The Berkshire Eagle Our Opinion: Death with dignity legislation has languished for too long on Beacon Hill — time for lawmakers to act December 20, 2022
We’ve used this space several times over the years to endorse sensible legislation that would give Massachusetts residents with debilitating terminal illnesses some control and dignity during the most difficult hours of their waning life.
However one wants to refer to it — medical aid in dying, death with dignity, physician-assisted suicide — reasonable policies have long been on the table. Since the narrow defeat of a death with dignity ballot question, no doubt affected by a well-funded opposition campaign led by the public policy arm of the state’s Catholic bishops, bills that would give sound-minded terminally ill patients the option to obtain lethal drugs have been filed in every single legislative session. Unfortunately, the state Legislature has lagged in delivering this compassionate option, with lawmakers failing to bring the bills to a full vote in either chamber throughout those past five sessions.
We hope a recent Supreme Judicial Court decision prods the Legislature into overdue action. The state’s highest court ruled Monday that doctors do not have a right under the Massachusetts Constitution to provide medication that would end a terminally ill patient’s life, which means that such an action could be prosecuted as manslaughter under current state law. Importantly, however, the ruling underscored that decisions about the legality of providing near-death patients with the means to end their own lives is something that should be tackled by elected legislators, not an unelected judiciary.
“These questions are best left to the democratic process, where their resolution can be informed by robust public debate and thoughtful research by experts in the field,” Justice Frank M. Gaziano wrote in the 64-page ruling.
The democratic will is certainly there. Bay Staters’ support for a death with dignity law has grown considerably in the years since the 2012 failed ballot initiative. A Boston Globe/Suffolk University poll released in April found that 77 percent of Massachusetts residents “believe a mentally sound adult with an incurable, terminal illness should have the legal option of asking a physician to prescribe aid-in-dying medication to end their suffering” — up from 70 percent a few years ago. Meanwhile, the 10 other states plus the District of Columbia that have such laws offer critical evidence against many of the reflexive arguments against medical aid in dying. While detractors cite hypothetical claims of sadistic doctors and greedy family members coercing or abusing vulnerable patients, they can’t point to specific examples of such incidents occurring in states like Vermont or Oregon where medical assistance in dying has been legal for years.
That’s because many of those laws have critical built-in protections and restrictions for patients who would seek life-ending medication. So, too, does the legislation that has languished for too long on Beacon Hill. The End of Life Options Act would only apply to patients who have been diagnosed with a terminal illness with a prognosis of less than six months to live by two separate doctors. Patients would have to make the request themselves twice — once verbally and again in writing with two witnesses, one of whom cannot be a relative of the patient or an employee of the health care facility. The patient could only do so after requisite mental capacity is confirmed by a licensed mental health clinician. Only under all those conditions would a doctor be allowed to prescribe life-ending medication, which the patient would be required to self-administer.
All of those safeguards would make Massachusetts’ death with dignity legislation among the most restrictive and cautious of all such laws in the country. In fact, it would be only the second such state law — after Hawaii’s — that would require a mental health evaluation.
There are many deeply opposed to doctor-assisted suicide, whether on religious or other grounds, who likely won’t ever be convinced that such end-of-life options are moral. They are entitled to that worldview, but they should not be entitled to force it on any and all patients who meet all the above criteria and seek some self-determination at the end of their life. It is worth noting that, according to data available from the parts of the country that have legalized medical aid in dying, one-third of those who go through the process of legally obtaining a lethal prescription never take it. Still, they have the peace of mind that comes with the choice of how their final days play out.
Massachusetts residents facing terminal illnesses and needlessly prolonged suffering should also have that peace of mind if they choose to seek it. Yet over the last decade as sensible and compassionate bills stalled in the statehouse, how many of our neighbors have been denied such a choice on how to limit the pain of their final hours and exit this world on their own terms?
Massachusetts shouldn’t deny them any longer. The SJC’s decision this week puts some topspin on a ball that has languished too long in the Legislature’s court. Now, lawmakers must move it forward. On the heels of the ruling, state Sen. Joanne Comerford, D-Northampton, and state Rep. James O’Day, D-Worcester, said they would each resubmit a version of the End of Life Options Act in their respective chambers next month. We hope the Berkshire delegation and the rest of their colleagues finally make this reasonable and compassionate policy a reality in Massachusetts.
