physician-assisted suicide

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Patrick, Citing Personal Experience, Voted Yes On Doctor-Assisted Suicide

Deval Patrick (WBUR)

For the record, Gov. Deval Patrick said his decision to vote in favor of physician assisted suicide was motivated largely by his experience with his mother near the end of her life, The Associated Press reports.

The measure was defeated by a narrow margin here in Massachusetts. But as Carey noted in a recent post, much of the passion in favor of the measure came from people who had actually witnessed a loved one die under painful conditions with much suffering; these survivors yearned for a more graceful and dignified path to death for the ones they loved.

And indeed, the AP writes:

Gov. Deval Patrick says his decision to vote for a ballot question that would have legalized physician-assisted suicide for the terminally ill was motivated largely by personal considerations.

Patrick told reporters Wednesday that he supported the question after his experience with his mother at the end of her life.

Patrick also pointed to the death of his grandmother some years earlier.

Patrick said he knew how important it was for his mother and grandmother to have some measure of control at the end of their lives, although he’s not sure they would have used the medication the question would have legalized.

‘Ethically, Is This Right For Doctors To Do?’ Help A Terminal Patient Die?

(Photo illustration by Alex Kingsbury/WBUR)

Ravi Parikh, a fourth-year student at Harvard Medical School, faced conflicting messages.

The American Medical Association, which he belongs to, and the Massachusetts Medical Society oppose Question 2, the measure on next month’s state ballot that would allow terminally ill patients to ask a doctor to prescribe them life-ending drugs.

Harvard Medical School student Ravi Parikh

In contrast, The American Medical Student Association, which he also belongs to, supports it.

Ravi faced conflict within as well. He’d applied to medical school for the usual reason — to heal patients, as spelled out in the Hippocratic oath — not to help them die.

But his medical education introduced him to the complexities of modern American dying.

It stressed patient autonomy as a “central guidepost.” Yet he saw patients losing control as they neared death. “No patient that I have spoken to wishes to die in pain, alone, or hooked to a ventilator,” Ravi said, “and yet that is the way in which many patients pass away in the ICU.”

Seeing similar confusion about the ballot measure among his peers, Ravi and fellow fourth-year Grant Smith helped organize a panel discussion for all local medical students earlier this month at Harvard.

It let the audience pepper panelists on each side of the issue with questions, and also use the teaching tool of a case study: A hypothetical elderly man with metastatic cancer who comes to his doctor asking for a lethal prescription.

That case discussion, Ravi said, brought out a valuable consensus among the opposing panelists: All agreed on the need for more and better end-of-life discussions with patients.

But on the “toughest question” — “Ethically, is this right for doctors to do?” — there was no clear answer, he said. Rather, each side argued that its position represented the true embodiment of “Do no harm.”

‘This conversation involves an irresolvable dilemma.’

If Ravi and his fellow students remain conflicted, they can at least be comforted that they are in plenty of good company.

By all indications, the ballot measure presents an extraordinarily difficult problem of medical ethics — a problem wrestled with nationally as states consider physician-assisted suicide laws. Thus far, only Oregon and Washington have passed them; polls suggest that Massachusetts may be next.

The ethical issues involved are hard and deep enough to divide not just medical associations but medical staffs — a Massachusetts General Hospital panel presented arguments for and against Question 2 earlier this month — and seasoned ethicists.

Consider the Boston-based Community Ethics Committee, a group of 18 diverse volunteers who gather to craft opinions on some of the thorniest of bio-medical issues. Continue reading

Fresh Air: Existential Emptiness At The End Of Life

Listen to Fresh Air today for an insiders view of death and dying from a former critical care nurse who now counsels terminally ill people at the end of their lives. Some of those patients choose to die with an overdose of medications, which is legal in Oregon, Washington and Montana. Massachusetts voters will decide whether to legalize physician-assisted suicide in November.

