I AM A family practice physician, with over 45 years of experience in caring for patients, ranging from time of birth, to witnessing and supporting them when they were dying – at home, in the hospital, or in a nursing home. Raised in an orthodox Jewish family with two Holocaust-surviving parents, I have always been exquisitely sensitive to and aware of the ethical issues that can lead to the loss of humanity — both in life and death. I was thus initially against medical aid-in-dying laws that allow terminally ill adults to gently end intolerable suffering in general.
But I converted to becoming a staunch supporter of the current Massachusetts End of Life Option Act from my perspectives as a physician, a daughter, and, most importantly, as a human being, after witnessing both of my parents’ painful deaths, despite help from hospice and palliative care, and regardless of their prior explicitly expressed wishes to die peacefully.
Numerous other physicians, as well as lawmakers, are converts on this issue. Last month, Delaware lawmakers passed medical aid-in-dying legislation after 10 years of debate on the bill since 2015. One lawmaker, Republican Rep. Kevin Hensley, was a longtime opponent of the bill, until his terminally ill mother used California’s End of Life Option Act to gently end her suffering last year. He vividly testified that her experience changed his mind and led him to vote for the bill.
The Massachusetts End of Life Options Act has the same core provisions as the Delaware medical aid-in-dying legislation, and both bills have a supermajority of public support. The relatively small percentage of opponents of medical aid-in-dying laws often try to compare them to other nations’ laws allowing euthanasia because they cannot point to even one documented case of abuse or coercion involving medical aid in dying.
For example, a 2020 University of Pittsburgh School of Law report concluded the experience with medical aid in dying in other jurisdictions “puts to rest most of the arguments that opponents of authorization have made — or at least those that can be settled by empirical data. The most relevant data — namely, those relating to the traditional and more contemporary concerns that opponents of legalization have expressed — do not support and, in fact, dispel the concerns of opponents.”
In Oregon, studies have concluded that medical aid in dying promotes appropriate and increased hospice use; contributes to more open conversations between doctors and patients about end-of-life care options; and results in greater knowledge about palliative, end-of-life and hospice care, as well as better-qualified clinician palliative care training.
I am thoroughly reassured by the required stringent mental health screening each potential patient undergoes to be sure that they are not suffering from untreated depression or mental illness, or feeling like they are a burden to their family, financial or otherwise – rather, that they are making a free will decision based on a desire to preserve their own choices at the end of life. I do not support Canada’s euthanasia law because it does not include these safeguards.
Four equally important requirements in US medical aid-in-dying laws and the Massachusetts legislation include:
the diagnosis of a terminal illness;
a remaining life expectancy of six months or less (the same eligibility standard for hospice admission);
the prescribed aid-in-dying medication must be self-ingested by a patient of their own free will; and
no physician would ever be required to write a prescription if they are not completely comfortable doing so.
Finally, the actual number of patients who choose this option of medical aid in dying to peacefully end their suffering where it is legal is actually about one-third lower than those who received a prescription. It is in large part due to the freedom from the fear, and the anxiety and the subsequent unmanageable pain that lack of options can actually cause. This calming, palliative effect may actually result in a terminally ill person living longer than expected, with a better quality of life.
These robust safeguards allow me to strongly support passing this medical aid-in-dying bill now in Massachusetts, so that terminally ill patients can have the option to choose how to end their last days of life painlessly, peacefully — and on their own terms.
Shelly Berkowitz is a semi-retired family practice physician who lives in Northampton.
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