An Election Issue of Grave Concern
I rarely use my blog for political reasons outside of higher education issues. I also try to take a national perspective since this blog is read by alumni/ae and friends from across the country. But today I want to share some thoughts on an issue that the citizens of Massachusetts will decide in a few weeks. And this issue raises significant moral and ethical questions about which we should all be concerned.
On November 6, the citizens of Massachusetts will vote on Ballot Question 2. A yes vote would legalize physician-assisted suicide in Massachusetts. In my opinion, and the opinion of many others, this ballot question not only threatens the dignity of life, but contains flaws, which would have unintended consequences to terminally ill patients and their families.
If passed, a patient who has been diagnosed with a terminal illness and given a prognosis of six months or less to live would have the ability to request a doctor’s prescription for medication to end his or her life. Jewish and Christian moral traditions have long rejected the idea of assisting in another’s suicide. Religious organizations are joined by secular groups including the Massachusetts Medical Society, Massachusetts Hospice and Palliative Care Federation, American Medical Directors Association, American Nurses Association, American College of Physicians, American Medical Association, and the Massachusetts Osteopathic Society in opposition to the practice of physician-assisted suicide.
Some of the key flaws in the Massachusetts ballot initiative which have been identified include:
- Doctors agree that terminal diagnoses of six months or less are often wrong. Many with terminal diagnoses live years longer.
- Patients requesting suicide do not need to be examined by a psychiatrist before receiving a prescription to commit suicide. Many terminally ill patients suffer from depression.
- Question 2 does not require a consultation with a palliative care or hospice expert.
- No doctor is present when the patient takes the lethal prescription. This is not a dignified way to die.
- There is no requirement that the patient notify family members. Compassionate care at the end of life should involve the loving support of family members.
- We should be supporting improved hospice and palliative care statewide, not legalized suicide.
In an open letter calling Question 2 “poorly written, confusing, and flawed,” five past presidents of the Massachusetts Medical Society- Leonard J. Morse, MD; Barbara A. Rockett, MD; Philip E. McCarthy, MD; Francis X. Rockett, MD; and Lynda M. Young, MD have cautioned that if the ballot question is passed, “the doctor/patient relationship will suffer and the way doctors deliver health care will be gravely changed.” Last month, the Massachusetts Medical Society posted,
“We are opposed to Question 2 for these reasons:
- The proposed safeguards against abuse are insufficient. Enforcement provisions, investigation authority, oversight, or data verification are not included in the act. A witness to the patient’s signed request could also be an heir.
- Assisted suicide is not necessary to improve the quality of life at the end of life. Current law gives every patient the right to refuse lifesaving treatment, and to have adequate pain relief, including hospice and palliative sedation.
- Predicting the end of life within six months is difficult; sometimes the prediction is not accurate. From time to time, patients expected to be within months of their death have gone on to live many more months — or years. In one study, 17 percent of patients outlived their prognosis. ”
Lynda M. Young, MD, MMS past president, testified about the MMS policy at a hearing of the Massachusetts House Judiciary Committee on March 6, 2012: “Allowing physicians to participate in assisted suicide would cause more harm than good. Physician assisted suicide is fundamentally incompatible with the physician’s role as healer. “Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life. ... Patients must continue to receive emotional support, comfort care, adequate pain control, respect for patient autonomy, and good communication.”
Dr. Joseph Gravel, president of the Massachusetts Academy of Family Physicians has been quoted as saying the ballot initiative does not include adequate safeguards to protect poor people suffering from a terminal disease who may want to end their lives rather than become a financial burden to their families. (Eagle-Tribune). In a statement he issued on behalf of the more than 1,000 family doctors who are part of the academy, he announced the group’s opposition to Question 2. “The role of family physicians is to provide compassionate, high quality health care to all the patients, in each stage of life.”
He continued, “This certainly includes end-of-life care. It is clear that we need to continue to work to provide those suffering from serious illnesses, depression, and other conditions that can lead to hopelessness highly effective palliative and hospice treatments that are now available. To really address this patient need, we also need to work to assure that everyone has access to a pre-existing, trusting, personal relationship with a primary care physician that can be enormously important during these very difficult situations.” (State House News Service)
The question of legislation by referendum has also been called into question given the complexity of the legal, ethical and moral issues involved. If the ballot question passes in November, there will be no other steps or requirements to be fulfilled and the flaws and unintended consequences will be part of a new law. If passed by the voters, physician-assisted suicide will be legal in Massachusetts on January 1, 2013.
As you can see, this is more than a religious issue … it is a legal issue … it is a medical issue … and it is a fundamental moral issue related to all people of all faiths and traditions. For those in Massachusetts, I would hope that much thought and reflection would precede a decision on how to vote on November 6. For those outside of Massachusetts, issues like these need our attention and concern.
(As always, your comments and questions are welcome.)