Two years ago, Dr. Roger Kligler needed a walker to travel a short distance from his Falmouth home. Then a loop or two around his cul-de-sac expanded to three or four. Eventually, Kliger was trekking to another neighborhood.
Nowadays, the 70-year-old physician, who was diagnosed with cancer 20 years ago, finds clarity with a meditative two-hour evening walk near a pond and bird sanctuary. Like so many times since Kligler became ill, his health has declined — only to remarkably rebound.
“I should be long dead,” Kligler, who has stage 4 prostate cancer, said Thursday via Zoom.
His experiences as a patient, as well as a doctor, have framed his views on dying. Kligler is the force behind a drive to legalize medically assisted death in Massachusetts. His case, which has stirred passionate debate on both sides, is scheduled to go before the Supreme Judicial Court for oral arguments Wednesday.
Legalization would allow doctors to prescribe lethal amounts of drugs to terminally ill patients who are deemed to have six months or fewer to live. The aim is to help dying patients avoid unbearable suffering, Kligler said.
Opponents of the practice believe doctors who supply dying patients with a fatal dose of drugs should be held accountable under the state’s involuntary manslaughter law. Kligler’s lawyers argue that the doctor doesn’t ultimately cause the death, the patient decides whether to obtain and then take the life-ending drugs.
As an internist, Kligler has seen cancer patients die painful, prolonged deaths. As a son, he watched his mother wither and agonize over 13 months with pancreatic cancer. His father-in-law also endured a losing face-off with the disease.
And as a cancer patient, Kligler has had his prostate removed, and undergone debilitating rounds of radiation treatment, hormone therapy, and immunotherapy.
“Having a good death is more important to me and to many people than having a longer life of suffering,” he said.
Kligler and the advocacy group Compassion & Choices, which pushes for better end-of-life options, in 2016 sued Massachusetts Attorney General Maura Healey and Cape and Islands District Attorney Michael O’Keefe over the constitutional right to die.
In 2019, the Suffolk Superior Court dismissed all but one count on summary judgment, saying patients do not have a constitutional right to end their lives with the help of their doctors. But the court ruled that physicians have the right to counsel patients about end-of-life options.
The terminology that frames the issue is a sign of the controversy’s intensity.
Proponents reject the phrase “physician-assisted suicide” and prefer “medical aid in dying,” saying that terminally ill people are not suicidal but rather seeking more control over their final days. Those who oppose such practices object to “medical aid in dying,” saying that doctors aid dying people all the time without helping them to kill themselves.
Healey contends that physician-assisted suicide is equivalent to involuntary manslaughter and doctors who prescribe lethal amounts of medication should be prosecuted, according to a legal brief filed by her office.
Healey’s office declined to comment Friday. “We are going to let our filing and argument speak for themselves,” a spokeswoman said.
John B. Kelly, director of Second Thoughts Massachusetts, a disability advocacy group that disapproves of medically assisted death and is closely monitoring the Kligler case, fears the process would get abused.
“As long as some people’s lives are seen as less worthy than other people’s, we can’t have a program like this,” Kelly said.
Kligler, a husband of nearly 45 years, father of three, and grandfather of five, doesn’t want to die. He just wants some autonomy over how and when, as his symptoms inevitably become too agonizing to bear.
“No one wins the battle against cancer,” he said. “What they do, is they have treatment and at some point you have to say what’s worse? Death or the treatment that you’re getting.”
Kligler isn’t there yet. Although he has a terminal illness, he would not be eligible for medically assisted death until his physician says he has only six months to live.
“What I wanted was, when I do meet the criteria, to have the option to be able to [access medical aid in dying],” Kligler said. “That’s the question that I asked the courts to consider.”
Courts in Massachusetts and nationwide have been reluctant to decide the debate over legalizing medically assisted death.
Suffolk Superior Court Judge Mary K. Ames deferred action in 2019 when she ruled that the state Legislature, not the courts, should decide the legality of medically assisted death. Healey has said she holds the same position.
Some form of medically assisted death is legal in 10 states — California, Colorado, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont, and Washington ― plus Washington, D.C.
In 2012, Massachusetts voters narrowly defeated a “death with dignity” ballot referendum, which would have allowed terminally ill patients to obtain lethal drugs if they had six months or fewer to live. Opponents outspent supporters by a 5-1 margin. Fierce opposition came from a broad coalition of religious, conservative, and antiabortion activists across the country.
“End of life” bills currently are before the Massachusetts Legislature, but there’s been little appetite, or talk, about moving them in either chamber. Such bills have floundered since voters rejected the ballot question.
In a legal brief in support of a continued ban on medically assisted death, four Catholic bishops from Massachusetts said legalization “would act to lessen the value of human life ... having grave, long-lasting, and far-reaching negative effects for society.”
The issue has been especially thorny for physicians.
The Massachusetts Medical Society took a neutral stance in its legal brief. The American Medical Association, in its code of ethics, reflects the moral tension on the issue. It says “physician assisted suicide is fundamentally inconsistent with the physician’s professional role” but also “articulates the thoughtful moral basis for those who support assisted suicide.”
This isn’t about anybody wanting to die, said Kligler’s lawyer, John Kappos. There would be strict parameters to determine a patient’s eligibility and competency, he said.
“We are talking about people who are seriously medically ill, usually it’s cancer patients, people who have debilitating illnesses,” Kappos said. “They want to live, they wish they didn’t have the illness. They’re just facing the reality of a lot of suffering, as they get down to days and weeks from dying and they want this option as a peace of mind and a way to just feel more comfortable and in control of their final days.”
Kligler has a 69-year-old friend from Gloucester with advanced breast cancer. She exhausted all of her treatment options, he said. She left Massachusetts on Feb. 23 and moved to New Mexico, where it is legal to obtain a lethal amount of medication if life expectancy is six months or fewer.
“It’s horrible that she had to leave home to be able to, you know, die in peace,” Kligler said.
Clarification: This story has been updated to better reflect the American Medical Association’s stance on medically assisted death.