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Thoughts on Ballot Question 2

A matter of life and death.

At a certain point in my youth, my siblings and I grew bored with the tropical fish and assorted caged rodents that constituted our family pets. Led by my sister, we three kids began to lobby hard for a pet dog of our very own. When I was seven, my parents finally relented – under the usual conditions that it would be our responsibility to walk and feed the dog.

Puppy Max arrived over February vacation. By mid-April he was, of course, strictly relegated to my father’s care. Even so, we all loved Max deeply.  And for a little more than 16 years, he lived a great dog-life.

But when the end came, it was ugly. Metastatic cancer left Max riddled with pain. He was unable to walk and had difficulty breathing. I remember his last day well. My dad gently lifted sweet Max into the car, then turned to me with tear-filled eyes and suggested that I say goodbye, as Max would not be returning home to us. 

“I’ll miss him tremendously,” my dad said. “But Max has suffered enough. It’s time to let him go.”

Presumably, the veterinarian agreed with my dad, and administered something lethal to help end Max’s suffering.

I bring up Max’s case because I find myself wondering: why is it that family pets get end-of-life options that, when considered for us humans, engender nothing but controversy?

Massachusetts’ residents will have a chance to weigh in on a “Death with Dignity” question next week, as part of Tuesday’s election. Clearly, this particular ballot question addresses a morally complex issue.  Should doctors be allowed to prescribe life-ending drugs at the request of terminally ill patients?  I have read the reasons to vote yes, and I have read the reasons to vote no. Yet, with one week left, I remain steadfastly undecided on Question 2.

The part of me that leans toward supporting this ballot initiative supports the fundamental right that terminally ill patients have some control over their own death and dying process.  I believe with all my heart that patients who are writhing in agony with an end-stage illness should be able to hasten the inevitable. If we can choose it for Max, well then, why can’t Grandma choose it for herself.

To be clear: I am not condoning the likes of Dr. Kevorkian, who assisted in the suicides of individuals, some of whom were not in the throes of end-stage anything. His actions were illegal and morally reprehensible. However, if there are certain criteria in place – e.g., the patient must be close to death, must be experiencing pain and suffering, the request must be approved by a panel of physicians, a nurse, a social worker, etc. – if these conditions are met, then I think I’d support easing a loved one out of their misery.

It would appear then that I believe it should be legal for physicians to end the suffering of terminally ill patients, under very specific circumstances, without facing a charge of murder. Is that in fact my position?

But even if I support empowering patients with the right to choose this option at the end of a terminal illness, another question arises concerning this specific ballot initiative: is it, as written, deeply flawed?

Under the terms of Question 2, patients could choose to end their lives without being evaluated for depression. Patients could also choose to end their lives without conferring with hospice and palliative care professionals. 

Furthermore, doctors are not required to be present when the drug is administered and patients must be able to administer the drug themselves, which excludes many suffering from ALS and Parkinson’s type of illnesses. 

Most concerning of all is the fear that disenfranchised patients with little or no health coverage would be led to request the life-ending drug because they have so few treatment options covered under their abysmal health insurance plans.

This last point stops me in my tracks.  As someone who has had to forgo medical procedures based on cost – and this is with typical health insurance – I have to wonder: would our most vulnerable patients feel obliged to request the life-ending option to spare their families mountainous medical debt?

None of us wants our loved ones to spend their last weeks on Earth writhing in pain. Yet, sometimes the only option to alleviate the pain is to administer a dose of something which accelerates the death. I am mostly OK with this.

Mostly. But not completely.

So how to vote?

Rob2013 October 30, 2012 at 04:26 PM
Well written article! This measure was never sent through legislative committees where flaws could be corrected. Voters should consult the full text of Question 2 on the official website of the Secretary of the Commonwealth of Massachusetts. It's at: http://www.sec.state.ma.us/ele/ele12/ballot_questions_12/full_text.htm#two
Robin Cushman Phillips October 31, 2012 at 10:50 AM
Well, I won't get to vote in this election, but I am with you, Lisa. This initiative does not sound as though it would be the best way to provide an end of life option. Maybe you should be leading the committee on this one!
Chris O'Hara November 01, 2012 at 03:32 AM
As a healthy 38yr old man i want options 2 and 3 available to me if i so choose..... Choices and options are nothing to fear
Kathryn Whittemore November 02, 2012 at 12:02 AM
Excellent and thought provoking column, Lisa. I have spent some time thinking about this ballot question from several points of view (ethical, religious, medical) and you raised a point I had not yet considered. In light of the current economic catastrophe, how can we be assured that patients would not choose physician assisted suicide over burdening their families with thousands and thousands of dollars in medical expenses? It is among one of many difficult decisions we'll face on 11/6!

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