Eight years ago, Massachusetts voters defeated a proposal to allow terminally ill patients to end their lives on their own terms, as opposed to in the excruciating pain and indignity that can mark their last days. Then, as now, whether to allow what has been called “death with dignity” raises profound ethical and moral questions, and seemingly pits two cherished principles against each other — that society ought to respect life, and that it ought to ease suffering and respect individual autonomy.
Now the state Legislature is tiptoeing back into this emotionally charged debate, considering a new proposal that would do what voters did not: allow medical aid-in-dying for some terminally ill patients. A bill to legalize the practice is now before the Committee on Health Care Financing. While there remain sincere and valid objections to the very idea, the bill deserves passage — and then vigorous oversight.
Although legislators should always be reluctant to go against the will of the voters, the fact is that much has changed since 2012. The Massachusetts Medical Society, which then led the fight against aid-in-dying on ethical grounds, has shifted its stance on the issue; it is now officially neutral. The proposal itself is also different, adding a requirement that patients undergo a mental health evaluation. And social attitudes appear to be shifting: Nearly 7 out of 10 Massachusetts residents are in favor of medical aid-in-dying, according to a Boston Globe-Suffolk University poll last year.
The bill, one of the strictest proposed in the country, requires that qualifying patients must have a terminal illness that would result in death within six months, a prognosis that must be confirmed by two doctors. They must make the request themselves, first verbally and a second time in writing before two witnesses, including one who is not a relative and does not work for the health care facility involved. And — the new safeguard — they must undergo a mental health evaluation by a licensed professional to determine they are mentally sound and not suffering from psychiatric or psychological conditions that may affect their judgment. Of the nine other states that have legalized medical aid-in-dying, only Hawaii requires a similar mental health evaluation. Patients who qualify would be provided with self-administered, lethal drugs.
What’s also new is that there is additional evidence suggesting that the very existence of aid-in-dying laws may act as a catalyst for more and broader end-of-life conversations between doctors and patients in general. Researchers looking at hospice use rates in several states noted Oregon’s high rate of hospice use and concluded in a 2015 study that “it is possible that the Oregon Death with Dignity Act has resulted in or at least reflects more open conversation and careful evaluation of end-of-life options” and “more appropriate palliative care training of physicians.” The same seems to be happening in California. Only a tiny number of patients actually make use of aid-in-dying laws — the option accounts for fewer than 1 percent of deaths in Oregon — but it may be prodding a much-needed focus on end-of-life care.
Nor have the greatest fears of opponents materialized. In the two decades since Oregon became the first state to legalize the practice, there have been no complaints or cases of coercion or abuse of the law reported there. Still, if the bill passes in Massachusetts, authorities should remain vigilant.
Opponents of the legislation make impassioned arguments. They insist that all dying patients who would qualify for these measures are, by definition, disabled people, and by allowing this subset of disabled patients to end their lives the Legislature would be reinforcing a “better dead than disabled” mentality. They also argue that these measures legalize assisted suicide and, as such, are discriminatory because the subset of qualifying people with disabilities is being treated in a different way when it comes to suicide prevention care and services. Lastly, opponents point to racial and ethnic disparities among the patients who have used these laws — who have been overwhelmingly white — and argue that these measures are being pushed by a small but privileged demographic who feel a loss of dignity when they’re dying.
The racial disparities are real, but they likely reflect, in at least some measure, existing inequities in access to health care in general. In an ideal world, those inequities would be resolved. But progress solving one social problem shouldn’t be halted by the failure to solve another.
Opponents from the disability rights community ultimately worry that measures that legalize physician-assisted death cheapen life. Sincere religious opposition also remains as strong as it was in 2012. But to relieve the suffering of those terminally ill patients who want it, a strictly regulated aid-in-dying system would be a humane step forward. It would still leave it up to individuals to choose whether it fits their own sense of morality to use it.
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