Judith Schwartz, east coast regional coordinator for the nonprofit Compassion and Choices, tells Terry Gross that the top reason terminally ill patients say they want help dying is not because they’re in excruciating pain. She said people want to die when they can no longer do any of the large and small things they love. For some people that doesn’t matter, she said, but for the people it matters to, it matters a lot, and those patients stare straight into the “existential meaningless” of life. Continue reading

Reader Connects Health Rationing Argument To ‘Death With Dignity’

third rail

(Photography.mojado.com via Flickr/Creative Commons)


The New York Times letter page carries a bounteous harvest of responses today to a provocative recent opinion piece titled “Beyond Obamacare” that began, “We need death panels.”

Opinion writer Steven Rattner went on:

Well, maybe not death panels, exactly, but unless we start allocating health care resources more prudently — rationing, by its proper name — the exploding cost of Medicare will swamp the federal budget.

But in the pantheon of toxic issues — the famous “third rails” of American politics — none stands taller than overtly acknowledging that elderly Americans are not entitled to every conceivable medical procedure or pharmaceutical.

Today, one reader responds by connecting dots between rationing and physician-assisted suicide (which is on the upcoming Massachusetts ballot and was discussed today on WBUR’s Morning Edition.) Readers, thoughts?

To the Editor:

Steven Rattner wants to reduce medical costs by not offering “every treatment, regardless of expenses or efficacy” in the last year of life. That’s reasonable — if and when we give the elderly (I am one of them) the right to choose their own gentle death, something that many religions would obstruct.

But even before we get to that, let’s consider the 76 million baby boomers who are or will be retiring and will drain Medicare. Would they be willing to join me in choosing death with dignity? Or would they prefer heart transplants at 85?

JO PROCTER
Baltimore, Sept. 17, 2012

Primer: Pro And Con On Mass. Assisted Suicide Ballot Measure

John Kelly and Marcia Angell

Con and pro: John Kelly, disabilities rights activist and founder of Second Thoughts, who opposes Question 2; and Dr. Marcia Angell, senior lecturer in social medicine at Harvard Medical School and former editor of the New England Journal of Medicine, who backs the measure. (Jesse Costa/WBUR)

Come November, if you live in Massachusetts, you’ll face a vote on a life-and-death issue (I mean, even more directly life-and-death than Obama v. Romney.) It’s Question 2 on the ballot, also known as the Death With Dignity initiative and the physician-assisted suicide measure.

It’s a big, rich debate infused by reports from earlier such measures in Oregon and Washington, and this 24-minute segment on Radio Boston is a great way to acquaint yourself with it.

(Points in dispute include even the language used: One of the measure’s proponents, Dr. Marcia Angell, notes: “These patients are dying. That’s why most proponents don’t like the term ‘physician-assisted suicide,’ because that compares it with a typical suicide, which involves somebody with a normal life expectancy choosing death over life. These people, unfortunately, don’t have that choice. They’re dying. And the only issue is the exact timing and the manner of death.”)

In case you run out of time yourself, here’s a telling story from the end of the segment, from a caller named Karen in Acton:

She didn’t want her son to remember her a way she didn’t want to be remembered.

My sister lived in Oregon, Eugene Oregon to be exact, and she had a son who had just turned 16. She was diagnosed with — and did have — appendix cancer, very rare and very lethal. She was only 52 yrs old when she died. This option, which was not easy to get — these end-of-life pills were not easy to get, she had to find a doctor who would agree to it, as you stated earlier. She had to have this terminal diagnosis, which there was no doubting. She was emaciated, she looked as if she belonged in a concentration camp near the end. But she wanted to have as much time with her son as possible. And we had the palliative care. I helped get everything in place so she could stay at home. And her knowing that it was her choice — she never used the pills. But she had them in her house because she did not want to get to the point where she could not have — she didn’t want her son to remember her a way she didn’t want to be remembered. Continue reading

Major Battle Over Assisted Suicide Brewing In Mass.

A London hospice patient

Mark my words: There’s a great big battle brewing in Massachusetts over helping terminally ill patients commit suicide.

