By JULIE MINDA
Covenant Health Systems of Tewksbury, Mass., is among the organizations opposing the Massachusetts Death With Dignity Act, an initiative slated for the Nov. 6 ballot in Massachusetts. The act would allow physicians to prescribe a lethal dose of medication for terminally ill patients wishing to end their lives.
"There is an underlying notion in Catholic health care — a reverence for life, from conception to the natural end of life, and physician-assisted suicide flies in the face of that notion," said MC Sullivan, director of ethics for Covenant. But, even from a secular perspective, she said, "This is a poorly written law that lacks safeguards" that would ensure patients have all the information and protection they need to make an informed choice when they have a terminal illness and are considering assisted suicide.
Backed by the organization Compassion and Choices, ballot Question 2 asks voters whether a licensed physician should be allowed to prescribe a life-ending dose of ingestible medication to a patient who is 18 years or older, mentally capable of making health care decisions and who has an incurable, irreversible condition that is expected to cause death within six months.
The proposed law would require the patient to request the dose on two occasions 15 days apart and to sign a form in the presence of two witnesses confirming the request. One of the witnesses must not be a relative, beneficiary of the patient's estate or owner or staff at a health care facility where the patient is residing or receiving care.
The law requires that the physician determine whether the patient qualifies to receive the prescription and that the physician inform the patient of his or her diagnosis and the prognosis that the patient has a terminal illness likely to result in death in six months or less. The physician also must inform the patient that the prescription is for a lethal dose and that death will ensue if the medication is taken. The physician must mention alternatives to the suicide choice. The physician must refer the patient to a consulting physician for a confirmation of the diagnosis of a terminal condition and a confirmation that the patient is mentally competent to make the decision and that the patient has made an informed and voluntary decision.
The physician also may refer the patient for psychiatric or psychological consultation, but that is not a requirement of the law. If the physician refers a patient for counseling, that physician is not to prescribe the lethal dose until a counselor confirms that the patient's judgment is not impaired because of psychiatric, psychological or depression concerns. The doctor may also recommend that the patient notify family members of his or her intentions and that the patient have another person present when taking the lethal dose. The physician would be required to ensure the patient understands he or she can rescind the request for the lethal prescription.
Physicians who currently assist in suicides typically use the barbiturate Seconal, according to Sullivan, who said, "I have been told that the lethal dose comes in the form of a quite large number of tablets, bitter tasting ... The mechanics of this death is not pretty. Many people have attested that it is a difficult act to accomplish without distress."
Missing patient safeguards
"It's important for people to understand this law is flawed and that there is the potential for abuse," Sullivan said of the Death With Dignity Act.
According to the Committee Against Physician Assisted Suicide — Sullivan is on the committee — the law does not require patients to meet with a psychologist or psychiatrist who could detect and diagnose mental health concerns, such as clinical depression — a treatable condition. Also, the ballot question does not have safeguards to ensure patients receive adequate information on — and access to — alternatives to physician-assisted suicide. Alternatives can include hospice care and pain control therapies.
Additionally, there is no requirement that the prescribing physician have expertise in end-of-life care. The committee also notes in its materials that a six-month prognosis for death — the threshold proposed in the act — is often "just an educated guess," and people can live much longer than doctors predict they will. The Committee Against Physician Assisted Suicide is an independent coalition of health care experts, religious organizations and civic groups.
Sullivan noted that Massachusetts legislators have indicated they are unwilling to modify or amend a law passed as a referendum — and this act is a referendum. A survey conducted by the YouGov America Internet pollsters for the University of Massachusetts Oct. 2-8 indicated that 65 percent of respondents favored the law; 19 percent opposed it; and 17 percent didn't know whether they supported the law.
Educating voters
The Roman Catholic Archdiocese of Boston has created materials for parishes and other Catholic organizations to educate voters about the concerns with the proposal. Among the materials are bulletin announcements, prayer cards, posters, bumper stickers, yard signs, homilies and sample emails for people to send to their friends and neighbors. CHA and the Supportive Care Coalition support the church's position.
In support of the archdiocese's campaign, Sullivan is speaking about the ballot initiative at Catholic parishes and other organizations as well as at Covenant facilities around Massachusetts. Covenant sponsors, manages or is affiliated with three hospitals and 28 long-term care facilities, primarily in northeast states.
Prior to joining Covenant, Sullivan was executive vice president at the Center for Practical Bioethics in Kansas City, Mo., and she has expertise in palliative care that she now is sharing with her audiences. She said many people she speaks to are stunned when they learn the details of the act, particularly when they discover that 18-year-olds can get a lethal dose without a parent's involvement, and that patients may die alone after administering their own dose.
Sullivan emphasizes in her talks that palliative care providers can address the underlying concerns that may prompt patients to consider suicide.
A document from the United States Conference of Catholic Bishops, "To Live Each Day With Dignity: A Statement on Physician-Assisted Suicide," says people often seek to escape suffering because they fear the dying process, losing control of their body, lingering with dementia or burdening others with their problems. Rather than responding to these concerns by offering death, the statement says, it is incumbent upon the medical community to offer palliative care.
Dr. Woodruff English is a physician who sits on the board of the Supportive Care Coalition; and Dr. James Shaw is a former coalition chair and past head of a palliative care unit in Providence Health & Services' Eastern Washington region. English said research has shown that people who consider assisted suicide often do so because of spiritual suffering. Shaw said a big concern with laws like the one proposed in Massachusetts is that patients may pursue physician-assisted suicide without exploring options that would address the concerns they're facing.
"In a vast majority of situations, we can support them without them feeling the need to pursue physician-assisted suicide," Shaw said of dying patients. He said they often just aren't aware of their options.
Information on the opposition to the Massachusetts bill is at www.stopassistedsuicide.org and www.suicideisalwaysatragedy.org.