I am writing in response to the letter printed on Sept. 27, "Williamstown residents support Death with Dignity Act."
I heartily agree that individuals approaching the end of life should be encouraged to have "honest and compassionate conversations" with their families and physicians regarding the care they want at the end of life. Too often, these conversations do not take place. Too often patients and families have expectations or perceptions about care that are inaccurate, leading to expensive and ultimately ineffective treatments.
However, Question 2, "Prescribing Medication to End Life," which will appear on the Nov. 6 ballot in Massachusetts, has no provision to encourage these conversations. What we should be doing is promoting communication between health care providers and patients concerning end of life issues, and encouraging compassionate care at the end of life so that individuals don’t feel that they have to have lethal medication on hand in order to ensure "death with dignity."
The answer to the issue of death with dignity will not be found in Question 2. If this Question is approved, it will allow terminally-ill patients to obtain and self-administer a lethal dose of medication which has been prescribed by a physician.
There are two major problems with this scenario. First, a patient who obtains and takes a lethal dose of medication is killing himself -- committing suicide. You can say, "Well, he’s going to die anyway, so why not let him choose the time and place?" -- but does terminal illness take away the moral and religious imperative not to commit suicide?
Second, the lethal medicine is prescribed by a physician, making the physician an active participant in his/her patient’s suicide. This act goes against the ethical code that guides the practice of medicine, and indeed, physician-assisted suicide is opposed by medical societies, including the Massachusetts Medical Society, the American Medical Association and the American College of Physicians.
But putting aside the moral and ethical arguments against prescribing medication to end life, who would actually qualify for this treatment? Not many. The patient must be capable of making decisions regarding his or her health care. Individuals with dementia or depression would not be able to take advantage of this law. Two physicians must determine that the patient has six months or less to live. Who can make that judgment? It is extremely difficult to tell with any certainty how long a person will live. The vast majority of people either die of a sudden, acute illness or accident, or of a chronic illness that does not have a defined endpoint.
So what is "death with dignity?" In my opinion, it begins with conversations -- with yourself, with family and those closest to you, and with your physician. What do you want to happen when you are ill? Who do you want to act as your health care agent -- the person you would choose to make decisions for you if you are unable? How aggressive do you want your care to be? What does "comfort care" mean to you -- the relief of pain and anxiety? Hospice care? Dying at home? Who do you want to be with you at the end of your life?
When you know the answers to these questions and talk about them, you are taking control of how you end your days. You don’t need lethal medication when you have enlisted the help of family, friends and your physician to honor your wishes.
Mary King, MD, FACP