That’s not an original thought; in fact, a post last month on the New Old Age blog at nytimes.com was headlined “The Next Death-With-Dignity Battleground” and described energetic efforts to put the issue on next year’s Massachusetts ballot.

But the signs are multiplying that the battle is indeed on its way. The group behind the ballot initiative, Dignity 2012, gathered nearly 80,000 residents’ signatures, which seems to be a comfortable margin over the 70,000 or so needed to put a measure on the ballot. And this weekend, delegates at a major meeting of the Massachusetts Medical Society voted to reaffirm their opposition to physician-assisted suicide, according to a society press release. It begins:

The Massachusetts Medical Society, the statewide association of physicians with more than 23,000 members, today voted to reaffirm its opposition to physician-assisted suicide, with its House of Delegates voting by a wide margin to maintain a policy the Society has had in effect since 1996.

Opposition to physician-assisted suicide was part of a larger policy statement that includes recognition of patient dignity at the end of life and the physician’s role in caring for terminally-ill patients. The policy was approved by more than 75 percent of the Society’s delegates.

Lynda Young, M.D., president of the Society, said that “Physicians of our Society have clearly declared that physician-assisted suicide is inconsistent with the physician’s role as healer and health care provider. At the same time we recognize the importance of patient dignity and the critical role that physicians have in end-of-life care.”

Stephen Crawford, spokesman for Dignity 2012, responds that the measure as proposed — the full language is here — is not about “physician-assisted suicide.”

“What this question will allow under Massachusetts law,” he said, “is for terminally ill patients to ask their doctor to prescribe life-ending medicine. That is not physician-assisted suicide in the sense we traditionally think of it. These are self-administered drugs.” Continue reading

MA ‘Death With Dignity’ Measure Proposes Physician-Assisted Suicide

Among the bumper crop of ballot measures (here’s the full list) that have just cleared their first hurdle by being certified by the state attorney general, several concern health care and will bear close watching here. But the one that intially grabbed me most is a “right-to-die” proposal titled the “Massachusetts Death With Dignity Act.” It would allow the sort of physician-assisted suicide for terminal patients that Oregon passed 14 years ago. It even includes a sample of what a request form would look like. (See above.)

‘For the patient, this is not a choice between life and death; it’s a choice of how to die — slowly, or sooner but more peacefully.’ — Dr. Marcia Angell

I noticed that the first signatory on the petition was Marcia Angell of Cambridge. “Hmmm,” I thought, “That Marcia Angell? Former editor of the New England Journal of Medicine?”
Indeed. She wrote an editorial in the New England Journal in 1997 titled “The Supreme Court and Physician-Assisted Suicide — The Ultimate Right”. She emails:

I’m delighted that the Attorney General certified the ballot measure. If it passes, terminally ill patients whose suffering becomes intolerable will be able to ask their physicians to help them hasten their deaths. Doctors will not be required to comply, but they will have that option. For the patient, this is not a choice between life and death; it’s a choice of how to die — slowly, or sooner but more peacefully. It will give citizens of Massachusetts the same choice as citizens of Oregon, where Death with Dignity has been available for 14 years and used only sparingly and exactly as intended.”

Meanwhile, the Catholic Church is already announcing its opposition in a press release titled ‘Massachusetts Catholic Bishops Oppose “Death with Dignity’ Initiative Petition.” It says in part:

This Initiative Petition is a first step in Massachusetts toward legalizing physician-assisted suicide, effectively authorizing the killing of human beings prior to their natural death. The Roman Catholic Bishops of Massachusetts stand firm in the belief that a compassionate society should work to prevent suicide, which is always a terrible tragedy, no matter what form it may take.

Personally, I stand with Woody Allen on hoping to avoid my own death entirely, but I figure if it has to come, the more control I have over it, the better. Readers, your thoughts? Measures still need to gather 69,000 signatures in order to be put on the ballot, so there’s plenty of time to think it through. For more background, here’s an excellent article that was just in The Berkshire Eagle.