, Salem, MA

November 3, 2012

Question 2: The choice to die

Tom Dalton
The Salem News

SALEM — The Nov. 6 election asks voters to make important decisions about who will be the next president of the United States, the next U.S. senator from Massachusetts and the next congressman from this district.

No decision on the ballot may be more important or profound, however, than Question 2: the Massachusetts Death With Dignity Act.

The choice, in a real sense, is between life and death. Should an individual who is terminally ill have the right to end his or her life?

Massachusetts could become the third state to adopt such a law. There are similar measures on the books in Oregon (1994) and Washington state (2008), both of which passed by voter initiative.

On the North Shore, the subject has been discussed and debated over the past few weeks. A Marblehead rabbi made it the subject of his sermon on Yom Kippur; a Catholic church in Salem held a forum on the issue; and a debate was staged at the Council on Aging building in Salem.

Among the chief opponents of Question 2 are the Catholic Church and the Massachusetts Medical Society.

Cardinal Sean O’Malley preached against it just days ago at a church in Lynn, and has listed “10 Reasons to Oppose Question 2” on his blog.

The key proponents are the Massachusetts Death With Dignity Coalition, the petitioners for the ballot question.

They have the backing of the American Public Health Association and The American Civil Liberties Union of Massachusetts.

Before this question even made it to the ballot, it was the subject of a legal fight over what to call it. Is it “death with dignity” or “physician-assisted suicide?”

“Physician-assisted suicide conjures up Kevorkian kind of conduct,” said Steve Crawford, a spokesman for the Death With Dignity Coalition. His reference, of course, is to Dr. Jack Kevorkian, who was sentenced to prison in 1999 after assisting in the death of a man suffering from Amyotrophic lateral sclerosis (ALS), known as Lou Gehrig’s disease. Kevorkian claimed to have assisted in more than 100 deaths.

“That’s not what this is,” Crawford insisted. “The only role the physician plays is to write the prescription. I would argue it is a misnomer.”

Under the Massachusetts ballot question, a doctor would be allowed to prescribe medication for a patient with a terminal illness who has six months or less to live. The pills or other medication would have to be self-administered by the patient.

Proponents argue that there are safeguards built into the law to prevent abuses. The consulting doctor, for example, must inform the patient of alternatives, such as hospice care, and refer the patient to another doctor to confirm the diagnosis and prognosis.

Poorly written law?

Opponents say the law is badly flawed.

“Everybody wants death with dignity,” said Rabbi David Meyer of Temple Emanu-El in Marblehead, who delivered a Yom Kippur sermon on the subject. “It’s just a matter of whether this is the proper solution, My answer is ‘No, it is not.’”

The two principal flaws, Meyer said, are the reliance on a pronouncement by a doctor that a person has only six months to live, and the lack of a required psychological evaluation.

“Six months is a thoroughly random number, and the medical field is notoriously wrong. It’s only a statistical average,” Mayer said.

The rabbi said a psychiatric or psychological consultation, which is required only if the doctor believes a patient is mentally impaired, should be mandated for every person considering ending their life.

“The lack of a required psychiatric evaluation is a huge problem, knowing that it’s a population that suffers from depression and depression can be treated,” Meyer said.

“I also bring my own personal experience to both those concerns,” he said. “I’ve been a rabbi for 30 years and I’ve seen people come through depression and find meaning and joy and love in their last weeks and months, and I’ve seen people out-live their diagnosis by years.”

There is a lot about this proposed law that people don’t know, provisions that are troubling, the rabbi said.

“People don’t realize that a doctor does not have to be present when the suicide medicine is being administered,” he said. “People don’t realize the next of kin doesn’t even have to be notified.”

There also have been significant medical advances, Meyer said, in hospice care and in easing the pain of terminally ill patients.

“What is of particular concern,” he said, “is that those least likely to have access to the discussion of what is available for hospice and palliative care are the most vulnerable in society — the minorities, the mentally ill, the elderly. ... They are going to be the ones to not know what is available and are going to choose suicide as the first response rather than the last response.”

A matter of choice

Paul Spiers of Danvers, a forensic neuropsychologist on the faculty at the Boston University School of Medicine, comes down on the other side of the question. In fact, he is one of the original ballot petitioners for the Death With Dignity Coalition.

Spiers said he has long believed in choice for terminally ill patients, a conviction that only grew stronger after he suffered a paralyzing injury when he fell off a horse nearly 20 years ago.

“It just crystalized my feelings about the importance of choice,” he said. “We have no choice about having a peaceful death at the time of our choosing. ... I don’t want to die in an ICU hooked to a machine and unconscious.”

Like others who support the proposed law, Spiers rejects the word “suicide.” This is not an irrational act made in a moment of desperation, he says.

“Your death has already been determined,” he said. “You’ve been given a terminal diagnosis. That’s why two doctors have to make a diagnosis. ... In this case, the death is preordained. You have cancer. You have ALS. You’re going to die from it. The question is when and how do you want to die.”

Maybe the best argument for Question 2, Spiers said, is that essentially the same law has had a trial run in Oregon and proved successful.

“There have been 1,000 prescriptions or so written” since the law went into effect, “but only 600 people have used it,” he said. Those who chose not to end their lives at least had the peace of mind of knowing they had a choice, he said.

“You’re not required to use it,” Spiers said, “but if you’re in excruciating pain or experiencing a very difficult death, it’s a choice. ... It’s a choice I want to have.”

Tom Dalton can be reached at