This year in Massachusetts, voters will decide on Question 2: an initiative petition to legalize physician-assisted suicide in the commonwealth. Ignoring any moral issues, the initiative is vulnerable to abuse and should not be passed into law.
Dignity 2012, a group in support of the issue referred to as ‘Death with Dignity,’ claims the proposed law “contains strict safeguards to ensure that the patient is making a voluntary and informed decision.” The safeguards written into the law, however, are insufficient. First, nearly all responsibility rests in the hands of a patient’s physician. Section 6 of the initiative states that no patient shall be prescribed the life-ending medication if either of two physicians deem that the patient suffers from a “psychiatric or psychological disorder or depression.” While the theory behind this precaution is practical, it falls short of effective. Only 15 days separate the date of request from the date of prescription of the lethal dose. There is no clear definition of what tests must be run in this time to check a patient’s mental capacity. According to Jennifer Popik, a medical ethics attorney, “There is no requirement that the patient be given a psychiatric evaluation... This means that a physician ... can prescribe suicide to that patient without even a specialist’s evaluation.” The “safeguard” concerning mental health is rendered useless because a psychiatric evaluation is not compulsory. A similar law in Oregon serves as a warning: According to a report by the Oregon Public Health Department, of the 71 patients who chose physician-assisted suicide last year, only one was referred for psychiatric evaluation.
Death with Dignity would open the door to a new form of elder abuse. Patients must submit three requests for the death-inducing drug. George Eighmey, a proponent of Oregon’s Death with Dignity law, argued in an interview this month with Rachel Zimmerman of WBUR, “It’s all about choice. You decide. No one else can decide for you. No one can force you into it, coerce you into it.” Eighmey’s argument is fundamental for supporters of Death with Dignity. Advocates seek control over end-of-life care and have built mandates into the act to combat outside influence. The requests must be witnessed by two individuals, one of whom can be a blood relative and/or an heir. Nonetheless, nothing prevents a beneficiary from encouraging a patient to choose assisted suicide. Moreover, once a doctor prescribes the drug, there are no safeguards in place to monitor how it is consumed by or administered to the patient.
More troubling is the fact that the state could be creating a whole new set of medical boundaries. The right to die is already embedded in Massachusetts law to the extent that it should be. All patients have the right to refuse treatment for any terminal illness. The right to palliative sedation allows patients to avoid suffering during death by medically induced unconsciousness without assisting suicide. If Question 2 passes, a precedent will be set that runs counter to our right to life.
Death with Dignity would make “terminally ill” adults with six or less months to live eligible for a lethal prescription. However, timetables set by doctors for terminally ill patients are far from exact and, often, patients are misdiagnosed. Patients may commit suicide based on false medical advice.
Finally, if Death with Dignity passes, patients will be at greater risk to predatory insurance practices. A similar law exists in Oregon and studies have shown that, as Popik points out, “Not one person has requested suicide because he or she was in pain. In fact ... the predominate motive is fear of becoming a burden.” There is no provision in the Death with Dignity act that addresses the cost of physician-assisted suicide compared to the cost of treatment. Given the option of assisted suicide, insurance companies may limit other treatments to cut cost. This means that patients, when weighing treatment options, may be influenced to commit suicide by insurance providers.
Death with Dignity deserves public consideration in Massachusetts but the initiative that will appear on the 2012 ballot is not ready to be passed. Question 2 is underdeveloped and leaves too much room for mistreatment and exploitation of the terminally ill.
Anthony Speranza is a Swampscott resident.