an abstract by Federico Gustavo Pizzetti and Amedeo Santosuosso
On November, 6, 2012, in a general ballot, the people of the State of Massachusetts has rejected 51-49% a law proposal which aim was to introduce following the provisions of Oregon and Washington State, the right for a resident in Massachusetts to obtain a prescription by physician for medication to end his or her life in a humane and dignified manner.
Here is the official summary of the proposed law, written by the Secretary of the Commonwealth of Massachusetts:
This 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 (1) 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, directly or through a person familiar with the patient’s manner of communicating, 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 require the attending physician to: (1) determine if the patient is qualified; (2) inform the patient of his or her medical diagnosis and prognosis, the potential risks and probable result of ingesting the medication, and the feasible alternatives, including comfort care, hospice care and pain control; (3) refer the patient to a consulting physician for a diagnosis and prognosis regarding the patient’s disease, and confirmation in writing that the patient is capable, acting voluntarily, and making an informed decision; (4) refer the patient for psychiatric or psychological consultation if the physician believes the patient may have a disorder causing impaired judgment; (5) recommend that the patient notify next of kin of the patient’s intention; (6) recommend that the patient have another person present when the patient ingests the medicine and to not take it in a public place; (7) inform the patient that he or she may rescind the request at any time; (8) write the prescription when the requirements of the law are met, including verifying that the patient is making an informed decision; and (9) arrange for the medicine to be dispensed directly to the patient, or the patient’s agent, but not by mail or courier.
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.
Participation under the proposed law would be voluntary. An unwilling health care provider could prohibit or sanction another health care provider for participating while on the premises of, or while acting as an employee of or contractor for, the unwilling provider.
The proposed law states that no person would be civilly or criminally liable or subject to professional discipline for actions that comply with the law, including actions taken in good faith that substantially comply. It also states that it should not be interpreted to lower the applicable standard of care for any health care provider.
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. Also, 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.
The proposed law states that if any of its parts was held invalid, the other parts would stay in effect.
Here is an instant analysis by Michael Cook, on BioEdge (Nov. 11, 2012): Has assisted suicide been scratched from the progressive agenda?:
One lesson from Tuesday night is that assisted suicide is not necessarily an item on a progressive agenda. While voters re-elected Barack Obama, added two Democrat senators, elected an openly-lesbian senator in Wisconsin, supported or legalised same-sex marriage in four states, and legalised recreational cannabis in Colorado and Washington, they rejected physician-assisted suicide in the playground of progressive politics, Massachusetts.
Question 2 on the ballot asked whether a doctor should be allowed to prescribe a lethal drug to end the life of a terminally ill person. If it had been approved, assisted suicide would have gained a beachhead on the East Coast and might have spread quickly throughout New England.
But voters rejected it by 51 percent to 49 percent, even though as recently as mid-September, a Suffolk University poll found that 64 percent of voters favoured legalising assisted suicide.
What turned voters around? Four factors seem to have been at work.
First, disability activists were strongly opposed to the measure. They feared that legalised assisted suicide would put pressure on them to take an early exit "We changed the nature of the campaign," said John Kelly, director of Second Thoughts, a disability activist group. "This is the first assisted suicide campaign in which the disability rights perspective has reached so many people." Their vigorous arguments persuaded voters that physical incapacity or incontinence do not rob people of their dignity.
Second, opponents of assisted suicide could not be tarred as theocrats seeking to impose their values on a post-Christian electorate. The Catholic Church strongly opposed Question 2, but stayed in the background. Second Thoughts, for instance, also backed Question 3 about whether to legalise the use of marijuana for medical purposes. It passed.
Third, the medical establishment was strongly opposed as it is nearly everywhere. Who knows better the hazards of allowing the healing profession to end lives?
Two of the leading supporters were Marcia Angell, a former editor of the New England Journal of Medicine, and Dan Brock, a professor of medical ethics, both of Harvard Medical School. However, the official position of the Massachusetts Medical Society, the publisher of the NEJM, was strongly opposed.
Finally, in the final weeks of the campaign, prominent progressives were emphatic in their opposition. In a New York Times op-ed, Dr Ezekiel J.
Emanuel, an architect of the Obama Administration?s healthcare policy, described assisted suicide as fundamentally skewed against the poor: Whom does legalizing assisted suicide really benefit? Well-off, well-educated people, typically suffering from cancer, who are used to controlling everything in their lives ? the top 0.2 percent. And who are the people most likely to be abused if assisted suicide is legalized?
The poor, poorly educated, dying patients who pose a burden to their relatives.
E.J. Dionne, a liberal stalwart who writes for the Washington Post, asked how assisted suicide ?would interact with the need to curb costs in our medical system?.
Writing in the Atlantic Monthly, a leading palliative care physician, Ira Byock, insisted that he was a card-carrying progressive, but that he detested assisted suicide. America is failing people who are facing the end of life and those who love and care for them. Giving licensed physicians the authority to write lethal prescriptions is not a progressive thing to do.
In Massachusetts the Kennedy family is more revered than the Windsor family is in the UK. So a message from the widow of Senator Ted Kennedy probably swayed many voters. Dismissing the slogan of "dying with dignity", Victoria Reggie Kennedy wrote in a local newspaper: for every complex problem, there's a simple easy answer. And it's wrong.
Supporters of assisted suicide will not give up. But the experience in Massachusetts shows that political progressives are deeply divided on this issue.