Death with Dignity

Death is difficult to talk about. The debate around how and when a person should die is emotional, but also mired in questions about individual liberty, the role of government, and what caring for someone really means.

The Massachusetts legislature is considering a bill which would allow physicians to prescribe life-ending medication to terminally ill patients who wish to die. Although the bill mirrors “death with dignity” laws passed in a handful of other states, it’s generated significant debate in Massachusetts.

The terminally ill diagnosis is defined as having received a prognosis that within six months the patient will pass away. In order to request a life-ending prescription, the diagnosis must be declared by an attending physician, confirmed by a consulting physician, and the patient must be cleared by a mental health professional to confirm that they’re not clinically depressed or mentally ill. The medication must be self-administered, and two witnesses must co-sign the patient’s written request for the medication, confirming the identity of the patient and attesting that they are not under duress, fraud, or undue influence. In 1997, Oregon passed a similar bill which provided a blueprint for other states.

Death is difficult to talk about. The debate around how and when a person should die is emotional, but also mired in questions about individual liberty, the role of government, and what caring for someone really means.

The debate around whether individuals should be allowed to request a lethal prescription is at the center of Massachusetts House bill H.1926 “An Act Relative to End of Life Options.” Here are notes from a recent hearing:

Argument in support

Those who are in excruciating pain and suffering due to a terminal illness will often hasten their end in ways most people would find gruesome and inhumane. Some testimony described terminally-ill individuals so eager to die they starved themselves, refusing to eat or drink for however long it took. Others choose not to accept palliative care options that could ease their suffering or prolong their life. Advocates of this legislation argue that passing this bill would provide patients with the option to die peacefully. The bill does not require all physicians to prescribe the medication. Physicians who disagree with the intent of this bill may refer patients to a physician who feels comfortable prescribing the medication; they are not obligated to prescribe it themselves. Nor does it require that the terminally ill ingest the medication once it has been requested; patients may rescind their request at any time or choose not to take it in the end.

It merely provides individuals with the option. Allowing patients to make this decision for themselves gives them a level of control and autonomy at a time when everything else seems out of their control. Some argue patients will continue to find other ways to relieve their suffering were this bill not to pass. Finally, delaying the passing of this bill has inspired Massachusetts residents to relocate to other states where they would have the agency to determine how and on what terms they pass away.

Argument against

Some argue that this bill asks physicians to go against their mission to heal and keep patients alive. During testimony, physicians recalled the Hippocratic oath to “do no harm,” and argued that giving individuals the option to end their own life clearly violates it. Others argue that prognoses are not always accurate. It is not uncommon for some patients to be told they will die within six months and then go on to live for many years. Many in the disability community also argue that this law would make it easier for people with disabilities to end their own lives. They argue that disabled persons often feel like a burden and would request this medication more often than other groups. The same argument was applied to those with mental illness.

Opponents of the bill worried that individuals who suffer from depression and other mental illness will be more inclined to use the medication. Others opposed the law for it representing government overreach, calling it “state-sanctioned suicide.” They worry that allowing patients to facilitate their own death is a slippery slope and opens the door for lawmakers to loosen the medical requirements necessary to request the medication.

In the 20 years since Oregon passed their own “death with dignity” law, a total of 2,216 Oregon residents have received life-ending prescriptions, and 1,459 persons have used them. Loss of autonomy, decreasing ability to participate in activities that made life enjoyable, and loss of dignity are the reasons given for wanting medication. Washington, Vermont, California, Colorado, and the District of Columbia have enacted similar end of life laws. The Massachusetts bill has not yet been scheduled for a vote.

Photo by Luke Richardson on Unsplash