Brain cancer patient Brittany Maynard decided to end her life over the weekend with pills prescribed by her doctor in Oregon — one of three states that have “death with dignity” laws — but doctors, medical ethicists, and patient rights activists in the Boston area remain sharply divided over whether doctors should actively participate in patient deaths.
The Massachusetts Medical Society has taken a firm stance against physician-assisted suicide, opposing a 2012 state ballot initiative that would have enabled terminally ill patients to ask their doctors to precribe lethal drugs but ultimately failed to pass by a slim margin. Sixty-five percent of New England Journal of Medicine readers, comprised of doctors, nurses, and other medical professionals, who responded to an online poll last year said they opposed such laws. The American Medical Association takes the position that prescribing lethal drugs is “fundamentally incompatible with the physician’s role as healer.”
But those views could shift if the public begins to call more strongly for such laws fueled by sympathy for 29-year-old Maynard, who became famous after online videos she posted last month went viral.
Support for a physician-assisted death law has grown to over 70 percent in Massachusetts, according to Compassion & Choices, a group that has been trying to pass aid-in-dying bills in Massachusetts and elsewhere. Legislation has been languishing in the state’s Joint Committee on Public Health, but it could get new momentum with Brittany Maynard in the spotlight.
“I think there’s a subtle change that’s occurring now where people see this is all about patients, rather than doctors,” said Dr. Marcia Angell. a senior lecturer in social medicine at Harvard Medical School and a former editor-in-chief of the New England Journal of Medicine. Her own husband, Dr. Arnold Relman, died at their Massachusetts home last June of metastatic cancer to his brain after doctors refused his request for drugs that would allow him to take his own life before he lost his mental capabilities.
“One of the things Brittany Maynard has done is bring this problem to the attention of young people because she was young and attractive, and not the usual person dying of cancer,” said Angell, who supported the Massachusetts ballot initiative.
Dr. Lachlan Forrow, director of ethics programs and palliative care programs at Beth Israel Deaconess Medical Center, said he voted no on the ballot initiative and continues to oppose death-with-dignity laws until pain management programs have been improved throughout the state. “My position is that we need to make sure patients aren’t choosing to kill themselves because they don’t have access to options to help them manage their pain, such as hospice or palliative care,” he said.
A 2012 Massachusetts state law that would require hospitals and long-term care facilities to inform patients about pain management programs has not yet been implemented because the state Health Department still has not issued final regulations on the new legislation.
Elder abuse has also been raised as a concern among some patients’ rights advocates who oppose physician-assisted deaths. “What starts as a choice by an individual can all too easily become a duty to die quickly if people feel like they’re a financial or emotional burden on their family,” said John Kelly, New England regional director of Not Dead Yet, a non-profit disability rights organization. “Not every family is loving, and some caregivers leave patients with few options on how they should proceed with their treatment.” Doctors, he added, can sometimes err in determining whether patients are indeed terminal — meaning they have less than six months to live.
Dr. Lisa Lehmann, head of the Center for Bioethics at Brigham and Women’s Hospital, said she would not be surprised if Maynard triggers a “ground swell of support for assisted suicide in much the same way that younger Americans are very open to the legalization of gay marriage.” But she added that she has “serious concerns about both physician involvement in the process and the legalization of assisted suicide.”
Lehmann said she’d like to see better safeguards on laws before supporting them. For example, the one on the Massachusetts ballot did not require a psychiatric consultation to assess if terminally ill patients had a potentially treatable depression before doctors prescribed them lethal medications.
“I do believe we should respect an individual’s seriously considered decision about how and when to end their life, but I don’t think we should entangle the medical profession in the process,” she said.
Angell, on the other hand, said doctors are making “way too much of this,” likening assisted dying with lethal drugs to ending medical interventions like feeding tubes and ventilators at a patient’s request — which is legal in all states. “In 30 years, this will be seen in the same way as ending life-sustaining treatment, which we now take for granted.”