Mass. Voters Face Assisted Suicide Ballot Question

by Sharon Wachsler

Although it is not on the Maine ballot this year, assisted suicide referendums are becoming more common, and there's a good chance that Mainers will face this question again eventually. Currently, Oregon and Washington have passed assisted suicide laws by ballot question, and Montana has legal assisted suicide as a result of legal precedent.

Meanwhile Massachusetts voters will be asked to vote yes or no on this issue on Tuesday. Disability rights activists are battling against the Commonwealth's generally liberal point-of-view to show that this law is not necessarily the choice for all progressives and social justice advocates.

The Cambridge Commission of Persons with Disabilities (CCPD) voted to oppose the ballot measure. Some of their reasons:

At first glance, Question 2 might sound like it gives individuals choice and autonomy, but the experience in the two states that have passed such laws leads CCPD to be very concerned. Modeled after Oregon and Washington’s assisted suicide laws, Question 2 fails to correct problems that have led to documented cases of abuse, discrimination, and pressures to choose suicide over medical treatment based on cost considerations.

 The National Council on Disability (NCD) also opposes the measure. Their Position Paper on Assisted Suicide states that:

The dangers of permitting physician-assisted suicide are immense. The pressures upon people with disabilities to choose to end their lives, and the insidious appropriation by others of the right to make that choice for them are already prevalent and will continue to increase as managed health care and limitations upon health care resources precipitate increased ‘rationing’ of health care services and health care financing.

The so-called ‘slippery slope’ already operates in regard to individuals with disabilities…If assisted suicide were to be legalized, the most dire ramifications for people with disabilities would ensue unless stringent procedural prerequisites were established to prevent its misuse, abuse, improper application, and creeping expansion.

Disability rights advocates point to a number of serious flaws in the Massachusetts law. Again, quoting from the CCPD newsletter:

• Lack of safeguards. The current language shows a striking lack of oversight and safeguards, putting people at risk of being misdiagnosed and receiving inadequate treatment (including mental health treatment). This is a recipe for elder abuse -- according to the Patients’ Rights Council, already 1 in 10 Massachusetts elders are abused, an increase of 31% in the last three years.
• Delegated Decision-making. The proposed law has a marked lack of clarity as to the impact of existing state laws regarding Health Care Proxy and Durable Power of Attorney in implementing assisted suicide. Under this initiative, an heir could be a witness and help someone sign up for assisted suicide despite a potential conflict of interest. Once a lethal drug is in the home, there is no requirement for professional oversight to monitor how that drug is administered.
• Expected Survival less than 6 months. A physician must diagnose a person as having a terminal condition with 6 months or less to live, opening the dangers of assisted suicide to many who are not terminally ill. Experience in Oregon and Washington shows that many people who appeared qualified within the defined time span, but declined assisted suicide, lived months or years beyond the doctor’s estimate, or even survived to recover from their disease.
• Lack of Mental Health Screening. The proposed law does not require an independent mental health evaluation of persons requesting lethal prescription medication (two physicians must agree that a patient qualifies for assisted suicide, but there is no requirement for either of them to be psychologists or psychiatrists). This reflects a widespread cultural and scientific bias that people with terminal diagnoses who ask for help to commit suicide are not in need of a screening for depression or an evaluation for any other mental health diagnosis.
• Continuity of Care. The proposed law does not include any requirement to investigate cases where physicians who have known a patient over time have found the patient ineligible for the criteria for assisted suicide. Physicians new to such cases who agree to assist in suicide are protected under the proposed law if they simply claim they acted in “good faith” -- a standard so low as to make any purported safeguards unenforceable.

Nobody is in favor of suffering -- whether dying or living. Advances in palliative care and hospice medicine have made great strides in the last two decades. Yet the proposed law offers suicide as a resolution to suffering without any requirement that all avenues of palliative treatment be exhausted to alleviate a patient’s suffering before suicide intervention.

This is why Massachusetts disability rights activists who have been studying -- and affected by -- debates over assisted suicide and euthanasia have named their group, "Second Thoughts." Because not only do people who sometimes decide they do want to kill themselves due to their diagnosis sometimes have second thoughts about that decision, but also because those who might reflexively think, "Yes," at reading Question 2 might not know all the facts, and if they did, have second thoughts and decide to vote no.

For myself, I always think of Diane Coleman's statement, published in the New York Times, "It’s the ultimate form of discrimination to offer people with disabilities help to die without having offered real options to live."

For further information on this topic, please visit Second Thoughts or NDY's Assisted Suicide Talking Points.