For Massachusetts voters, there are two questions on the ballot this November that warrant attention (in truth, there were 3 questions, but Question 1 has already been settled). Interestingly, both Question 2 and Question 3 have to do with medical care in the state.
Specifically, Question 3 eliminates the state criminal and civil penalties for the medical use of marijuana in the Commonwealth. It does not provide immunity from federal law. It also does not require medical professionals to authorize use of medical marijuana. Not surprisingly, the Massachusetts Medical Society is opposed to this measure. However, considering that the Commonwealth passed a voter referendum a few years ago legalizing possession of marijuana in the amount of one ounce or less, I would not be surprised if this initiative passes as well. Interestingly, I also haven’t seen much press about this issue, either for or against the ballot measure. This may be related to the fact that I could care less about this ballot measure, although that’s probably hypocritical considering I’m a physician.
Question 2, on the other hand, I find critically important. This ballot measure has been dubbed the “Death With Dignity” initiative. Some have called it physician-assisted suicide, euthanasia, and physician-assisted dying. If Question 2 becomes law, it would allow physicians to write prescriptions for life-ending medications for terminally ill patients. Terminally ill is defined as having an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months. The initiative is fashioned after existing law in two states, Oregon and Washington, where it has been in place for 15 and 4 years respectively.
Supporters of Question 2 feel that the law would expand choices for terminally ill patients, allowing mentally competent adults to end suffering that cannot be adequately controlled in a human and dignified manner. Supporters point to evidence from Oregon and Washington showing that a relatively small number of patients request these prescriptions and an even smaller proportion end their own lives. Additionally, there exists no evidence of abuse of the law. Much like Question 3, physicians are not required to participate; additionally, pharmacists are not required to dispense the medication.
Opponents of Question 2 feel that the law is not clear enough, does not contain enough safeguards, and does not mandate psychiatric evaluation. Opponents point out that diagnosis of terminal illness is often an estimate. Additionally, they point to the availability of palliative care and hospice care for relief of suffering for terminally ill patients.
I cant adequately express my support for this bill in a logical or coherent manner. I cant even point to personal experience with my father on this issue, as I’m fairly sure he would never have accepted physician-assisted dying as an option.
I believe this partly because, quite simply, it wasn’t an option. My father never had the option to die peacefully at home. Like so many Americans, he passed in a hospital bed, although thankfully on the hospice service. However, neither he nor my family got to decide when that moment occurred. I can still remember my sister’s anguish at waking up and noting that my dad had stopped breathing due to the ativan and morphine he received. I also remember how the medication seemed to keep coming even though at some point my father was no longer coherent enough to say whether he needed more or less.
Everyone is entitled to their own opinion on this issue, but something strikes me as odd about opposition to this initiative from the medical community. Medical professionals are constantly complaining about the government and how laws, policies and regulations are restricting their ability to practice. And yet, here is an initiative that not only offers patients a choice but simultaneously expands the scope of practice for physicians.
While opponents may be correct that the law is confusing or unclear, the charge that palliative care and hospice services are “the better way to go” is misleading. Nowhere in the initiative is there language excluding the use of palliative and hospice care. In fact, allowing the Death With Dignity initiative to become law may facilitate the palliative and hospice care conversation. Furthermore, Question 2 allows patients who continue to suffer despite care received through hospice to take control and end their own suffering in a way that palliative care and hospice may not be adequately able to address. And while opponents are correct that a prognosis is always an estimate, unbearable suffering is not in the eyes of the patient.
One of my mentors in medical school said that a physician’s role was to extend a patient’s life, but to prepare them for death. Death, like taxes, is inevitable. The vast majority of us will never know the suffering that a small number of terminally ill patients will bear. But for that minority of people, perhaps they shouldn’t have to bear it either?
Clearly, I have a position on this issue, but I’m curious about the rest of you out there. If you live in Oregon or Washington, what are your thoughts on a law that has been in existence for quite some time and most recently upheld by the US Supreme Court in 2006? I’d like to hear from Massachusetts residents as well. And for those of you that reside outside of one of these three states – please weigh in.
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