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Having the choice to die matters

For most of us, Question 2 is personal.

We see this ballot measure — which would allow some gravely ill people to get medication with which to end their lives — through the lens of our own experience. Here is a husband whose wife's passing was far more drawn out, and difficult, than she wanted. He will vote yes. Here is a wife who saw her terminally ill husband live far longer, and with more fulfillment, than doctors predicted. She will vote no.

My spectacular mother was recently diagnosed with Alzheimer's, which claimed her mother. She knows what is coming, how awful this is going to be. After she forgets how to cook, and who we are, she will lose her ability to speak, to walk, to eat — gone from herself long before she is gone from the world. And so, even though this law wouldn't apply to her, the idea of gaining some control over an impending death appeals to me with far more immediacy now. I will vote yes.

The proposal on Tuesday's ballot would affect a very small group of people: those who are terminally ill and are expected to live six months or less. They must be competent to make their own decisions, and make three separate requests for the lethal dose of medication. So, people with Alzheimer's wouldn't have access to it. They must also be able to swallow the drug. Which means many with ALS couldn't self-administer the medication.


In Oregon, where an almost identical law was approved 15 years ago, the Death With Dignity Act accounts for a tiny fraction of deaths. Last year, 114 of the patients who requested the lethal dose received it, and 71 of those used it to end their lives. Most were dying from untreatable cancers.


Some opponents of Question 2 believe people should never be allowed to end their own lives, and would oppose the law no matter how it was written. I respect their views. I simply don't believe they have a right to impose them on those who don't share them.

Some advocates for people with disabilities object to the law because they say it devalues their lives, equating profound disability with a life no longer worth living. That's a huge stretch: The choice here isn't between life and death. It's about choosing the manner and timing of a death that is coming soon anyway. That's not to say people who have been given six months or less to live can't have fulfilled lives, or defy their grim prognoses. But those people are unlikely to exercise this option.

Opponents also say the law could be abused by selfish relatives who would push loved ones into ending their lives sooner, but there's been no evidence of that in 15 years in Oregon. They say some patients would end their own lives because they're depressed and not thinking straight. But the law would require that a doctor who believes a patient's judgment is impaired refer them for a mental evaluation. A study shows only 1 in 6 requests for the pills are granted in Oregon.

"Fundamentally, this is a personal decision," says Marcia Angell, a senior lecturer at Harvard Medical School, and the measure's lead sponsor. "Nobody should presume to tell a dying patient they must suffer some more."


Angell knows this better than most. In 1988, her father's prostate cancer spread. In hospice care, unable to do the things that gave his life meaning, he took a gun from his bedside table and shot himself. "If he had been able to get them, those pills would have been on his bedside table," Angell says, "and my mother wouldn't have had the awful shock of finding his body."

Using those pills to hasten the end wouldn't be everybody's choice. I don't know if it would be my mother's. Or mine. But it's a choice we should have.

Yvonne Abraham is a Globe columnist. She can be reached at abraham@globe.com.