increase the ease or accessibility of suicide. Question 2 is, rather, about giving new power to doctors - and protecting them from any repercussions of using (or abusing) that power. Read the full text of the question (http://www.sec.state.ma.us/ele/ele12/ballot_questions_12/full_text.htm#two). Pay attention to the end matter, e.g., sections 18 and 19: to the provision, for instance, that a doctor who actively coerces a patient to kill him or herself faces a maximum sentence of only 3 years in prison... or a one thousand dollar fine.

I believe that people have a right to make this decision with the input of their doctor and loved ones. This proposed law, however, does not have enough safeguards. To give someone a script for a bunch of pills and send them on their way is irresponsible.

I guess there could be abuses of this right, but there are certainly abuses now on the opposite end of the spectrum, that is, the system we  have now. There are many people who would prefer to end their lives when they become irreversibly ill, but are subjected to "heroic" efforts and/or machines because of their relatives' needs, desires, or guilt.

But how does it actually work now? My Dad was in hospice at age 90 for the better part of 18 months. Despite his terminal lung cancer, for which he wanted no further treatment, he was at home and had a pretty good quality of life...until he didn't. He didn't want to live that way. Yeah, sure he was depressed...wouldn't you be? He also, I might add, was not religious--if anything, he was a principled atheist. When he lapsed into unconsciousness, his breathing soon became compromised and I was instructed by the nurse to administer more morphine so he wouldn't have to thrash about and struggle for breadth. (In the old days, they used to tie you down to the bed). The morphine makes breathing easier...but it also, in higher does,  eventually kills you. Everyone knows this. The family member does this, without the nurse present. It's all hush-hush, but it is the humane thing, and it was in-liine with my father's living will. Was this wrong...or should we have allowed him the dignity of thrashing? Perhaps this treatment saved my unconscious father a week of suffering. Let's acknowledge the reality of things. Adults have a right to make decisions about their lives. Let the legislation be improved and the loopholes closed after this referendum pasees. Liz Walker raises some good points, but the process she suggests will lead nowhere but to paralyzing inaction and endless contemplation.

Bravo, Liz Walker! We can certainly debate the issue of whether terminally ill patients ought to be at liberty to end their lives; but this is quite a different matter than putting physicians in the position of providing poison (termed, "lethal medication doses") to such patients. Stripped of the comforting euphemism of "death with dignity", Question 2 proposes that physicians ought to be active participants in ending their patients' lives. This undermines both the physician's role as healer, and the implicit ethical contract between the physician and society.

Ronald Pies MD

In the last days that my dad was ambulatory, without knowing was lay ahead, only that his quality of life was dialing down, given his idea of what a meaningful life was--and this after a year of suffering through chemo and radiation--he popped the question at the kitchen table: how does a person commits suicide? What would you have had me tell him? Hang in there Dad? Suicide would be upsetting to us even though it is your choice? The man could no longer go out.He couldn't read. Couldn't watch TV. Appetite gone. More and more tired. Pretty soon he would be in diapers. As it turned out, his deterioration accelerated to the point where this issue became moot. But what would you have had me tell him? Didn't he have a right to go out his his own terms? Make his last autonomous decision? After advising us on that, in a way that also applies to those who might not even be receiving the quality of at-home hospice care my father had, please advise on how the law has worked in Oregon. I have heard it has worked well, and all the scare stories did not materialize. Thanks.

Mind your own business, Liz. I want the option. Don't tell me what I should or shouldn't do when I'm not harming you or anyone else.

I'm pretty sick of busy bodies trying to tell EVERYONE what THEY think is best and then trying to enforce it by law.

Since we have freedom of religion, I'd strong prefer that you keep your religion out of my life.

In the last six years both my mother and my father died long, slow, painful deaths from cancer. During the last several months of their lives, the hospice care teams suggested we "use a litte more morphine" to help them feel better, though the morphine barely touched their pain. Their bodies wasted away, and they both lost the ability to communicate with their family about one month before they passed. Finally, during the last ten days of their lives, they could not eat or drink.

Why do we make people like my parents suffer like that? What gives us the right to say "this is what God wants"?