May Doctors Help You to Die?

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Metropolitan Museum of Art, New York/Art Resource
Jacques-Louis David: The Death of Socrates, 1787

On November 6, Massachusetts voters will decide whether a physician may provide a dying patient with medication to bring about a faster, easier death if the patient chooses. On the ballot will be a Death with Dignity Act that reads:

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.

The growing number of jurisdictions permitting physician-assisted dying, and particularly its possible acceptance in heavily Catholic Massachusetts, might suggest a new movement, but in fact what we are seeing is an outgrowth of a decades-long evolution in public attitudes toward how we die, which began with the 1976 case of Karen Ann Quinlan. Quinlan was a young woman found unconscious and not breathing after taking Valium and drinking heavily at a…


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