The Sun Chronicle Our View: Putting an end to needless suffering December 19, 2022
Advocates for physician-assisted suicide are optimistic that 2023 is the year that those suffering from a terminal illness will have the right to die with dignity.
We support that effort.
Legislative leaders say they see a growing consensus on Beacon Hill to approve a bill that will allow Massachusetts to join 10 other states and the District of Columbia in allowing terminally ill patients to receive a doctor’s help to hasten death. The incoming governor, Democrat Maura Healey, also backs the legislation.
The measure would appear to also have public support. Polls taken before a 2012 referendum on the matter showed that voters supported physician-assisted suicide by about 10 percentage points but heavy spending by opponents led to a 51-49% defeat.
Since then, support for the right to die has grown, including a Boston Globe Suffolk University poll released in 2020 that said 70% of Massachusetts residents want the Legislature to legalize the practice.
The legislation outlines that to qualify for medical aid in dying, a patient would need to be mentally sound and deemed terminally ill with six months or less to live. Two physicians would need to sign off on the practice.
Once a patient receives the life-ending drugs and chooses to die, they would be required to take the medication without help.
A patient would also be allowed to change their mind after receiving the drugs and opt not to consume them.
Proponents say it can offer a peaceful death to those who are terminally ill. Dan Diaz, an advocate whose wife, Brittany Maynard, ended her life through physician-assisted suicide after a terminal cancer diagnosis, explained to WGBH recently why he is supporting the bill.
“Brittany was not going to allow the brain tumor to basically be in the driver’s seat and dictate the amount of suffering she was going to endure,” Diaz said. He and Maynard moved to Oregon in 2014 to get access to the treatment.
Diaz said without the legislation, people with terminal illnesses are currently taking matters into their own hands by consuming fatal doses of medication.
Opponents argue that many people who have chosen physician-assisted suicide did so not because of pain, but because of a loss of abilities and feeling like a burden on others. They say improving access to quality hospice care is really what is needed.
In our view, however, it is far more compassionate to give those assured of death in a short time a chance to do so with less pain and greater dignity. It can also be a relief to their loved ones. Society, by in large, is in favor of ending needless suffering for animals, including our beloved pets. Yet somehow, many balk at extending such mercy to our fellow humans. Why?
We urge that physician-assisted suicide legislation be approved in the coming year and urge local lawmakers to support the effort.
The Boston Globe To ease suffering for dying patients, Massachusetts should legalize medically assisted death , December 18, 2022
What interest could the state possibly have in preventing a patient suffering from an incurable illness, and poised to live their last few months in extreme pain, from peacefully dying on their own terms?
Dr. Roger Kligler, a retired Falmouth physician who has advanced prostate cancer, sued the state in 2016, arguing that terminally ill adults have a state constitutional right to end their lives. After the case wound its way through the courts, the Supreme Judicial Court heard it last March. During oral arguments, Justice Serge Georges Jr. asked Assistant Attorney General Maria Granik: What interest does the state government have in telling Kligler “we’re not going to let you end your life on your terms; we want you to end it on ours?”
Indeed, why shouldn’t the state allow a terminally ill patient to end their own life? What interest could the state possibly have in preventing a patient suffering from an incurable illness, someone who could live their last few months in extreme pain, from peacefully dying on their own terms?
Those are some of the fraught and multilayered questions about choice and bodily autonomy that the controversial case raises. The SJC could rule in Kligler’s favor and agree that no state statute or law prohibits medically assisted death, or they could side with the Commonwealth and decide that dying patients have “no fundamental constitutional right to assisted suicide,” as Granik put it. The court could also rule that the issue belongs in the purview of the Legislature and that state lawmakers should come up with a set of rules for physician-assisted death.
Ultimately, the SJC’s upcoming decision in the case adds more urgency for state lawmakers to act on legislation that provides a strict and narrow framework under which doctors should be allowed to write prescriptions for lethal drugs at the request of terminally ill patients. Ten states, along with Washington, DC, have legalized some form of medically assisted death, including Maine and Vermont. Oregon became the first to enact such a measure 25 years ago.
A recent Globe news story confirmed that state lawmakers are planning to file such a bill again in the upcoming session. “This is a quality of life issue,” said state representative Jim O’Day, one of the main sponsors of the legislation. “It’s a complex and difficult conversation to have, for sure, but the option to provide patients and their loved ones with peace of mind and comfort” is too important to ignore.
