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Physician-Assisted Suicide on the Massachusetts Ballot

Marcia Angell (MED’67) delivers BU’s Pike Lecture

| From BU Today | By Rich Barlow

Harvard’s Marcia Angell explains her support for physician-assisted suicide to Bostonia. Photo by Jodi Hilton

Should terminally ill people have the right to end their lives with a doctor’s help? Massachusetts voters will decide next month whether to pass the Death with Dignity Act. If approved, the Bay State will become the fourth state to legalize physician-assisted suicide.

Marcia Angell (MED’67), a senior lecturer in social medicine at Harvard Medical School and a former editor of the New England Journal of Medicine, was the first person to sign the petition putting the issue on the ballot. She explained her support for the law October 15 when she gave the ninth annual Pike Lecture on Health Law at the School of Law. The lecture commemorates N. Neal Pike (LAW’37), a lawyer and activist for people with disabilities.

Oregon passed the nation’s first such law 15 years ago, and both sides point to it to buttress their claims. Among the opponents is Cardinal Sean O’Malley, Roman Catholic archbishop of Boston, who wrote in a recent article that “even proponents of PAS readily acknowledge that modern medicine can manage the pain in almost every case. Very few Oregon residents that request PAS indicate unbearable pain as the reason…”

Angell says that only .2 percent of Oregon deaths, or 1 in 500, have been physician-assisted since that state’s law was passed. She prefers to call it “physician-assisted dying” because “it should be distinguished from the usual suicide, in which someone with a normal life expectancy chooses death over life.” The Massachusetts initiative would allow terminally ill patients who have a prognosis of six months or fewer of life to request a prescription for a lethal drug from a doctor. They would have to make the request twice verbally and then make a written, witnessed request. Two doctors would have to confirm the terminal diagnosis and that the patient was mentally competent to make medical decisions. Doctors would also be required to present patients with alternatives, including pain control. The patient would ingest the drug himself.

The commonwealth of Massachusetts offers a primer on the pros and cons of the ballot initiative here.

Bostonia spoke recently with Angell, an authority on medical ethics and health policy, about the ballot measure.

Bostonia: The Massachusetts Medical Society opposes the measure, saying that physician-assisted suicide is “fundamentally incompatible with the physician’s role as healer.” To what degree is this debate simply one of differing philosophy?

Angell: It seems to me that this argument misses the point in two ways. First, assisted dying is specifically limited to patients for whom “healing” is no longer possible because they are dying of an incurable illness. And second, the focus of the debate should be on the individual patient’s needs and wishes, not on the physician’s self-image.

Does the society’s view represent the majority of Bay State doctors?

There have been no polls of Massachusetts doctors, so we don’t know how they view the Death with Dignity Act. When the issue was debated by the society’s delegates, the decision to oppose the measure was not unanimous. Moreover, since the delegates are self-selected, in the sense that they choose to be politically active within organized medicine, they are probably not representative of the state’s doctors.

The society also says that patients predicted to die within months often live much longer. Is that a valid concern?

The notion that doctors can’t tell whether a patient is dying from a terminal illness is simply wrong, although it’s true that a life expectancy of six months is a statistical average. Such a patient could live for four or five months or for seven or eight. The point is that the patient faces an imminent death and is suffering unbearably. If they could live a few months longer, they would not welcome it. But it is not hard to diagnose terminal illness, such as disseminated cancer or late-stage Lou Gehrig’s disease, and stories that such patients have gone on to live long lives, suddenly relieved of suffering, are like urban myths—undocumented.

What are the negative public health consequences of not allowing assisted suicide?

It would deny patients who are dying in agony the choice of getting medication to die sooner and more peacefully. And it would deny them the control over their own lives that they had exercised when they were healthy. If death is inevitable, why would anyone want to tell someone else that they must go on suffering?

Many doctors decry how the profit motive hurts American medicine. Do critics who worry about insurers subtly or not so subtly pushing suicide as a cheaper alternative to costly treatment have a point?

We have nearly 15 years of experience with this law in Oregon, and there has been no evidence of insurers trying to coerce terminally ill patients to use the law. Moreover, it’s implausible that it would work.

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