This is the ninth in the Prospect's series on the 174 measures on state ballots this year.
Six years ago, Mesfin Nega was attacked outside a nightclub. He suffered a broken neck and a damaged spinal cord that transformed the previously healthy 32-year-old into a quadriplegic. As The Washington Post later reported, Nega had made a pact with his friend Shimelis Yegazu: If one were ever to suffer an injury that required him to be connected to life-sustaining equipment, the other would take it upon himself to disconnect the equipment. Nega and Yegazu made the news last week when Yegazu followed through with this pact, administering a lethal dose of phenobarbital to Nega, and then taking a fatal dose himself.
Nega’s story raises a question that has been off the political radar for some time: Should a patient who wants to end his or her own life have the right to receive a physician’s assistance doing so? Debate here doesn't fall along usual partisan lines—there is no party orthodoxy for Republicans or Democrats on physician-assisted suicide, and the fact that a reasonable, moral case can be made on either side renders this a particularly contentious issue. For instance, is it humane to keep someone who is in constant agony—like Mesfin Nega—alive simply because modern technology enables us to do so? One of the cruel ironies of modern medicine, it seems, is that it allows us not just to ease suffering but also to prolong it. But would the administration of lethal medication not violate a physician’s pledge to “first do no harm”?
Currently, only three states—Oregon, Washington, and Montana—have legalized physician-assisted suicide. Massachusetts could be added to the roster come Tuesday, when the state votes on a ballot initiative to approve so-called "death with dignity" legislation. Massachusetts' Question 2 is modeled after Oregon’s Death With Dignity Act, and would give terminally ill patients with six months or less to live the option to receive a prescription for life-ending medication.
If recent polls prove accurate, Massachusetts voters will vote “yes” on Question 2. The latest poll, from Public Policy Polling, showed 56 percent of the state's residents in favor of the measure. This is particularly noteworthy given that it's been the measure's opponents who seem to have had more fundraising success. Even with a handful of prominent backers—the ACLU of Massachusetts and the National Association of People with AIDS among them—proponents of the Death with Dignity initiative have raised a combined sum of just $562,087; those opposing Question 2 have raised over four times that amount: $2,395,031.
Despite its obvious moral dimension, most of the political debate has centered on the practical implications of legalizing physician-assisted suicide. In effect, states where Death with Dignity legislation is already in place are receiving renewed attention. Because the Massachusetts initiative is modeled so closely after the Oregon statute, this is particularly true of the latter. Since its implementation there in 1998, a total of 935 people have had legal, lethal prescriptions written—596 patients have died from the medications prescribed under the law, according to the Oregon Public Health Division’s latest report.
On the campaign's website, proponents of Question 2 argue that “the greatest human freedom is to live, and die, according to one’s beliefs.” They maintain that Oregon exemplifies how safeguards can prevent abuse. The Massachusetts statute would share many of Oregon’s precautions. A patient would be required to submit both an oral and written request to his or her attending physician with at least two witnesses present, and then reiterate the oral request at least 15 days after the initial request. Receiving the prescription would require the approval of at least two physicians confirming that the patient is capable of making and communicating voluntary, informed medical decisions—though there doesn’t seem to be any mechanism in place that would prevent patients from “doctor shopping” until he or she found two such doctors. If all these conditions were met, there would then be a mandatory waiting period of fifteen days between the patient's first request and the writing of the life-ending prescription.
Opponents, meanwhile, argue that these safeguards are far from sufficient. Doctors are often unable to accurately estimate life expectancy—patients frequently outlive prognoses by months or even years. There is no requirement for patients to see a psychiatrist or counselor unless the attending physician “believes the patient may have a disorder causing impaired judgment.” Thus it is theoretically possible, if improbable, that the measure could be used as a state-sanctioned means for severely depressed patients to commit suicide instead of receiving psychiatric care. The group No on Question 2 warns that the measure represents a “recipe for elder abuse,” because an abusive caregiver or heir could potentially serve as a witness to the patient’s request for life-ending medication, though the text of the initiative does require at least one non-heir to be a witness. Opponents also argue that doctors in Oregon who have failed to make required reports have received no penalty, and the Massachusetts initiative fails to provide the resources or authority to oversee the measure’s implementation.
Though the most common arguments against Question 2 are framed in practical terms, moral criticisms of the law have been leveled elsewhere. Boston Globe columnist Tom Keane has written that Question 2 would both “enshrine” the “selfishness” of suicide into law and make the mistake of supposing that some lives are not worth living. Cardinal Sean P. O'Malley, who heads the Roman Catholic Archdiocese of Boston, condemned the initiative (then still in the signature-gathering phase) at a mass for state lawyers and jurists last year. Even Vicky Kennedy, wife of the state's late senator, has opposed the measure in an op-ed, arguing it would exclude family members from the decision-making process.
Given Massachusetts’ significant Catholic population, the church’s opposition makes it all the more striking that by all current indicators, Massachusetts appears poised to answer Question 2 with a decisive “yes” on Tuesday. If so, the Bay State will once again become a trailblazer of sorts in health care. That said, its leadership here would most likely not be touted by a certain former governor as a “model for the nation.”