The proposed legislation includes strict requirements for a patient to request medically assisted death. The patient must have a terminal illness diagnosis and a prognosis that they have less than six months to live, both of which must be confirmed by two doctors; the patient must be able to self-administer the medication, which can’t be prescribed until mental capacity is confirmed by a licensed mental health clinician; and no doctor, health provider, or pharmacist is required to participate in the process. Patients must also be able to make the request themselves, first verbally and a second time in writing before two witnesses, including one who is not a relative and does not work for the health care facility involved.
The mental health evaluation is a cornerstone of the legislation; only Hawaii requires such a step. It’s why the proposed bill is one of the most cautious and comprehensive in the nation.
Opponents of legalizing medically assisted death passionately disagree. They believe that opening the door even a crack to assisted suicide will send the state down a slippery slope, and that vulnerable people will eventually be pressured or coerced into ending their lives. They argue such laws contribute to a stigmatization of disabled people by devaluing their lives and deeming them a burden to society. Nineteen disability organizations, filed a brief in the Kligler case in support of the state. Opponents of medically assisted death also worry that the safeguards in the bill will eventually be deemed “barriers to access” and will be removed over time by legislators.
“You can’t safeguard against inherent problems in the public policy,” said Matt Vallière, executive director of Patients Rights Action Fund, a national organization that opposes medically assisted death. They include “the fact that we have a broken profit-driven system and glaring disparities in health care. We have an ableist society that views the lives of people with disabilities as less worth living. Those things you cannot safeguard, and you can’t safeguard the fact that coercion always happens behind closed doors, and that not everybody has a nice family.”
Twenty-five years have passed since the first state made medically assisted death legal, meaning there is ample data to evaluate how the law has played out and if any unintended consequences, like abuse or coercion of vulnerable patients, have materialized. According to a review of state reports from Compassion and Choices, a national organization that advocates for medically assisted death laws, roughly 5,100 patients have taken a prescribed drug to end their life in nine of the 11 jurisdictions where such laws have been enacted. Abuse of vulnerable patients like disabled people has not been documented. In Oregon, the former executive director of Disability Rights Oregon said that, under his watch until 2019, his organization never “received a complaint that a person with disabilities was coerced or being coerced to make use of the [Oregon Death with Dignity] Act.”
It’s only compassionate to let people like Kligler have the choice, if and when they meet the requirements, to request medically assisted death. These choices are unique and very particular to the individual in question. If a patient chooses to end their life via medically assisted death, they are not in any way, shape, or form devaluing their lives or the lives of others — they just believe that living in extreme pain is not worth it — for themselves. Denying them that choice is inhumane.
The Daily Hampshire Gazette Guest columnists Alberto Gambarini, Jerome Medalie and Stanley Handman: “Elders support death with dignity,” May 29, 2020
“We know full well that our lawmakers need to do all they can to ease the medical and economic pain of the COVID-19 crisis for our citizens. But we believe they could also provide relief from suffering for many people who are terminally ill with other diseases, like cancer, and are facing extreme pain at the end of their life. These two priorities are not mutually exclusive …
“We’re grateful for the gift of our very long and satisfying lives, but we don’t want our ending to be filled with such suffering, frustration and loss of dignity. That’s why we attended the public hearing on the bill [End of Life Options Act], held last June at the Statehouse by the Joint Committee on Public Health, and offered our testimony, along with many others …
“We urge readers to contact your state legislators...and ask them to support H.1926 and S.1208 [End of Life Options Act] by passing it...in the [2020] session.”
The Daily Hampshire Gazette, “Editorial: Time to act on ‘death with dignity’ bill,” May 28, 2020
“For some, the COVID-19 pandemic has brought end-of-life issues into renewed focus, as more than 6,500 lives have been lost statewide to the virus. As we’ve editorialized on these pages several times over the years, the time to pass this bill [the End of Life Options Act (H.1926/S.1208)] is overdue …
Lawmakers must advance it.”
The Berkshire Eagle editorial, “Our Opinion: Time has come for End of Life Options Act,” May 21, 2020
“…with COVID-19, which has claimed more than 6,000 lives around the state, prompting a renewed focus on end-of-life issues, we believe that this will be the time the legislation [End of Life Options Act (H.1926/S.1208)] becomes law …
“Medical science can do amazing things, but in enabling people with terminal illnesses to live longer the result can be prolonged suffering that patients should have the right to bring to an end.
