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Assisted Suicide on the Ballot: Beyond Fear Tactics

Posted by Dr. Lachlan Forrow  October 28, 2012 08:01 AM

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Should a doctor in Massachusetts be legally permitted to write a prescription for a patient to use in suicide?  On November 6, the people of the Commonwealth will decide. 

This is an issue about which deeply thoughtful, caring, and principled people in Massachusetts have profoundly differing views.  Each "side" has, among its most passionate advocates, people I greatly admire.  The moral, practical, political, religious, and other issues that Question 2 raises for people are almost infinitely complex.  But the choice each of us will face when we vote is as simple as it can be. 

Just two choices.

YES.

NO.

I have serious misgivings about whether a ballot initiative is the best way for the people of Massachusetts to make decisions about profound, complex moral issues.  My misgivings are especially great when, as I believe is true of Question 2 next Tuesday, many people are going to have to cast their vote without having had the time, opportunity, or help they needed to develop a clear and accurate understanding of what those issues are. 

I am further distressed that too many of the ads, op-eds, and advocacy emails that I have seen -- from both sides -- seem to me to present seriously distorted, irresponsibly exaggerated  claims that are designed to frighten you into voting one way or the other.  If I didn't know better, I would be more frightened than ever about myself or a loved one ever having a so-called "terminal illness".   

Scaring people by misinforming or misleading them, even if you think you are doing that in order to help them do what is good for them, is wrong.  The fact of our inevitable mortality is, for most of us, scary enough. Exploiting those fears for political purposes, however well-meaning, is wrong.  It was wrong when Sarah Palin and others promulgated lies about non-existent plans for alleged "death panels" during the national health care reform debates.  It is wrong today in Massachusetts when people exploit your fears to get you to vote the way they think you should on Question 2.

More specifically, I think it is wrong here in Massachusetts when scare tactics are used to frighten people into thinking that Question 2 is "a recipe for elder abuse", as if that is even remotely the intent of its proponents, or even remotely acceptable to them.   I also think it is wrong to promulgate fears that, if Question 2 passes, insurance companies will encourage you to commit suicide in order to save themselves money, as the "No on 2" website implies in a video titled "Barbara's story" that features a headline from Oregon:

"Health Plan covers assisted suicide but not new cancer treatment...Don't let her experience in Oregon happen here in Massachusetts."

I do not believe any health plan in Massachusetts would ever do that.  Suggesting that they would is insulting to them and their leaders.  I sometimes disagree with our health plans and their leaders, but in my experience the leaders of Massachusetts health plans care deeply about trying to ensure that their subscribers receive the best patient-centered value out of every health care dollar spent. 

And even if leaders of a health plan in Massachusetts were one day as venal as some people believe they already are today, they are not that stupid.  The people of Massachusetts are vigilant, and even a single well-documented case of a health plan trying to encourage a patient to commit suicide in order to save money would lead to such a public backlash that that plan's "business success" would be devastatingly damaged, if not ruined forever.  As it would deserve to be.

Similarly, I think it is wrong when proponents of Question 2 suggest that, unless a doctor is legally permitted to write lethal prescriptions, you or a loved one may well be forced to endure a prolonged period of terrible physical suffering.  Here is what the "Yes on 2" website says:

Patients dying of late stage cancer, and other terminal illnesses, can face weeks or months of extreme pain and suffering before death.

They clearly want you to believe that unless Question 2 passes, you are at high risk of being forced to experience unconscionable levels of suffering.  In truth, whether Question 2 passes or not, the only reason a patient in Massachusetts need ever face "weeks or months of extreme pain and suffering before death" is if their medical caregivers are utterly incompetent. 

Scaring people does not usually help them think more clearly, or help them make decisions more responsibly.   And for the overwhelming majority of people, no matter how they decide to vote, and no matter what the result on November 7, there is little or no reason to be scared about what happens with Question 2.

In my next posting, I will try to offer more detailed reassurance.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

Lachlan Forrow, MD is Director of Ethics Programs and Director of Palliative Care Programs at Boston's Beth Israel Deaconess Medical Center and Associate Professor of Medicine at Harvard Medical School. More »

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