Will Voters Sign Off on Assisted Suicide?

When Massachusetts voters head to the polls today, pundits are confident that the famously liberal state's citizens will deliver its electoral votes to President Barack Obama, as they did in 2008. What's far less certain is whether they will endorse a controversial "death with dignity" ballot question that would legalize physician assisted suicide in Massachusetts, making it the third state to approve the end-of-life procedure for terminally ill patients.

Polling conducted for the website MassLive.com over the weekend found voters supporting the measure, Queston 2 on the ballot, by a margin of 44 to 42 percent. But this was a sharp decline from polls earlier in the campaign that pegged support at more than 60 percent. Opponents of the measure, including many Catholic groups, have spent about $2.6 million on a campaign to defeat it, according to the Boston Globe, far more than advocates have raised to promote it. "Everyone who is involved in this believes that if it passes in Massachusetts, it’s a gateway to the rest of the country," Terrence Donilon, a spokesman for the archdiocese of Boston told the Globe.

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How Physician-Assisted Suicide Works

The proposed law would allow physicians to prescribe a fatal dose of medication to incurable, terminally ill adults estimated to have no more than six months lo live — typically in the form of about 100 barbiturates, designed to cause the patient to slip into a fatal coma within a half hour. The patient must voluntarily and orally make a request for the medication on two occasions, at least 15 days apart, plus make a written request signed by two witnesses, one of whom is not a relative, beneficiary or representative of the patient's care facility. Doctors must determine that the patient is mentally capable of making the decision and refer the patient to another physician for a second opinion on both the medical prognosis and mental evaluation. Once the drugs are provided, the patient must take them manually; doctors cannot deliver the dose directly.

In general, the debate on Question 2 has pitted conservative groups opposing the measure against liberal groups supporting it. But one notable Democrat has been outspoken in her personal opposition to the law. In a column for the Cape Cod Times, Victoria Reggie Kennedy, the widow of U.S. Sen. Edward Kennedy, wrote that the law goes against her late husband's vision of universal health care "by asking us to endorse patient suicide — not patient care — as our public policy for dealing with pain and the financial burdens of care at the end of life. We're better than that. We should expand palliative care, pain management, nursing care and hospice, not trade the dignity and life of a human being for the bottom line."

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Kennedy added that her husband was told early in his treatment for brain cancer that he had no more than four months to live, but he survived for 15, during which time he was able to take part in Senate votes and speak at the Democratic National Convention. "Not everyone will have the same experience we did," she wrote. "But if Question 2 passes I can't help but feel we're sending the message that they're not even entitled to a chance."

A Fundamental Right or a Misguided Choice?

Supporters of the law call it a fundamental human right and an end-of-life option voters should support not only for the sake of their parents and loved ones but, when the time comes, for themselves as well. "This is a decision for terminally ill patients alone, not politicians, government, religious leaders, or anyone else," Dignity 2012, the group which proposed the Massachusetts law, argues in a statement. "We all deserve the right to make this decision for ourselves if we are faced with the final stages of a terminal illness. This is the most personal of decisions and it should not be denied to a terminally ill patient who might find comfort in it." The group also points out that no physician would be compelled to take part in an assisted suicide if he or she was opposed to the law for any reason.

Some physicians support the measure as a crucial step toward greater recognition of patients' desires, not only near the end of life, but throughout their care. Others, though, wonder if the patient always truly knows best. They believe that if palliative care programs improved, even those facing imminent death would decline the assisted-suicide option.

"It’s not uncommon for any of us to hear people expressing a wish to die and our nurses regularly get asked by people who are just getting started with us and in a lot of pain," Nate Lamkin, a social worker at a Boston-area hospice, told the Globe. "The vast majority of the time, when someone’s symptoms are brought under control, they withdraw that request."

In practice, relatively few people in Washington and Oregon seek assisted suicide — about 110 have the drugs provided to them in each state annually and only about 70 end up taking them. Oregon passed its law in 1997, Washington in 2008. (Montana's State Supreme Court has ruled that physician-assisted suicide is legal, but the state has no law regulating its practice.)

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Ezekiel Emanuel, an oncologist who has served as a health policy adviser to the president, argued in a New York Times column that some of our perceptions of end-of-life care and assisted suicide may be misguided. Patients, he wrote, tend to seek assisted suicide not because they are in great pain but because they are depressed. Studies of people who elected assisted suicide in Oregon found that only 22 percent cited pain as the prime motivating factor; most others cited psychological distress, including depression. In a study of terminal Dutch patients who sought assisted suicide, at least 50 percent were depressed.

"In this light," Emanuel writes, "physician-assisted suicide looks less like a good death in the face of unremitting pain and more like plain old suicide. Typically, our response to suicidal feelings associated with depression and hopelessness is not to give people the means to end their lives but to offer them counseling and caring."