From quality of life to end of life, there’s a crying need for policy solutions

Sister Jeanne Arsenault returns to her room after breakfast at St. Chretienne Retirement Residence, a home for Catholic nuns in Marlborough, on Aug. 26.
Sister Jeanne Arsenault returns to her room after breakfast at St. Chretienne Retirement Residence, a home for Catholic nuns in Marlborough, on Aug. 26.Craig F. Walker/Globe Staff

US should be ashamed of its mortality rates — and do something about them

The Globe Spotlight Team’s series “Last words” (Page A1, Sept. 27-29) has identified and described the striking racial and ethnic divide in mortality rates related to the COVID-19 pandemic. Meanwhile, US infant mortality figures are damning, with infants of color dying at a higher rate than white infants.

US mortality rates over the past decade have grown for all people from age 15 to 60, and much more than in any other industrialized country. Even US teens die at higher rates than counterparts in Europe and Asia. Much mortality reflects what economists Anne Case and Angus Deaton have called “deaths of despair,” especially suicide, drug use, and gun violence. But this early mortality also reflects accumulated poor health, leading to obesity and cardiovascular illness as well as poor mental health. Deaths occur much more frequently in Americans without college degrees and in low-income people of color.

When we draw attention to disparities, we must address their causes. While a number of nursing home deaths could have been prevented, as the Spotlight series details, many other deaths reflect decades of poor health and toxic environments, with poor people of color lacking adequate income, housing, nutrition, and health care. Children and youth in other industrialized societies never face such comprehensive threats in such large numbers. It is time to stand up, document these issues, and assure basic rights for all people.


Dr. James M. Perrin


The writer is a professor of pediatrics at Harvard Medical School and associate chair in pediatrics at MassGeneral Hospital for Children.

Not enough housing to meet expanding demand of aging population

As advocates with disabilities, we appreciate the Spotlight Team’s highlighting the COVID-19 death toll at nursing homes in the state, where 1 in 7 residents died, accounting for more than 60 percent of COVID-19 deaths in the Commonwealth. This tragedy is amplified by the fact that your polling in 2019 revealed that “nearly three out of four people would prefer to die at home, but chances of a home death are only one in four.” The pandemic further motivates seniors and people with disabilities to avoid congregate care facilities.


We want the supports and accessible housing that will allow us to live a full life in our communities. Currently, there is not an adequate stock of appropriate housing options to meet the expanding demand of our aging population. This is especially true because our buildings are older than in much of the nation. So it makes little sense that under Massachusetts law, a loophole permits developers to convert large older buildings, such as mills and schools, into housing without making units that can be adapted into accessible apartments.

A bill before the Legislature (H.4425) would ensure that any “gut” rehab of a pre-1991 building converted into more than 20 residential units would make all of its units accessible or adaptable, thus expanding housing options for seniors and people with disabilities. This measure must be enacted into law as soon as possible.

Paul W. Spooner

Executive director

MetroWest Center for Independent Living


Chris Hoeh

Advocacy representative

Greater Boston Chapter of the United Spinal Association

Jamaica Plain

Everyone should have power to make end-of-life decisions

Re: “Is death the great equalizer?”: Bravo to the Globe journalists who researched and wrote this three-part series vividly exposing the economic and ethnic disparities in our health care system. We must eradicate these disparities so that everyone has equal access to the full range of end-of-life care options.


One small but important step toward achieving this goal is to authorize medical aid in dying as an end-of-life care option for every terminally ill, mentally capable adult in Massachusetts. Everyone should be empowered to make end-of-life care decisions based on their unique culture, beliefs, and spiritual values.

In fact, these laws have improved care for many terminally ill people, by spurring doctor-patient conversations about all end-of-life care options, such as hospice and palliative care, and better utilization of them.

Seventy percent of Massachusetts residents support medical aid in dying, according to a November 2019 Boston Globe-Suffolk University poll, including a majority of those across the demographic, geographic, and racial spectrum.

That’s why we request that the Globe endorse the End of Life Options Act and urge the Legislature to pass this measure before the legislative session ends.

Brian Monteiro


The writer is campaign manager for Massachusetts and the New England states with the national organization Compassion & Choices.