Nine years ago Massachusetts voters defeated a ballot initiative that would have legalized physician-assisted suicide for the terminally ill. But the campaign to allow doctors to prescribe lethal drugs for dying patients never ended, and bills to overturn the voters’ decision have regularly been introduced in the Legislature. On Oct. 1, the Joint Committee on Public Health held an extended hearing on the current legislation, Bill H.2381, and heard testimony from scores of witnesses on both sides of the issue.
The bill is named the “End of Life Options Act.” Advocates in the past have used other language to describe the practice, including “death with dignity” and “aid in dying.” In the careful language of the American Medical Association, however, “despite its negative connotations, the term ‘physician-assisted suicide’ describes the practice with the greatest precision.” The connotations are negative because assisting suicide, in the view of most AMA members, “is fundamentally incompatible with the physician’s role as healer.”
The controversy over assisted suicide is among the oldest policy disputes in Western medicine. More than 24 centuries ago, a physician taking the Hippocratic Oath vowed to “not give a lethal drug to anyone if I am asked, nor will I advise such a plan.” In that era, as the prominent oncologist, bioethicist, and health care adviser Ezekiel Emanuel has noted, “Physicians commonly provided euthanasia and assisted suicide for ailments ranging from foot infections and gallstones to cancer and senility.” Then as now, there was a strong emotional lure to the belief that doctors should be able to help ailing patients die when they no longer wished to stay alive. Doctors in antiquity who opposed the practice took the oath to solemnize their resolve.
In 1994 Oregon became the first state to legalize assisted suicide, but in the 27 years since then, only a handful of states have followed suit. The practice is still illegal in 40 of the 50 states. It ought to remain illegal in Massachusetts.
The misery of those in their last illness can be heartbreaking, as everyone surely knows. When it is clear that death is no more than weeks or months away, when all that remains is the prospect of pain or the collapse of bodily functions, when none of life’s pleasures are still within reach — when, as both my father and my mother kept saying in the months before they died earlier this year, “this is no way to live” — it may seem to some like an act of compassion to help the profoundly ill do away with themselves.
It isn’t. A civilized society does not encourage depressed or despairing people to kill themselves. It tries to prevent them from doing so, which is why suicide hotlines have counselors on call 24/7. We rightly regard the recent surge in suicides among young Americans as a national calamity. We instinctively recognize that it is monstrous to urge the vulnerable, fearful, or hopeless to take their own lives. There have always been individuals who decided their lives were no longer worth living, but our culture is to see such decisions as tragic and to grieve for them — not to embrace them as a path to dignity or as a prudent solution to the sorrows of old age or sickness.
What people attracted to suicide are most in need of is treatment to relieve their physical or psychological pain, not a prescription for poison with instructions on how to take it. It is impossible to imagine a law that would authorize, say, police officers to supply guns, loaded and cocked, to terminally ill patients who say they want to end their lives and who have signed a written request to that effect. Isn’t a law allowing physicians to do what amounts to the same thing just as grotesque? Procedures for facilitating suicide belong in dystopian sci-fi movies, not in the Commonwealth of Massachusetts.
To cloak suicide in the trappings of health care is a sham. Not surprisingly, falsification is integral to assisted-suicide laws. The measure before the Legislature, for example, specifies that the physician who signs the death certificate after the patient commits suicide “shall list the underlying terminal disease as the cause of death” — a flat violation of the basic standards for certifying deaths. A patient with inoperable lung cancer may have only six weeks to live, but if he dies in a car accident, is murdered in an armed robbery, or jumps from a bridge, his cause of death will not be listed as cancer. Yet if he commits suicide by taking lethal drugs under the provisions of H.2381, his cause of death must be listed as cancer.
Moreover, the bill specifies that committing suicide with the poison pills provided “shall not constitute suicide” for purposes of any insurance policy with a suicide clause (a routine provision that bars a payout if the insured commits suicide within 24 months of buying the policy). The proposed law would thus force insurers to cover a death that had been explicitly excluded by the insurance contract. It also provides that the assisted suicide shall not be referred to as suicide or assisted suicide in any “state regulations, documents, and reports.” If a bill must go to such lengths to camouflage its true nature, perhaps its true nature isn’t a good one.
Reduced to its essence, a law authorizing assisted suicide sends the message that some people — because they are sick, or old, or disabled, or terminal — may be better off dead. To embody such a view in law would be terrible at any time. In an era when so many Americans have been taking their lives, it is downright dangerous. Suicide is now the 10th most frequent cause of death in the United States and the second leading cause among those younger than 35. By legalizing assisted suicide, Beacon Hill, intentionally or not, would be adding credence to the awful conclusion already reached by too many people in mental distress: that suicide is a reasonable solution to life’s most painful problems.
But there is nothing reasonable about assisting suicide. It certainly isn’t health care, and it shouldn’t be allowed in Massachusetts.