Massachusetts, like most of the United States, has been in a woeful state of denial about the way its medical system handles the end of life. Too often, doctors shy away from frank discussions with terminally ill patients about their options — from continuing treatment, to palliative care, to some combination of both. Worse, society is so scared of such conversations — so conflicted about how far doctors should go in declaring a patient’s condition to be terminal, so reluctant to ever give up hope — that many insurers, including Medicare, don’t even cover the cost of an end-of-life conversation. Instead, they keep plowing money into treatments, while too many lives end in hospital beds, after unnecessarily painful side effects from unsuccessful drugs and devices.
Now, like a clanging wake-up call, comes the Question 2 “death with dignity” ballot initiative, which would establish procedures under which doctors could prescribe life-ending drugs to terminally ill patients. It draws heavily on the experiences of the two states that allow so-called physician-assisted suicide, Oregon and Washington. But it’s not, in itself, an answer to the far deeper question of how to help patients make end-of-life decisions.