Massachusetts voters will literally face a life-or-death decision when they enter the voting booth Nov. 6: whether to legalize physician-assisted suicide for people with terminal illnesses and a prognosis of six months or fewer to live.
During my long career in television journalism, I frequently covered health issues and now, as an ordained minister in Roxbury, I regularly counsel those who are ill and those who are facing end-of-life decisions.
For those who favor assisted suicide, this is a fundamental matter of choice; for those who are against doctors being able to prescribe lethal doses, the notion of the Commonwealth — and particularly physicians — encouraging suicide, seems counter to basic notions of preserving lives.
Strong feelings aside, here are two simple reasons to vote no on Question 2, regardless of where you stand on the broad concept: First, this particular initiative is deeply flawed and lacks proper safeguards and, second, a ballot question is no way to deal with such a complex and significant issue.
Here are just a few examples of the ballot question's flaws:
■ Patients with a prognosis of six months or fewer to live could choose to end their lives, even though most doctors admit they cannot accurately predict life expectancy.
■ Patients could choose to end their lives without ever talking to a spouse or family member. Supporters of the initiative call it a “compassionate choice” but leaving families in the dark and patients on their own on this profound matter strikes me as anything but compassionate.
■ Patients could obtain the drug without ever being evaluated for depression, a diagnosable and treatable condition that is common among cancer patients. Studies by the National Cancer Institute and others have shown that about a quarter of all cancer patients are depressed; the National Institute of Health estimates that 30-to-50 percent are depressed.
■ Patients could obtain a lethal prescription without talking to hospice and palliative care professionals, who are trained to help people with ongoing diseases (some terminal, some not) to manage their symptoms and minimize pain.
In sum, this proposed law means a patient could receive a suicide prescription at the most vulnerable time in one's adult life, without the knowledge and support of family, friends, or trained professionals. Even for those who are in favor of the idea of assisted suicide in concept, this troubling scenario is reason to reconsider Question 2.
And there are more reasons to oppose this ballot initiative.
Even though it is called "physician-assisted," a doctor is not required to be present when the drug is taken. Further, this ballot question does nothing for the patients we typically associate with profound and unavoidable suffering. Alzheimer's and dementia patients would not qualify because one must be of sound mind to obtain the lethal dose. Patients with ALS, Parkinson's, and other diseases associated with motor skills dysfunction might fail eligibility if they are unable to administer the pills themselves.
Finally, doctors would be put in an extraordinarily unfair position, forced to consider whether to violate their central oath — to do no harm — or to acquiesce to their patients' desire to do the ultimate harm: to take one's life. In part, this is why the Massachusetts Medical Society and the Massachusetts Family Physicians Academy are urging voters to defeat Question 2.
There are better ways to address end-of-life issues. As a start, the Commonwealth should invest more in palliative and hospice care so people can better manage their diseases and alleviate their suffering. And, if we are to consider making assisted suicide the law at all, the Legislature and the executive branches should get the full input of doctors, nurses, public health officials, patients, mental health professionals, religious leaders, and citizens across the Commonwealth — before acting on this most serious of issues.
Given the real life and death issues at stake, a healthy, in-depth discussion is the least we should expect.
Liz Walker isa a television journalist, documentary film producer, and now an ordained minister in the African Methodist Episcopal Church.