“The legislation is currently before the Joint Committee on Public Health with a May 30 deadline for action. We urge the committee to approve it and put it before members for a vote. Ideally, before the end of the year, the bill will be passed and signed into law by the governor.”
“Nine states and Washington, D.C., have passed these [medical aid-in-dying] laws already. There are significant safeguards built into the law [End of Life Options Act]. In states where medical aid in dying is authorized, ‘studies show that end-of-life care improves overall.’
“No one wants to die, but we will someday. If I am terminal, I want no part of pain, the ICU, tubes, noise and commotion. I want a peaceful death at home.
Join me in urging your Senator or Representative to...support its passage. This is not about Democrats or Republicans. This is about your decision, respecting your end-of-life wishes. Be empowered.”
The Salem News letter to the editor by Marblehead resident Betty Breuhaus, “Pass 'death with dignity' bill,” Jan. 29, 2020
Maine, Vermont, New Jersey and six other states, plus Washington D.C., have already passed a death with dignity law over the past 22 years. And there are enough safeguards in all these laws so that there has not been one substantiated case of abuse or coercion toward an elder, disabled, or low-income person. I think it’s time for Massachusetts to do the same.
Worcester Telegram & Gazette op-ed by Woods Hole resident Alan Steinbach, PhD, MD, “As I See It: Voters Support End of Life Options Act,” Aug. 9, 2019
“The Massachusetts End of Life Options Act contains the same safeguards against abuse and coercion shown to be effective by more than 40 years of combined experience in 10 jurisdictions where medical aid in dying is already authorized, starting with Oregon in 1997. Over the decades, there has not been a single proven case of abuse or coercion related to medical aid in dying. Not one...
“Death is extremely personal. We are all entitled to decline medical treatment, based on our values and priorities. Terminally ill individuals should also have the additional option of avoiding the agonizing end stages of disease based on their individual values and beliefs.”
Worcester Telegram & Gazette op-ed by Gilbertville resident and retired registered nurse Peggy AM Bacon, “As I See It: Massachusetts ready to legalize End of Life Options Act,” Aug. 9, 2019
“Today, you and I can make many choices about our health. Do we exercise, eat healthy, brush our teeth, go to the doctor, take our medications as prescribed? Should we be diagnosed with a terminal disease, we make more choices. Perhaps where to get our care, which specialist to see, what treatments to pursue, and at some time some of us will say, it’s time to stop — no more interventions, no more medications. This is our right and our choice...
“This act is not about what is right or wrong for the individual. This act is about choices. This act says, I as a competent adult with a terminal illness and have the right to choose how, when and where I die, with a little help from my friends.”
Jewish Journal letter to the editor by Rabbi Elias Lieberman of the Falmouth Jewish Congregation, East Falmouth,
“Letter: Why I support the Massachusetts End Of Life Options Act,” June 27, 2019
“As a person of faith who chose a profession in which I am expected to offer guidance to those facing the ultimate existential questions, I believe firmly that terminally ill, mentally capable adults should have the option to die peacefully if their suffering renders living intolerable.”
“I do not presume to speak for all Jews. But I feel strongly that anyone’s deeply-held religious convictions should not preclude the exercise of the most fundamental of personal decisions by others.”
“I do offer experience gained ministering to the dying and to their loved ones. I’m urging legislators to grant the precious gift of autonomy to those for whom the personal decision to end unendurable suffering at the end of their life would be the greatest of blessings.”
Falmouth Enterprise/CapeNews.net editorial, “Compassionate End Of Life Care,” June 21, 2019
“There is ample precedent. California, Montana, Oregon, Vermont and Washington all have authorized medical aid in dying. There is a good deal of support for it in Massachusetts...
“It is not assisted suicide; it is compassionate care for patients who wish to die with grace and dignity.”
Berkshire Eagle editorial, “Our Opinion: End of Life Options Act merits a vote in favor,” Jan. 11, 2019
“Medical assistance in dying legislation has stalled in five consecutive legislative sessions (a session lasts two years) and was narrowly defeated in a 2012 ballot initiative. However, a significant change in the issue's dynamic came two years ago when the Massachusetts Medical Society, which had long opposed medically assisted death and was a fierce opponent of the ballot measure, officially switched its position on the issue to neutral. An internal poll of MMS members found that 60 percent of respondents now favor allowing doctors to prescribe a lethal dose of medication to patients who seek it, and 41 percent wanted the group to actively support an assisted suicide bill in the Legislature...
