Massachusetts state bill would allow medical assistance in dying

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The law would allow terminally ill patients to end their lives with drugs if they meet specific criteria.

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For patients facing a terminal diagnosis with six months or less to live, the state legislature is debating whether or not such residents should be given the option to end their lives whenever they choose.

the Invoice“A law relating to end-of-life options” would allow, in very specific circumstances, the possibility for very ill people to obtain a prescription for end-of-life medication from a doctor.

It is proposed that a process be put in place to ensure that only those who want to use the law for the intended purposes get the drug. They would have to apply to a doctor and meet certain criteria, including going through a 15-day waiting period, making a written request, and having the request approved by a mental health professional.

They also cannot benefit from medical assistance in dying solely because of their age or a disability, among other criteria, according to the law.

The idea behind the law is not unique to Massachusetts. In fact, the neighboring states of Vermont and Maine have had such laws since 2013 and 2019, respectively. The nation’s oldest medical assistance in dying law came into effect in Oregon in the mid-1990s.

The Massachusetts bill was reintroduced in the Legislative Assembly in February. A audience was held virtually on October 1 by the Joint Committee on Public Health – where the bill was returned in March.

A similar proposal was narrowly defeated in Massachusetts in a ballot question vote in 2012, and opinions remain deeply divided, with strong arguments both for and against the bill. Here is an overview of each.

Advocacy for medical assistance in dying

During a recent virtual press conference, Peg Sandinexecutive director of Death with Dignity in Portland, Oregon, said the laws have worked “perfectly” in each of the states that have them.

“There is no abuse, no coercion, no fraud,” she said.

For those hoping for the state to pass the law, it can’t happen soon enough.

Lee Marshall, a retired nurse and psychotherapist in Gloucester, has been battling stage 4 metastatic breast cancer since 2018. She was first diagnosed with the disease in 2011 and underwent a mastectomy and courses of radiotherapy and chemotherapy.

Her healthcare team thought she was cancer free, but about three years ago she learned that her cancer had metastasized and she had tumors in her brain, bones, liver and lungs. , she said at the press conference.

Since then, she has undergone more chemotherapy for it to cause unwanted side effects — nausea and vomiting, fatigue, cognitive changes, skin rashes, mouth sores and lack of appetite, among others, Marshall said.

Her prognosis is now less than a year of survival, and she said she could enter palliative care “very soon”.

It’s not that Marshall wants to die, she said.

“I want more time to be silly with my husband, Paul, and my friends,” she said. “I want more time to dance, crack jokes, make pottery and enjoy nature walks. I thought I would live to be 80, but I probably won’t see 70. I’m terrified of the lingering pain that will leave me with no enjoyment in life and no ability to say, “Enough is enough.”

She lobbied for the law to pass, asking lawmakers “to listen to terminally ill voters, their constituents who have seen a loved one die a needless and painful death, and to have compassion to move on.” end-of-life options”.

Michael Martinetti of Lexington has suffered from a rare neuromuscular disease since the 1990s. It’s a condition that will shorten his life, he said at the press conference.

Currently in an electric wheelchair, the disease “will eventually make me incapacitated”. He could also have spinal cord and peripheral nerve degeneration, and could develop diabetes and heart disease, including heart failure and an enlarged heart. He said these things were already beginning.

The proposed law, he said, protects people with disabilities, like himself, from coercion, noting that having a degenerative or chronic illness, being in a wheelchair or using a ventilator is not enough to qualify if you don’t. ‘re not also terminally ill.

“The end of my life will be difficult,” he said. “I want autonomy and the freedom to make my own decisions.”

Lawmakers recognize that not everyone will want to use this law.

“This bill is not for everyone,” State Representative Ted Phillips of Sharon, a co-sponsor who drafted an earlier version of the bill, said at the press conference. “We have worked very, very hard over the years to make it very clear in the legislation that there is no ambiguity about who this bill affects, that this decision cannot be made for you, that decision is yours alone.”

The Case Against Physician-Assisted Dying

But not everyone in the state is convinced the proposed law would be a good thing if passed, and some believe better care should be provided to people at the end of life, rather than medical help at the end of life. pass away.

Dr Laura Petrilloa palliative care physician at Massachusetts General Hospital, notes that the law would “essentially decriminalize” a physician giving a patient life-ending drugs.

She noted that she was practicing in California when the state passed its medical assistance in dying law. Those involved in creating the law reviewed it carefully – Petrillo said she attended many meetings to discuss the law before it was passed there.

“I would say the main reason we’ve taken this so seriously is that it’s a radical change in the way medicine is practiced, something that none of us have ever done. done, to intentionally end a life,” she said during a virtual press conference arguing against the bill’s passage. “There are a lot of misconceptions about what palliative care and palliative care are, but we don’t intentionally end lives in our practice, and that deeply affects everyone involved. It affects deeply held beliefs and is irreversible.

Doctors there believed that medical assistance in dying should be a “last resort” compared to “high quality end-of-life care”.

In today’s pandemic-focused world, healthcare systems are under strain and “public perception of science and medicine is more strained.”

“It’s a really tough time in healthcare to talk about the inside, and a lot of people are hanging by a thread, and our collective ability to absorb more challenges is limited,” he said. she declared. “That’s why now is literally the worst possible time for end-of-life options law.”

Petrillo also described the inequalities the pandemic has laid bare.

“The pandemic has also made it extremely clear that bias – such as ageism, ableism and racism – is present in all aspects of society, and especially medicine, and not only affects the way people feel accountable to each other in a public health sense, but they also lead to disparate health outcomes, including mortality,” she said.

Petrillo pushed for “better end-of-life care.”

“We’ve made a lot of progress in recent years to increase communication about end-of-life preferences,” she said. “There is a lot more to be done to ensure that people have access to a period of high quality medical care, but especially end-of-life care, and resources to have care that matches their goals. at the end of life.

John Kelly, a Boston-based disability advocate who is paralyzed from the shoulders down, also advocated for better end-of-life care, especially at home.

“Massachusetts should instead fully fund home care for everyone so no one has to rely on unpaid caregivers and face the prospect of a nursing home or [medical aid in dying],” he said. “Massachusetts should provide world-class palliative care. Equality under the law depends on it.

On behalf of the League of United Latin American Citizens, Maria Rivera Brown said the group does not support medical assistance in dying, noting that “we have faced health care disparities for many, many years. years”.

“We believe medicine should be about prolonging life, not ending it,” she said. “We believe they have no right to predict when someone is going to die. All patients deserve the best treatment options and recovery care.

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