Death with Dignity

Massachusetts has a “Death with Dignity” or “Assisted Suicide” ballot question this year.  The discussion about it didn’t get much oxygen for a while, with the focus on the presidential and senatorial election here.  But now we’re seeing the ads run on both sides, and the Globe has an article about it this morning.  The Ballotpedia article I linked to above gives the details of the procedure, which involves a diagnosis of six months or fewer to live, confirmed by two separate physicians, two separate requests fifteen days apart, and confirmation that the patient is mentally capable of making the decision.

From what I can tell, the ballot question has run a predictable course.  Polling shows people strongly in favor of it.  But now most religious groups and professional medical associations have come out against it, as have the Globe and the Herald.  The opposition appears to have much more money to spend, and I expect the measure will probably lose.

The religious argument against it is, of course, that life is a gift from God and it’s not up to the patient or the physician to decide when to end it.  Well, OK, if that’s what you believe, don’t do it.  But why prevent others, with different beliefs, from acting differently?  In this sense, the religious argument against assisted suicide goes further than it does for abortion, where a second life is at stake.

Here are some medical arguments.

  • The doctor’s role is to heal, not to harm.  Well, OK, but I have the same response as I had to the religious argument: If you don’t want to participate in assisted suicide, don’t.  Don’t prevent others with different beliefs from doing so.
  • Medicine isn’t an exact science, and who’s to say that any particular diagnosis will turn out to be wrong?  Obviously the bill includes a safeguard against misdiagnosis, but miracles happen.  The question is whether we should forbid all patients from taking their own lives because of the possibility of miracles or misdiagnosis.
  • The patient could be depressed. I don’t really know what to say about this one except: well, duh!  Maybe a skilled clinician can sort out someone who has a medical case of depression from someone who is just depressed because, you know, he’s going to die in a few months of a horrible disease that will rob him of all his mental and physical abilities and cause him incredible agony.  I personally would find that difficult to sort out.
  • The patient could be pressured into killing himself.  To avoid expensive medical bills, for example, and preserve the estate for the heirs.  This makes some sense to me.  On the other hand, two doctors must verify that the patient has the mental capability to make health care decisions.  This isn’t really that much different from the current situation, where the patient gets to say whether or not heroic lifesaving measures should be taken on his behalf.  The problem to me is the pressure, not the financial concerns themselves–seems to me that, in a country where healthcare costs can easily ruin a family, you can’t ever just ignore them.

This kind of issue is hard, morally and practically.  For me, the best argument in favor of the ballot question is the relief it will give a lot of people just knowing that the option is there if they need it.  But, as in Oregon, relatively few people will actually end up taking advantage of it.

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