Under the ballot question, terminally-ill adults in Massachusetts could request that a doctor prescribe a lethal dose of pills.
Voters next month will decide the fate of a ballot question that would dramatically change health care law in Massachusetts by allowing the terminally ill to self-administer drugs to end their lives.
If Question 2 is approved on Nov. 6, the Massachusetts law would mirror similar laws in Oregon and Washington.
Under the ballot question, adults in Massachusetts could request that a doctor prescribe a lethal dose of pills. To be eligible, people would need to be diagnosed with a terminal illness and be given six months or less to live by a primary doctor with verification by a consulting doctor.
Dr. Shawn CharestThe ballot question, which qualified with the signatures of about 125,000 registered voters, says that terminally ill patients would need to make three requests for the medications, including two oral and one written, with two different waiting periods between the final request and the prescription.
On their website, opponents said the proposed law would hurt the doctor-patient relationship, that safeguards are lacking in the measure and that improved hospice and palliative care are needed, not doctor-assisted suicide.
Supporters, on their own website, said "death with dignity" is a personal choice for the terminally ill, that the process contains protections against abuse and that while patients are grateful for the choice to end their lives, the option is used sparingly in Oregon and Washington.
Among opponents are the state's four Roman Catholic bishops, including Bishop Timothy McDonnell in Springfield, the Massachusetts Medical Society and the Hospice & Palliative Care Federation of Massachusetts.
Dr. Lewis CohenDr. Shawn C. Charest, a specialist in palliative care at Mercy Medical Center in Springfield, said he opposes the proposed ballot law partly because he said it tampers with the delicate relationship between a physician and patient.
If a doctor approves the lethal medication, a patient might question whether the physician is looking out for the patient's interests or the bottom line of an insurance company, he said. It would be much more economical to prescribe the medication instead of second or third line chemotherapy for a cancer patient, for example, he said.
"It's a very slippery slope,'' said Charest, who has worked with thousands of dying people.
He said the proposed law would require a huge amount of administrative oversight for a small number of patients. He said it could take away attention and money that could go to hospice and palliative care, which serves thousands of people.
He said there is no mandate for a patient to disclose to next of kin an intention to take the pills. This is an unacceptable oversight, he said, when some elderly terminally ill patients suffer from high rates of depression and may feel they have become a burden on people caring for them.
The ballot question does say a doctor must recommend that a patient notify next of kin, but that a request for lethal medication can still be granted if a patient declines, or is unable, to notify a family member.
A supporter of the ballot question, Dr. Lewis M. Cohen of Northampton, a psychiatrist and professor of psychiatry at Tufts University School of Medicine, said he is a strong advocate and practitioner of palliative care, but an additional option is needed. Dr. Cohen was one of the original 15 people who signed the petition for the ballot question.
Approval of the ballot question would help some people avoid suffering and would give people more control in their final days, he said. Morphine, commonly used to control pain and other symptoms, is not for everyone who is dying, he said.
"It still doesn't help a small percentage of people," said Cohen, author of the 2010 book "No Good Deed: A Story of Medicine, Murder Accusations, and the Debate Over How We Die." "That small percentage wants the choice that death with dignity offers," he said.
His mother-in-law, Myra P. Berzoff, 91, of Northampton, who suffered from emphysema, wanted the option provided by the ballot question and was profiled in The Republican on Aug. 20. She passed away Oct. 13, ending her goal of voting in support of the ballot question before she died.
Berzoff had said she didn't know whether she would actually use the life-ending medication. But in a process that probably was drawn out longer than she would have preferred, Berzoff was provided morphine while in hospice and slipped into a coma that lasted a couple of days before she died, Cohen said.
Supporters of the ballot question include the National Association of People with AIDS, the American Civil Liberties Union of Massachusetts and the American Public Health Association.
Stephen G. Crawford, communications director for Dignity 2012, said the effort is a "grassroots campaign" with donations from 1,100 individuals including several hundred from Massachusetts.
"Most people believe that people should have the right to make this decision for themselves in their final days," he said.
Crawford said he is surprised by opposition from leaders of hospice and palliative care. Crawford said Oregon has one of the best hospice programs in the nation. If anything, approval of the ballot question would enhance hospice in Massachusetts, he said.
Approval of the ballot question would simply add another voluntary option for a very small group of people, he said. The proposed law would mimics laws enacted in Washington in 2009 and Oregon in 1997. Crawford pointed out that relatively low numbers of people have used the law. A total of 114 people who received the lethal medications prescribed by a doctor in Oregon last year and 103 in Washington, according to reports by public health authorities in those states. But about a third of those in each state did not use the drugs.
Crawford said that if the law is approved, participation would also be "totally voluntary" for physicians, hospitals and treatment centers.
Rosanne Meade, chair of the Committee Against Physician-Assisted Suicide, said the proposed law is poorly written with many dangerous flaws.
"Death with dignity is something we all want," said Meade, a retired teacher whose career included stints in public schools in Ludlow, Springfield and Ware. "This would not be death with dignity."
Meade said the ballot question takes a cavalier approach to terminal illness. It seeks to offer an "easy out" to the terminally ill when they are likely depressed, sad and hopeless, she said.
"The message to people is, hospice and palliative care are something you can just write off because they don't always work well," she said.
Meade said hospice and palliative care are very good in Massachusetts. She said people generally don't know about hospice unless they, or someone close to them, is receiving such care.
Five years ago, she got a first-hand look at the system when her 93-year-old mother was in hospice at Massachusetts General Hospital, dying from osteoporosis, leaving her in pain and with difficulty breathing. Her mother was comfortable in the days before her death and family members had a chance to see her, she said.