Death with Dignity?
Illustration by Shout
AFTER A FALL at his Florida retirement home, Lester Angell was robbed of any mobility not already lost to metastatic prostate cancer. An impending hospital admission promised to steal what little autonomy the 81-year-old had left. As the last act of an independent but terminally ill man, Angell took control of the time and circumstances of his death by reaching into his nightstand and pulling out a pistol.
“No one should have to die alone that way,” says his daughter, Dr. Marcia Angell, a senior lecturer in social medicine at Harvard Medical School. Fourteen years after she wrote about his death in the New England Journal of Medicine, Angell is certain her father would have lived longer and met a more peaceful end if, rather than a gun, he’d had a prescription on his nightstand. “It was wrong that medicine abandoned him then, and it’s wrong now,” she says.
Today Angell is helping lead the drive to place physician-assisted suicide on the Massachusetts ballot next November. Hundreds of volunteers are buttonholing voters outside grocery stores across the state, collecting the 70,000 signatures necessary to put the measure on the 2012 ballot. If the initiative passes, we’ll join Oregon and Washington as the only states that allow physician-assisted suicide.
Getting there will not be easy: America is evenly split between supporters and opponents of physician-assisted suicide, according to a 2005 poll conducted by the Pew Research Center for the People & the Press. So the side that prevails next November will be the one that succeeds in framing the debate: Is physician-assisted suicide a patient’s right to choose “death with dignity”? Or, as Cardinal Sean O’Malley contends, is it a despicable act of “sheer brutality”?
BEFORE WE GET INTO the debate, let’s look at what’s proposed in Massachusetts: At the end of his or her life, a mentally competent adult would request a prescription for a fatal dose of medication, usually barbiturates. Two doctors would have to certify that the patient is within six months of death, and is making the request voluntarily. The patient would be required to ask two separate times, at least 15 days apart; one request would need to be in writing and witnessed by two people. Before any prescription could be written, the doctor would then have to wait 48 hours after receiving the second request, and would also have to inform the patient about alternative courses of action, including pain management and hospice care. Physicians would be prohibited from administering the lethal dose themselves, and no doctor who objected to the law would be required to write such a prescription.
It’s a measured proposal loaded with safeguards, and it reflects the wisdom and experience of a diverse group of experts: Angell and her 14 co-petitioners, including a rabbi who served for 24 years as a chaplain and director of pastoral care at Beth Israel Deaconess Medical Center; two professors of medical ethics at Harvard; a psychiatrist from Tufts; a professor emeritus of law and bioethics at Boston College; and the executive director of the state’s American Civil Liberties Union chapter.
The professionalism of the advocates and the proposed checks and balances should, but won’t, derail the fear-mongering by those who insist that such a law would open the door to the involuntary killing of the weak, the disabled, the elderly, or those whose care has become a financial burden for their families or the state. “By rescinding the legal protection for the lives of a category of people, the government sends a message that some persons are better off dead,” Cardinal O’Malley told the lawyers and judges who this fall attended the annual Red Mass for members of the legal profession. “Those who choose to live may be viewed as selfish or irrational, as a needless burden on others, and might even be encouraged to see themselves in that way.”