By Bill Kirk
---- — One doctor calls it “dangerous” and “misguided” and says it should be rejected.
Another says it’s all about the personal rights of patients, and should be embraced.
On election day Nov. 6, Massachusetts voters will decide who is correct.
Ballot question 2, entitled “Prescribing Medication to End Life,” would allow someone with a terminal illness to request medication that would end their life.
At six pages long, the law would go into effect in Jan. 1, 2013, if voters approve it. And it would make Massachusetts just the third state in the nation to have a so-called “physician-assisted suicide,” or “death with dignity” law, on the books.
But many physicians and physicians’ groups, as well as most religious organizations, say the law as written is full of holes, is unethical, and would lead to exploitation of poor people.
“They call it physician-assisted suicide, and every physicians’ society is opposed to it,” said Lawrence doctor, Joseph Gravel, president of the Massachusetts Academy of Family Physicians, which is one of a dozen or so medical groups against the ballot question. “People who put this forth may be well-intentioned, but they are also misguided.”
He said the law doesn’t include adequate safeguards to ensure it’s not abused by insurance companies looking to cut costs. And it doesn’t protect poor people suffering from a terminal disease who may want to end their lives rather than be a financial burden to their families.
Proponents, however, say the ballot question would provide relief for suffering patients and their families and has plenty of safeguards in place. Moreover, they say, physicians have been helping ailing patients die for years using morphine.
“There’s a lot of alarmist stuff out there,” said Dr. Paul Spiers, PhD., a neuropsychologist in Danvers who serves on the
faculty of the Boston University School of Medicine. “This has been the law in Oregon for 15 years, and there’s been no slippery slope” of abuse of the law.
He noted that people who use the law “have to be terminal” and their request for life-ending medication “has to be corroborated by two physicians.” He added, “there are 13 safeguards built into the law, the same as in Oregon and Washington.”
Modeled after laws in those two Northwest states, Ballot Question 2 requires a person with a terminal disease to make a request to a doctor that their life be ended. The law would require the patient be deemed mentally competent and be diagnosed by “attending and consulting physicians” as having an “incurable, irreversible disease” that will cause death within six months.
The patient would have to “orally communicate to a physician on two occasions, 15 days apart” the request for the medication, while also being granted an opportunity to rescind the request. There are other measures as well in the law, set up to insure that the patient knows the alternatives to an assisted suicide; and making it illegal to coerce a patient or forge a request.
Despite these and other guidelines, there is still significant opposition to the proposal. The Catholic Church has come out against it, as have leaders in the Jewish community.
Rabbi Robert Goldstein, of Temple Emanuel in Andover, said he can see both sides of the argument, but that “most of my rabbinic colleagues are opposed to Question 2.”
Reform Jewish rabbis and cantors in the Commonwealth of Massachusetts issued a statement, signed by rabbis from all over the state, opposing the measure because “it opens the possibility of misuse which may endanger certain patients; that prognoses of terminal illnesses are often mistaken; that the physician-patient relationship may become confused through permitting assisted suicide.”
Goldstein said he did not sign the statement..
“The fact that I’m not opposed to it is controversial, even though I haven’t supported it, either,” he said. “I’m kind of a libertarian on these issues.”
He said one reason many oppose the law is because it “intrudes on the sacred relationship between doctor and patient.” He went on to note that “Jewish law prohibits you from killing someone, so assisted suicide is contrary to Jewish law."
However, he added, “I don’t think of it that way. I think of it as a physician having the prerogative to increase pain-killing drugs.”
He noted that in many cases, particularly with cancer patients suffering from a lot of pain, physicians will increase morphine levels for a patient, knowing that the patient will die more quickly.
“Isn’t that the same thing?” he asked. “You’re not killing patients, you’re bringing them relief.”
Dr. Gravel, who works at the Greater Lawrence Family Health Center in Lawrence, agreed with Goldstein that the ballot question intrudes on the relationship between doctor and patient, but disagreed that giving morphine is the same as writing a prescription for a drug that is designed to bring death to a person.
