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Ethicist: Mass. should legalize physician-assisted suicide

Of the numerous ballot initiatives that will be decided at the state level on Tuesday, none is more hotly contested than the Massachusetts bill to decide whether to legalize physician-assisted suicide. The citizens of Massachusetts, my home state, should vote to legalize.

The proposed measure allows terminally ill patients to be given access to lethal drugs. A terminally ill patient is defined as someone with six months or less to live. The patient’s terminal diagnosis and mental competency must be attested to by two doctors. Patients would have to make a request to their doctor twice orally and once in writing. The written request would have to be witnessed. 

Yet even with such restrictive conditions, opponents of the proposal say doctors should never, as a matter of professional ethics, intentionally hasten the death of one of their patients, even one who is terminally ill. The codes of medicine and nursing ethics reject helping patients die.

Many professional organizations, including the American Medical Association, agree. The AMA "strongly opposes any bill to legalize physician-assisted suicide" because the practice is "fundamentally inconsistent with the physician's role as healer."  The Massachusetts Medical Society also opposes the bill. “Allowing physicians to participate in assisted suicide would cause more harm than good,” Dr. Lynda M. Young, the society’s past president told Massachusetts legislators earlier this year. “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer."

Some disability groups and religious organizations are fighting hard to get a "no" on the “Question 2,” initiative as well.  They believe that the terminally ill who are disabled deserve better palliative care and emotional support rather than a prescription of deadly medicine. They also worry that people may feel compelled or coerced into choosing death because their care is expensive, they see themselves as a burden to others or because relatives are thinking that they do not want to spend the grandchildren's college tuition to keep grandpop going in a nursing home or ICU. Given the current push to contain medical costs, the biggest fear is that the vulnerable will get the bum’s rush to the hereafter.

These objections are concerning, but not convincing. Two states have already enacted legislation very similar to that proposed in Massachusetts. The disturbing scenarios against legalizing physician-assisted suicide for the terminally ill are not supported by what has happened in Oregon and Washington.

Although there are requests from the dying for lethal pills, few ask and almost no one takes them. In Washington in 2010, 68 physicians wrote lethal prescriptions for 87 patients, 51 of whom took the pills and died. The rest never took the pills. That is an incredibly tiny number relative to all those who are terminally ill in Washington. The Oregon experience is the same.

The critics are worrying about a shift to mass suicide inspired by heartless doctors and families pressuring dying patients to end it. That has simply not happened in Oregon or Washington. There is no persuasive evidence that the dying are being rushed, duped or bullied to die by anyone. 

The interesting thing is that many people find it more empowering to have the ability to end their lives if they want to do so. Many say the ability to choose gives them the strength not to do so. 

The question about a doctor’s involvement can be overcome by giving each physician the right of conscience to be involved or not. Some doctors will want nothing to do with assisted suicide. Others will. Given the polarizing nature of physician-assisted suicide, the decision ought to be each physician’s to make. Medicine does not have to be all in or all out.

The proposed Massachusetts law is very restricted and contains important safeguards. Experience in other states shows little reason for worry about abuse or misuse.  Instead the more people who are going to die know they can end their lives sooner if they choose, the more many of them fight harder to live. Making assisted suicide possible in Massachusetts rightly puts a choice in the hands of a very few who may not use it, but value having it.

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