Marcia Angell: What Went Wrong, What’s Next For Death With Dignity

(stevegarfield/flickr)

Here Dr. Marcia Angell, former editor of The New England Journal of Medicine and lead backer of the doctor-assisted suicide measure that failed this week, talks with WBUR’s Sacha Pfeiffer about what went wrong and how to move forward.

Here’s the full interview:

Marcia Angell: Well, it’s not clear what will happen now. I think we have to regroup and think about that. The bad news is that we lost, but the good news is that the margin was razor-thin. And what this tells us is that people know that we’re ready for this, that this is the decent thing to do. So I don’t think that this is going to go away. But, by law, we can’t do another ballot initiative for another five years, I think.

What I’m looking for is what’s happening nearby. I would suspect that we would see a ballot initiative like this in perhaps Maine, maybe New Jersey, maybe Vermont. And we also can look north to Canada and see what’s happening there. The supreme court of British Columbia overturned a Canadian law against assisted dying, and that’s pending appeal. If the decision in British Columbia stands up to the appeal, then all of Canada will permit assisted dying.

Sacha Pfeiffer: You make me think of a gay marriage parallel here: that the more time passes, the more we see other states approving same-sex marriage. So are you hoping there’s a strategy of acceptance, and if you come back in a few years the state will be more accepting?

MA: Oh yes. I have no doubt about that. We have had long experience now in Oregon and quite a bit of experience in Washington. We know that this law works. It works exactly as intended. And I think this is just a matter of state by state and maybe even country by country coming to accept this as just a good part of medical practice.

SP: Of course, there were also opponents who simply had very deep religious convictions that taking someone’s life, even if you’re taking your own life, is just wrong — that, in their view, it’s God’s decision. Do you think there’s anything you could do to try to win over those people?

MA: No, no. They cannot be won over. And they would often say that there was something about this particular law they didn’t like — either it had too few safeguards or it was too restrictive. Or, on the other hand, they would say that it was too loose, that doctors didn’t have to be present. So you saw a lot of often inconsistent argumentation about the safeguards. But I think this is a fig leaf for people who would not have approved of it in any case.

SP: The Massachusetts Medical Society was also an opponent. You, of course, are a doctor. There are many doctors who do support it, but many don’t. Do you think there’s anything you need to do to win over more of your medical colleagues?

MA: That, I think, could happen. The doctors in Oregon opposed it at first, and there are a lot of doctors there who now say, “We were wrong. This has worked well and exactly as intended.” But, you know, we don’t really know how many doctors either support it or oppose it in Massachusetts because there’s been no poll of doctors here.

SP: You said you can’t bring another ballot initiative for about five years. Would there be another avenue besides a ballot initiative?

MA: There are two avenues in addition to the ballot initiative. One is the Legislature, and I think that’s very unlikely to approve such a law in Massachusetts.

SP: Why do you think that?

MA: Well, the Legislature, I think, is more concerned about the ideology of the church and the Massachusetts Medical Society than the general public.

SP: So you think legislators may not want to cast an unpopular vote?

MA: With powerful institutions, yes. But it’s possible as time passes. And then the other way would be through the courts. Massachusetts does not have a law prohibiting physician-assisted dying, and so it’s conceivable that it could go through the courts.

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