“The Berkshire Eagle has supported these legislative efforts over the years, as well as the ballot question, and supports this effort as well. We urge the Legislature to move the End of Life Options Act out of the Joint Committee on Public Health in the weeks ahead and put to a vote. Ideally, it will be passed into law and sent to the desk of Gov. Baker for his signature.”
STAT News column by Falmouth resident, retired internist and terminally ill Compassion & Choices volunteer advocate Roger Kligler, MD, “I’m a doctor with end-stage cancer. I support medical aid in dying,” Jan. 31, 2018
“When I was in my 40s, I watched my mother and my father-in-law suffer agonizing deaths from cancer. I remember thinking, ‘That’s not the way I want to die.’ As an internist, I have treated patients in the office and the hospital, including intensive care units. I took over the primary care of patients who were terminally ill when specialists were no longer able to help them. I passionately believed that my professional responsibilities included caring for my patients at the ends of their lives...
“While nine constituent societies of the American Medical Association — eight states and the District of Columbia — previously had changed their position from opposition to neutral on medical aid in dying, I am proud to say the Massachusetts Medical Society is the first one to adopt a policy of neutral engagement.
I believe that the time is coming when all terminally ill people be able to get the help they deserve when they ask their physicians to be able to die to end intolerable suffering.”
Berkshire Eagle editorial, “Our Opinion: MMS takes key step on death with dignity,” Dec. 4, 2017
“...After years and many attempts to pass such a law, and with various interested parties arguing against its passage on moral and religious grounds, a legislative committee once again has the matter under consideration. This time, however, the powerful Massachusetts Medical Society, which has traditionally thrown its weight against an assisted suicide bill, has opted to take a neutral stance…
“End-of-life decisions should be made by the individual, who should have the right to seek assistance from physicians willing to do so ethically and by following proper safeguards. Let us hope that this commendable move by the MMS hastens the arrival of the day when those rights are guaranteed in Massachusetts.”
Daily Hampshire Gazette editorial, “Editorial: Time for End of Life Options Act in Massachusetts,” Feb. 29, 2017
“The bill in the Massachusetts Legislature, modeled on an Oregon law, would establish specific steps a patient must take before being prescribed lethal medication. They include medical certification of a terminal illness expected to cause death within six months, written and oral requests for the medication that must be approved by two doctors, as well as a psychological examination to determine if the patient is of sound mind. After a 15-day waiting period, the patient would be given the drugs. When — and if — the medication is used is up to the patient…
“The Northampton City Council and Amherst Town Meeting in November each endorsed the End of Life Options Act, urging the Legislature to approve it. Ward 6 City Councilor Marianne LaBarge, a co-sponsor of the resolution in Northampton, described a history of deadly cancer in her family, and how difficult it was to watch both her parents suffer before they died.
“She said of her father, ‘If he had the opportunity today to say, “I want to end my life,” and not to have to continue with the unbearable suffering he went through, he would have agreed to take dying medication.
“‘I do feel strongly that how we die should be a personal, individual choice.’
“We agree. It is time for Massachusetts to ease that decision-making process — for terminally ill patients and their doctors — by adding to their legal, end-of-life options.”
Boston Magazine article by Falmouth resident, retired internist and terminally ill Compassion & Choices volunteer advocate Roger Kligler, MD, “The Death I Want,” Jan. 15, 2017
“I don’t know when death will arrive. It could be a few months or a few years. In all honesty, that part doesn’t really scare me anymore, and I don’t devote much time or energy dwelling on it. What does scare me, however, is the strong likelihood that I will spend my last days on Earth unable to do the normal things that make life enjoyable, losing my autonomy and dignity, being barely alive yet in severe pain, drifting in and out of a morphine-induced haze while my loved ones take shifts on a deathwatch. That is not how I want to die. Would you?...
“Time is not on my side. Terminally ill people like me cannot wait several more years and hope that this end-of-life care issue lands on a ballot and passes, nor can we wait for the legislature to act. I want this option to be clearly authorized in Massachusetts in my lifetime—for me, for you, for everyone...
“These terminally ill people did not want to die. Like me, they would have given anything to live. They just wanted the option of a graceful exit. We should all have that same right.”