“If death is a side-effect of pain medication, that’s not what we’re talking about,” he said. “That’s adequate and appropriate medical practice.”
He said palliative care, or taking care of people at the end of their life, is “way too nuanced and complex a topic for a simple ‘yes’ or ‘no’ answer on the ballot.” He said that when people go to vote on it, most of them won’t even have read the entire law.
“It opens up issues of trust about what a physician’s responsibility is to the patient,” he said. “Physicians are increasingly employed by organizations that may be financially stressed, so even if the physician is looking at the best interests of the patient, there will be some patients who will be concerned, and ask, is their physician trying to save money by being a conduit to this?
"A hospital or organization could literally benefit by someone dying rather than having very expensive end of life care,” he said. He noted that end-of-life care is extremely costly, while more and more health providers are under tremendous pressure to reduce health care costs.
“I don’t think family doctors should be in that position,” he said, adding “Do I think an insurance company is going to send me a letter and say, ‘You have to off this patient’? No. They are going to say, 'Look at your costs last month, your costs were higher than average, and we are going to pay you less.'”
At least one proponent of the bill said there has been a lot of alarmist rhetoric from the opposition about how more people are going to die when that hasn’t happened in Oregon, where the law has been in place for 15 years.
Dr. Spiers, of Danvers, said people who have used it have been terminally ill.
"In Oregon, there have no excess of people abusing the law,” he said. “It’s all people with recent terminal illness. It has to be corroborated by two physicians. The person who is ill has to make the request. The family can’t make the request.”
Spiers became involved in the issue when he was asked by a friend to serve on a panel to tell his personal story: In 1994, he fell off a horse and suffered a spine injury and traumatic brain injury. He is paralyzed from the neck down.
"I would not have been eligible for this,” he said. “The law wouldn’t allow me.”
He said critics’ complaints that the law jeopardizes people with disabilities is untrue.
“From my perspective, this law protects people with disabilities,” he said. But, he noted, if he were diagnosed with a terminal illness, he would want to have the choice of whether to end his life.
“It’s supposed to be the patient’s choice, not the physician’s choice,” he said. “They say, ‘We are physicians, we can’t kill people.’ But I say, ‘it’s not you, it’s the disease that’s killing me. I want to be able to die among family on my own.’”
Excerpts from Question 2
Question 2, titled 'Prescribing Medication to End Life,' is on the Nov. 6 statewide ballot. Here are some highlights of the ballot question, based on a summary of the law published by Secretary of State William Francis Galvin:
-- The proposed law would allow a physician licensed in Massachusetts to prescribe medication, at a terminally ill patient's request, to end that patient's life.
-- To qualify, a patient would have to be an adult resident who is medically determined to be mentally capable of making and communicating health care decisions; (2) has been diagnosed by attending and consulting physicians as having an incurable, irreversible disease that will, within reasonable medical judgment, cause death within six months; and (3) voluntarily expresses a wish to die and has made an informed decision.
-- The proposed law states that the patient would ingest the medicine in order to cause death in a humane and dignified manner."
-- The proposed law would require the patient ... to orally communicate to a physician on two occasions, 15 days apart, the patient's request for the medication. At the time of the second request, the physician would have to offer the patient an opportunity to rescind the request.
-- The patient would also have to sign a standard form, in the presence of two witnesses, one of whom is not a relative, a beneficiary of the patient's estate, or an owner, operator, or employee of a health care facility where the patient receives treatment or lives.
-- The proposed law would make it punishable by imprisonment and/or fines, for anyone to (1) coerce a patient to request medication, (2) forge a request, or (3) conceal a rescission of a request.
-- The proposed law would not authorize ending a patient's life by lethal injection, active euthanasia, or mercy killing.
-- The death certificate would list the underlying terminal disease as the cause of death.
-- A person's decision to make or rescind a request could not be restricted by will or contract made on or after January 1, 2013, and could not be considered in issuing, or setting the rates for, insurance policies or annuities.
-- The proposed law would require the attending physician to report each case in which life-ending medication is dispensed to the state Department of Public Health. The Department would provide public access to statistical data compiled from the reports.