This article was originally published in the Daily Hampshire Gazette on November 2, 2012. An interview with MHC President Lynn Pasquerella on the same topic aired the same day on New England Public Radio.
By KRISTIN PALPINI
Should a doctor be allowed to a prescribe a lethal drug to terminally ill patients seeking to end their lives? This moral dilemma, also known as the proposed Death With Dignity Act or Question 2, is a matter Massachusetts voters will face on the November ballot.
If approved, the act would make Massachusetts the third state to allow what some people frame as doctor-assisted suicide. Oregon has allowed such end-of-life measures for 14 years. Washington state enacted similar legislation in 2009.
Debra Hertz of Northampton said Death With Dignity could have brought a great deal of relief to her husband, who died at age 60 from Lou Gehrig’s disease (ALS) in May.
“We talked a lot about how people should have this option in a situation like his, when you have an illness for which there is no hope, no treatment,” she said.
Hertz’s husband, Michael Southerland, was a preschool teacher at the Hampshire Community Action Daycare Center for 20 years and co-owner of ARC Garage, both in Northampton. A runner, Southerland first noticed something was wrong when he got “drop foot,” an inability to pick his feet up high enough for adequate mobility, and began falling during his runs. He was diagnosed with amyotrophic lateral sclerosis, a neurodegenerative disease that saps muscle mobility, but not feeling.
When her husband died, Hertz said, he was only able to move his head. Southerland had declined to go on the feeding and breathing machines necessary to sustain life at the end of ALS.
“Your chest muscles stop working at the very end so you need a breathing machine and a feeding tube, but nothing happens cognitively to your mind. You’re still there, you just can’t speak or breathe or eat,” she said.
At Southerland’s memorial service, Hertz circulated a petition to get Death With Dignity on the November ballot.
“I don’t know if he would have used it,” Hertz said of her husband taking a lethal drug, “but he wanted the option. We’re better to dogs in our society than people. We help them out of their misery and here we make people suffer.”
The proposed Death With Dignity law would allow a physician to prescribe a lethal medication to terminally ill patients who have less than six months to live, provided that the patient is an adult, mentally capable, terminally diagnosed by an attending physician and a consulting physician, and voluntarily expresses a wish to die. The participation of physicians, pharmacists or any other medical professional in the prescribing and delivery of the deadly drug would be voluntary.
Under the law, the person wishing to end his or her life must request from a doctor, on two occasions 15 days apart, the desire for the medication. At the time of the second request, the doctor would have to offer the patient an opportunity to rescind the request. The patient would also have to sign a form expressing his or her desire for the drug in the presence of two witnesses, one of whom cannot be a family member, beneficiary or connected with the health care facility where the patient receives treatment.
The doctors involved would have to inform the patient of alternative treatment and care options, such as hospice care and pain control, refer the patient to a psychologist if they believe the patient may have impaired judgment, and arrange for the medicine to be delivered directly to the patient or the patient’s agent.
The patient could then decide when and if he takes the lethal drug. Not everyone who picks up the prescription winds up taking it, according to data provided by health departments in Oregon and Washington.
“The question of whether public and legal policy should permit physician-assisted suicide is distinct from whether it might be morally justified in individual cases,” said Lynn Pasquerella, president of Mount Holyoke College. Pasquerella is also an ethicist. One of the focuses of her research has been end-of-life issues. She said she is undecided about Question 2.
“As a result of technology, death is less of a discrete act and more of a negotiated event,” Pasquerella said in an email to the Gazette. “There is a sense of vulnerability that a complex strategy will be put in place to prolong life without a consideration of the quality of life.”
Critics say the Death With Dignity Act as written does not provide enough safeguards against mentally ill people securing the drug or prevent patients from being coerced into killing themselves. There are also no rules regarding storage of the lethal pills once they’re brought home.
Furthermore, the Massachusetts Medical Society says that asking doctors to provide lethal drugs is antithetical to what healers stand for and goes against the Hippocratic Oath, a sort of medical code of conduct.
“For thousands of years we’ve been all about keeping patients alive and healthy,” said Richard Aghababian, president of the Massachusetts Medical Society. “Now we want to help them commit suicide? ... We can help control nausea and pain. We can make the last days humane.”
Pasquerella said she sees room in the Hippocratic Oath for Death With Dignity.
“The goal is to provide the best care possible, and when the burdens of treatment or sustaining life outweigh the benefits for the person whose life is involved, the right to autonomy of that patient could be considered as including the right to be aided in dying in the most humane and compassionate manner,” she said.
Proponents contend that concerns about coercion and distraught people taking the drug are scare tactics, pointing out the carefully crafted steps included in the law to ensure that a person’s decision is free from outside influences. They also maintain that providing a terminally ill person with a choice to end his or her life is the humane thing to do.
“You need to make three different requests over a period of time. Some of the requests have to be in writing. To coerce someone to go through this is not feasible,” said Lewis Cohen, a staff psychiatrist at Baystate Medical Center and a professor at Tufts University School of Medicine. He wrote the 2010 book “No Good Deed: A Story of Medicine, Murder Accusations and the Debate over How We Die,” which is about doctors and other medical professionals who have helped terminally ill people die.
He noted that he was speaking for himself, and not as a representative of the hospital, which has not taken a position on Question 2.
“As if somebody is going to risk murdering someone else, a family member, when that person is going to die anyway in a matter of a few weeks,” Cohen said.
Another common criticism of the law is that the ill person has to have six months or less to live. Aghababian said it is impossible to accurately predict if someone will die in six months.
“People will sometimes miraculously come back from what you think is a terminal illness,” he said. “I can tell you when a person has 24 hours left to live, but it is absurd to think that someone can accurately say you have six months left to live.”
Since the Death With Dignity law was passed in Oregon in 1998, 20 doctors have been referred to the state’s board of medical examiners for violating the act, said Katrina Hedberg, an epidemiologist with the Oregon Public Health Division. However, she said, the infractions committed by these doctors were minor, usually things like filing paperwork late or writing a prescription before completion of the state’s seven-day waiting period.
“There’s a lot of checks and balances in the law,” Hedberg said. “In every case, we found that the physician was acting in good faith even though they were out of compliance with the law.”
Aghababian said he doesn’t see the sense in legalizing Death With Dignity.
“I never thought to myself, ‘Boy, I wish I had helped that patient commit suicide,’ ” he said. “In my 33 years, I can’t remember anyone asking me, ‘Can you help me die, doc?’ ”
Cohen said it’s a misnomer to equate Death With Dignity to physician-assisted suicide. He said taking a lethal pill when you’re terminally ill should not be considered suicide. He said suicidal people with mental illnesses like depression or schizophrenia are in a different state of mind from people at the end of their lives looking for a way to escape pain.
“For a few dying people it is an incredibly important option to have,” Cohen said of Death With Dignity. “Palliative medicine is wonderful, hospice is wonderful, but it has its limits for some people, and for those few people Death With Dignity is a lifeline.”
Kristin Palpini can be reached at firstname.lastname@example.org.