Massachusetts Death with Dignity Act: Framing the issue
The Massachusetts "Death with Dignity" Act is an initiative petition for a law to be submitted for approval or disapproval by the voters of Massachusetts on the November 2012 ballot. This petition allows a Massachusetts adult resident, who has been diagnosed with a terminal illness that will likely result in death within six months, to request and receive a prescription for a lethal drug to end his or her life. If passed, the petition would legalize physician-assisted suicide. Two physicians need to determine the terminal diagnosis, the mental state of the patient, and that the patient is acting voluntarily. The patient must make two oral requests within no less than fifteen days of one another. A written request is also required with a minimum of forty-eight hours between the written request and the writing of a prescription for the lethal drug.
The first step in the initiative petition process has been accomplished. Supporters of the bill submitted over 86,000 certified signatures, more than enough to lay the petition before the legislature. It is likely that the legislature will not take action on the petition and that supporters will obtain the approximately eleven thousand additional signatures necessary to place the petition on the ballot in November.
There are two categories of problems associated with the initiative petition for physician-assisted suicide--problems of a fundamental nature and those concerning a lack of adequate safeguards. Both sets of problems ultimately arise from the fact that physician-assisted suicide is a denial of the dignity of the human person. The first category pertains to problems such as giving support to the notion that a person is better off dead, or the fact that the petition places physician and patient on a path toward suicide for the patient rather than genuinely addressing the physical, emotional, social, and spiritual needs of the patient. Palliative and hospice care offer a wide range of choices to meet these needs. They are able to treat all pain and alleviate the fears of dying patients. Other fundamental problems posed by the petition include a corrosion of the physician/patient relationship, a threat to the integrity of the health care profession, and a failure to uphold the common good.
The second category of problems includes, among other things, the lack of adequate measures in the petition to ensure that the patient is truly giving informed consent. For example, there are inadequate guarantees relating to items such as the evaluation of the patient's mental status, the witnesses to the written request, and monitoring of the act of ingesting the drug. There are also problems with the provision regarding a prognosis of death within six months, and there is a lack of information about what will be included in the annual report from the department of public health on requests for physician-assisted suicide. However, even if every practical problem with the petition were fixed, the petition would still be morally unacceptable because of the fundamental problems present at its core.
All of the problems with the petition, taken singly and together, belie the claim that the petition ensures a free and informed choice on the part of the patient. What is more, the petition is designed not to end the suffering of these patients, but rather is directed at ending the patient. How can it be said that physician-assisted suicide ends suffering when there is no patient who survives to experience or be the recipient of relief from pain and suffering? The petition fails on the three items it is supposed to ensure: choice, compassion, and safeguards.
On February 11-12, in conjunction with World Day of the Sick and the memorial of the feast of Our Lady of Lourdes, the Archdiocese of Boston launched an educational campaign to address the issues outlined here. The campaign is designed, first, to help Catholics learn about physician-assisted suicide and Catholic teaching on end of life care and, second, to learn what they can do to defeat the petition. The campaign consists of three phases to take place during February, May, and October. A variety of materials, resources, and workshops will be available to parishes and parishioners so that Catholics may learn about the issues and the proposed law.
Blessed John Paul II eloquently wrote that "to forego extraordinary or disproportionate means is not the equivalent of suicide or euthanasia; it rather expresses acceptance of the human condition in the face of death," and he encouraged "'methods of palliative care,' which seek to make suffering more bearable in the final stages of illness and to ensure that the patient is supported and accompanied in his or her ordeal" ("The Gospel of Life," n. 65). It is critically important that we come together as individuals and as a Church to understand that palliative and hospice care are very effective at addressing all the needs of the dying and that the petition to legalize assisted-suicide is not needed and will do a tremendous amount of harm. As Cardinal Seán asked in his homily on February 11-12 for the parishes of the archdiocese (available at www.suicideisalwaysatragedy.org), let us work together to build a civilization of love for those who are terminally ill and dying.
Peter J. Cataldo is Chief Health Care Ethicist for the Archdiocese of Boston.