Do we have the right to die?

World looks to Massachusetts as it votes on physician-assisted suicide

By Nicholas Nehamas

Noel David Earley, an advocate for assisted suicide from Rhode Island. He died of Lou Gehrig’s disease in 1997. (Reuters)

On Tuesday, Massachusetts voters will decide if their state should legalize physician-assisted suicide for the terminally ill.

For supporters, the right to die is a question of compassion for the suffering. For critics, assisted suicide is a process rife with the potential for needless death.

Either way, it’s a global issue.

“I think it’s fair to say that assisted suicide as a movement started in Holland and then shifted over to the U.S. when Washington and Oregon legalized it,” Arthur Caplan, a medical ethicist at NYU’s Langone Medical Center, tells Latitude News. “Now other parts of the world are watching Oregon, Washington and Massachusetts to see if they want to go in that direction too.”

Assisted suicide, in which a doctor prescribes a fatal dose of medicine for the patient to ingest, differs from euthanasia, in which a doctor administers the medication.

Assisted suicide is legal in Switzerland (1942), Holland (2002), Belgium (2002) and Luxembourg (2009) — voluntary euthanasia is also allowed in the latter three countries. The Swiss law in particular has sparked controversy because it allows healthy people to die, if they so choose. In 2009, the 85-year old British conductor, Edward Downes, and his 74-year old wife, Joan, ended their lives together at a suicide clinic in Zurich. Joan had terminal cancer. Edward was almost completely blind.

Assisted suicide remains illegal in the UK, after Britain’s High Court said it was up to Parliament to change the law, not the court. After the decision, the man who brought the legal challenge, Tony Nicklinson, began refusing food and died of pneumonia in August. He suffered from so-called “locked-in syndrome,” a condition in which the body is paralyzed, but the mind continues to function at a high level.

While physician-assisted suicide remains controversial even in countries where it is legal, it’s not very popular among patients. The Economist reports that 460 assisted deaths took place in Switzerland last year. In Belgium, assisted suicide represents less than one percent of total deaths. In the Netherlands, euthanasia and assisted suicide account for around three percent.

Death with dignity

Under the proposed Massachusetts law — which is largely modeled on the Oregon (1994) and Washington (2008) legislation — a person suffering from a terminal illness may ask a physician to prescribe lethal medication if: 1) a doctor has diagnosed the patient as having six months or less to live and 2) a psychiatrist has ruled them medically competent to make health-care decisions.

The patient must take the medication on their own. It cannot be administered to them by a physician. Caplan points out that this means someone like Stephen Hawking, Terri Schiavo or Terry Nicklinson would be unable to end their lives legally.

Ballot procedure in Massachusetts requires an official argument for and against each question. Representing the “pro” side is Heather Clish, who lives in Reading. Her father, dying of brain cancer, took his life in his native Oregon. She writes:

My dad knew he wanted to die in the comfort of his own home; competent and aware instead of detached and sedated; on his own terms instead of those of a fatal disease that had already taken too much. My dad was already dying, but because of this law, he could say goodbye to those he loved, with dignity and grace in my mother’s arms.

I urge you to vote “Yes” because, while this choice isn’t for everyone, everyone has the right to this choice.

But some doctors in Massachusetts, including the Massachusetts Medical Society, oppose physician-assisted suicide. The society’s president, Dr. Richard Aghababian, tells Latitude News, “as an organization, we are very much tuned in to death with dignity. We want our physicians to be compassionate and provide suitable end-of-life care. But we don’t want physicians to be in the position of helping people commit suicide. That’s against the Hippocratic oath.”

And Aghababian believes the process of predicting death is “fraught with error.” Seven-and-a-half years ago, a doctor told him he only had six months to live.

Moreover, he says the Massachusetts law is flawed because it doesn’t require patients to discuss their decision in psychiatric therapy.

“When you’re given the diagnosis that you’re going to die,” Aghababian says, “it’s only natural that you become depressed. In Oregon, only seven percent of patients saw a psychiatrist. That’s not enough. Some of these people may have curable depression.”

A slippery slope?

A protest against Jack Kevorkian, a physician who illegally helped people in Michigan end their lives. (Reuters)

Diane LeBlanc, a member of the City Council in Waltham, MA, also doesn’t think the law provides enough protections.

“There’s no physician there at the time of death, no family notification,” she tells Latitude News. “If you read what’s being being proposed, you can’t help but conclude that it has so many flaws and so many loopholes that you have to vote no. It’s a matter of life and death.”

LeBlanc says there hasn’t been a full public discussion on the issue, and many voters she’s talked to in Waltham don’t even know the question is on the ballot.

Even if a better law were proposed, LeBlanc would still oppose it.

“Just from a public policy standpoint,” she says “I don’t know how you can say suicide is okay in some circumstances, but not in others.”

Caplan, the NYU bioethicist, says concerns over assisted suicide aren’t necessarily realized in empirical data. He believes the Massachusetts law provides more than adequate protection, saying it requires one “to be declared terminally ill by two doctors. You have to be declared mentally competent. You have to request the pills twice orally and once in writing, and the written request requires a witness. And you have to take the pills yourself.”

Caplan says he originally opposed such laws.

“My reasoning went that it might be nice to have the right to go to a doctor before we get the right to be killed by a doctor,” he explains. “And I still believe that’s the more important thing.”

But his other concerns haven’t come true.

“I just don’t see the kind of abuses I was worried about in Oregon, Washington and the European countries: the poor and disabled being pushed to do this, hospital and palliative care declining,” he says. “Only 71 people took advantage of the law in Oregon last year.”

“Having said that, I do think you need to be vigilant,” Caplan continues. “I’m not saying people shouldn’t monitor what’s going on, or that anyone should be bullied or rushed off to the hereafter . . . but so far, many years of experience don’t show that coming true.”

A recent poll by the Boston Globe found 47 percent of voters support the idea of assisted suicide while 37 percent oppose it and 16 percent are undecided.

“If it passes here in Massachusetts in a presidential election year,” says LeBlanc, the Waltham councilwoman, “you can bet it’s going to be on the ballot in a whole bunch of states next time.”