Once again we have an opportunity to address the long-needed remedy around issues of medical aid in dying. Please let us not let this opportunity pass us by. With overwhelming support from residents, it is time to let prevailing opinion decide, not the state and not religious groups. We each have our own morals, ethics, or religion.
The April 15 Opinion section presented contrasting views, under the overline “Should Massachusetts allow medical aid in dying?” from Cardinal Seán P. O’Malley, archbishop of Boston ( “No. Physician-assisted suicide is a slippery slope.” ), and writer Phil Primack ( “Yes. Prolonging the inevitable is no way to live.” ). The point-counterpoint generated a range of reaction from readers:
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As helpful as hospice and palliative care can be in many situations, they are not sufficient in all situations. They do not come close to answering all patients’ needs.
As a mental health professional with a specialty in suicide bereavement, I want to offer my perspective on the debate over end-of-life care. For more than 40 years, I have worked with families dealing with the aftermath of a loved one’s suicide. I am no stranger to the pain and grief families experience. However, I have been taken aback by references to some patients’ wish to end their suffering when terminally ill as “physician-assisted suicide.” I am dumbfounded that people would compare the tragedy of someone taking their life due to mental health problems to those at the end of their life wishing to hasten their certain death in the face of the certainty of suffering.
Individuals should be free to make their own medical decisions. Let’s trust ourselves, with the help of our physicians, to make the best decisions for our own care at the most difficult of times.
I am the last person who would be “pro-suicide.” This is not about encouraging someone to take their own life; this is about compassionate end-of-life care.
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Mimi Elmer
Cambridge
The writer is a licensed independent clinical social worker.
As doctors, we can help our patients from succumbing to despair
As a physician dedicated to the well-being of my patients, I feel compelled to emphasize an additional aspect in the discourse surrounding physician-assisted suicide: the profound impact of existential suffering and despair experienced both by individuals facing debilitating illnesses and by their loved ones. It is during these moments of profound loss and fear that our role as physicians transcends mere medical treatment and calls us to provide unwavering support and a reliable presence.
The sense of meaninglessness that can accompany a terminal diagnosis should not lead us down the path of condoning assisted suicide. Rather, it should serve as a catalyst for deepening our commitment to compassionate care and fostering genuine human connections with our patients. In the face of adversity, our patients need to know that they are not alone and that we are steadfast allies in their journey, offering solace every step of the way.
Instead of succumbing to despair, let us embrace our patients with empathy, providing them with the comfort and reassurance they need to navigate the challenges ahead. Let us stand together in rejecting the notion that death is the answer to despair and instead reaffirm our commitment to walking alongside our patients with understanding.
Dr. Lorenzo Berra
Cambridge
The writer is affiliated with the Mass General Research Institute and is the Reginald Jenney Associate Professor of Anesthesia at Harvard Medical School. The views expressed here are his own.
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Differing with Cardinal O’Malley: Suicide is not ‘always’ tragic
Seán P. O’Malley argues that suicide “is always tragic whether administered under a doctor’s care or self-inflicted.”
My friend Chris Corbett was diagnosed with ALS and took his life on his 80th birthday, with physician-supplied ingredients. “Eventually,” according to the Mayo Clinic, “ALS affects control of the muscles needed to move, speak, eat, and breathe. There is no cure for this fatal disease.”
Chris was in complete command of his mental faculties and did not want to live with this disease. If Cardinal O’Malley had written that suicide is often tragic, I might agree. But I cannot agree with his sweeping statement that it is always tragic.
William Vaughan Jr.
Chebeague Island, Maine
State’s End of Life Options Act includes key safeguards
I grew up Catholic and respect Cardinal Seán P. O’Malley, but I couldn’t disagree more with him about this important topic and the pending End of Life Options Act. His characterization of this measure as “physician-assisted suicide” and the use of the phrase “slippery slope” in the headline and in the body of the essay serve only to inflame and mislead readers. The legislation has significant safeguards that would prevent a slippery slope or abuse based on financial or other considerations. It is limited to terminally ill patients of sound mind making a fully informed decision to end suffering and pass in a peaceful way. It is compassionate.
As for the concern about a slippery slope among some people with disabilities, I was the president of Spaulding Rehabilitation for many years; most traumatically injured and congenitally disabled people would not be eligible under the End of Life Options Act’s restrictive requirement regarding terminal illness.
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It is long overdue for Massachusetts residents to have this option to end intolerable suffering.
David E. Storto
Concord
The writer is a volunteer for Compassion and Choices.
Two Boston doctors have several concerns about legalizing this practice
As two Boston inpatient physicians, we welcomed Cardinal Seán P. O’Malley’s op-ed opposing physician-assisted suicide. However, the implication is that opposition is limited to conservative Catholics. In fact, a recent set of summaries from the Pew Research Center shows that most major world religions oppose physician-assisted suicide. Disapproval goes back to Hippocrates, whose oath states, “I will do no harm [nor] give a lethal drug to anyone if I am asked.”
Importantly, the largest physician associations in the United States — the American Medical Association and the American College of Physicians — oppose physician-assisted suicide. In a 2019 national study, fewer than 9 percent of physicians stated that they would perform it if it were legalized.
We have several concerns about legalized physician-assisted suicide. We worry it will take the focus away from what is really needed: robust investment in and expansion of quality palliative care. Much of the push for physician-assisted suicide stems from this inadequacy. We also worry about the coercion patients may experience; the testimonies of a Nevada physician in 2017 and a California woman in 2016 suggest some insurance companies may cover drugs for physician-assisted suicide but not other treatments.
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We worry about possible racism and inequity, since physician-assisted suicide has the strongest support among educated white people and much less support from Black and Hispanic communities, according to a 2019 report from the National Council on Disability. Patricia King, a law professor at Georgetown, told the Washington Post that, as the reporter paraphrased, “many in the Black community distrust the health care system and fear that racism in life will translate into discrimination in death.” Similarly, Dr. Lydia S. Dugdale of the Yale School of Medicine, wrote that legalizing physician-assisted suicide “may just be adding to the atrocities committed by society and the health profession toward Black and Hispanic patients.”
We worry most that legalization would disrupt the patient-doctor relationship. “Compassion” means to suffer with. Our calling is to provide healing and comfort to our patients in their time of need. We must invest in improving patients’ quality of life, not treat them as expendable.
Dr. Thomas Heyne
Boston
Dr. Nancy Hernandez
Boston
The writers are attending hospitalists at Massachusetts General Hospital and instructors in medicine at Harvard Medical School. They speak for themselves and not their institutions.
Modern Hippocratic oath offers a different view of a physician’s care
As a supporter of medical aid in dying, I wonder whether Cardinal Seán P. O’Malley is aware of the modern version of the Hippocratic oath that doctors of my generation and subsequent ones took upon graduation. Written in 1964 by Dr. Louis Lasagna, it takes social and psychological factors into account when trying to determine the most empathetic care of one’s patients. It is more than 340 words long and includes the following:
“I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug. … Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.”
Dr. Mark Rodehaver
Brookline
Medical aid in dying? Doctor-assisted suicide? Depends on view.
