It is hereby declared that the public welfare requires a defined and safeguarded process by which an adult Massachusetts resident who has the capacity to make health care decisions and who has been determined by his or her attending and consulting physicians to be suffering from a terminal disease that will cause death within six months may obtain medication that the patient may self administer to end his or her life in a humane and dignified manner. It is further declared that the public welfare requires that such a process be entirely voluntary on the part of all participants, including the patient, his or her physicians, and any other health care provider or facility providing services or care to the patient.If this ballot initiative passes, it will be binding, and Massachusetts will join Oregon, which implemented a virtually identical statute in 1998, and Washington, which did the same in 2009, as the only states where voters approved this form of physician-assisted dying, sometimes called aid-in-dying. (These terms are favored by proponents over the older term, physician-assisted suicide, because they distinguish it from the typical suicide in which someone with a normal life expectancy chooses death over life. Here the patient is near death from natural causes anyway, and chooses the timing and manner of an inevitable death.) Montana, through a 2009 decision by its Supreme Court, not a voter referendum, also permits physician-assisted dying.
Euthanasia—the act of directly injecting medication to cause death rather than providing medication for the patient to take if he or she chooses—is also a form of assisted dying, but it is banned everywhere in the United States. It is also banned in Switzerland, where assisted dying is otherwise allowed. However, euthanasia is legal in the Netherlands, Belgium, and Luxembourg, where they make no moral distinction between the two forms of assisted dying, and euthanasia is favored because it’s easier and faster. In June, the British Columbia Supreme Court overturned the Canadian law against assisted dying.1 If that decision stands on appeal, Canada will likely join the Benelux countries in allowing both forms of assisted dying.
Before Quinlan, there wasn’t much explicit attention given to whether and how to bring about an earlier death in permanently unconscious patients, or in patients who, although conscious, were suffering unbearably at the end of life. In fact, in the 1960s, when I trained in medicine, dying was hardly mentioned in medical school or training programs, except as a failure of treatment. It was rarely spoken of to families, let alone patients, who were never to be denied hope for a recovery, no matter how dire the prognosis. Sometimes when patients were in obvious misery at the end of life, doctors would increase the dose of morphine, with the expectation that it would hasten death, but they usually didn’t consult with anyone about it (an order for a large dose of morphine could lead to trouble even in those days), and it was more a reflection of doctors’ compassion and courage than patients’ needs and desires.
There were a few, isolated concessions to the inevitability of death during this period. In 1957, Pope Pius XII held that there is no moral requirement for doctors or families to provide “extraordinary” medical treatment, by which he seemed to mean futile or extremely burdensome treatment. In 1968, a group of prominent physicians recommended that death be redefined to include brain death even while respiration and heartbeat continued, and that treatment could be withdrawn from such patients. Also in the 1960s, Dame Cicely Saunders introduced the British hospice movement to the United States, and Elisabeth Kübler-Ross published her book, On Death and Dying, which argued for greater acceptance of death. Nevertheless, until the case of Karen Ann Quinlan, removing life-sustaining treatment, particularly artificial feeding, would generally have been considered tantamount to euthanasia, and simply was not done.
Nor was it nearly as urgent a question as it later became. Before the time of Quinlan, we simply didn’t have the technology to sustain life artificially for very long. In addition, there was another reason the right-to-die movement began about the time of Quinlan. As medicine became more specialized, of necessity it became a team endeavor, not a purely private matter between one physician and one patient. So a physician could not quietly increase the dose of morphine, as before. Instead, these sorts of decisions were removed from the bedside, discussed among team members, and became subject to ethical and legal oversight.
by Marcia Angell, NY Review of Books | Read more:
