Dr. David Clive
Professor of medicine at the University of Massachusetts Medical School; Newton resident
My support for the legalization of medical aid in dying stems from many years of experience as a physician caring for patients with chronic kidney failure, and teaching medical students how to practice compassionate end-of-life care.
Eight states and the District of Columbia to date have legalized this option, and another has implemented it to comply with a court order. With the End of Life Options Act now under consideration by our state lawmakers, I hope Massachusetts soon joins that list.
The bill is modeled on the Oregon Death with Dignity Act, the first statute of its kind in the nation. Data from more than 20 years of implementation in Oregon demonstrate that predictions by opponents of patient coercion and overutilization of the law have been unfounded.
As with Oregon’s law, the Massachusetts legislation is replete with safeguards to ensure the rationality, authenticity, and steadfastness of each patient’s decision to seek the option. The patient must express that decision on two occasions, at least two weeks apart. Two physicians must agree the patient has less than six months to live. A mental health professional must confirm the patient has sound judgment.
Most terminally ill individuals in Oregon do not pursue this option, and about a third of those receiving a prescription never take it. Still, they die having had the comfort of knowing the option existed for them if and when they were ready to exercise it.
Opponents often argue that good palliative and hospice care obviates the need for assisted dying. But my 10 years’ experience as a volunteer hospice physician has taught me that even the highest-quality care cannot alleviate the suffering of some dying patients. Nor can such care prevent the loss of autonomy and control many individuals say is critically important for them at the end of life.
Medical aid in dying can provide patients an option to achieve a planned and peaceful death. To deny anyone that comfort based upon other people’s moral or religious views is simply unfair.
The issue at the heart of the death with dignity debate is one of personal choice. I hope our state legislators will recognize that.
Dr. Laura A. Petrillo
Palliative care physician at Massachusetts General Hospital; Newton resident
Although the United States is in the throes of the greatest health and economic crisis of our era, a bill to legalize physician-assisted death has advanced through the Massachusetts Legislature, drawing on our lawmakers’ valuable time and attention.
As a palliative care physician, I wish we were focused on just about anything to improve care for seriously ill patients and their families besides this polarizing issue.
Even before COVID-19, it was clear our health care system fails people as they die. The 2014 Institute of Medicine report, “Dying in America,” revealed that patients experience fragmented care and that families are the backbone of caregiving, with limited support. Even when patients are insured, health care is expensive, driving people to ration their medications and forcing families into bankruptcy.
There is also enormous societal bias connected with aging that leads to over- and under-treatment of older adults. Ageism in turn exacerbates discrimination on the basis of socioeconomic status, since inequality leads to earlier and greater effects of aging among patients from disadvantaged groups.
Our flawed health care system, steep medical costs, and ageism all contribute to interest in physician-assisted death, which proponents term “death with dignity.” The implicit message is that being sick is pitiful and burdensome. Indeed, in Oregon, where physician-assisted death has been legal since 1997, 59 percent of those who ended their lives in 2019 cited as one reason concern about being a burden to family and friends. In addition, 7.4 percent of patients mentioned financial implications of treatment as a motivating concern.
We have an urgent responsibility to improve the experience of dying so no one feels the only option to maintain their dignity is to hasten their death. In an optimal system some may still make that choice, but we are a long way away from an optimal system, and COVID-19 has only worsened financial strain and stigmatization of older adults as a burden on society. I hope the proposed bill is not adopted and that instead we focus more broadly on fixing our current health care system and providing relief and protection to individuals and families in this time of crisis.
As told to Globe correspondent John Laidler. To suggest a topic, please contact email@example.com.