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Medicine Politics Science

Massachusetts May Soon Change How the Nation Dies 439

Posted by Soulskill
from the i-bet-it-involves-the-red-sox dept.
Hugh Pickens writes "Lewis M. Cohen reports that this Election Day, Massachusetts is poised to approve the Death With Dignity Act, a modernized, sanitized, politically palatable term that replaces the now-antiquated expression 'physician-assisted suicide.' Oregon's Death With Dignity Act has been in effect for the past 14 years, and the state of Washington followed suit with a similar law in 2008. But the Massachusetts ballot question has the potential to turn death with dignity from a legislative experiment into the new national norm, because the state is the home of America's leading medical publication (the New England Journal of Medicine), hospital (Massachusetts General), and four medical schools (Harvard, Boston University, University of Massachusetts, and Tufts). If the act passes in Massachusetts, other states that have previously had unsuccessful campaigns will certainly be emboldened to revisit this subject. The initiative would allow terminally ill patients with six months or less to live to request from their doctor a prescription for a lethal dose of a drug. Doctors do not have to offer the option at all, and patients must make three requests, two verbal and one written. They must self-administer the drug, which would be ingested. The patients must be deemed capable of making an informed decision. 'It's all about choice,' says George Eighmey, a key player in instituting the Oregon law, defending it against repeal and shepherding it into reality. 'You decide. No one else can decide for you. No can can force you into it, coerce you into it or even suggest it to you unless you make a statement: "I don't want to live like this any more" or "I'm interested in that law out there, doctor, can you give me something to alleviate this pain and suffering."'"
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Massachusetts May Soon Change How the Nation Dies

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  • Question: (Score:3, Informative)

    by Mitreya (579078) <mitreya.gmail@com> on Friday November 02, 2012 @02:09PM (#41856605)
    Is it really that difficult to acquire a lethal dose of a drug without doctor assistance?

    Or is this aiming to legally protect doctors who are assisting patients?

    • Re:Question: (Score:5, Informative)

      by mcmonkey (96054) on Friday November 02, 2012 @02:12PM (#41856645) Homepage

      Is it really that difficult to acquire a lethal dose of a drug without doctor assistance?

      Or is this aiming to legally protect doctors who are assisting patients?

      Yes, and yes.

      • by h4rr4r (612664)

        So then how do people get illegal drugs?
        Are doctors supplying those?

        You know you can just buy carbon monoxide, right?

        • Re:Question: (Score:4, Insightful)

          by flimflammer (956759) on Friday November 02, 2012 @04:05PM (#41858489)

          You think that because you can ultimately kill yourself with carbon monoxide that terminally ill patients actually want to go that way?

          They might as well put a bullet in their temple.

          The whole point is for a peaceful, clean death with as little pain as possible.

    • by Firehed (942385)

      I imagine this allows ill patients to get access to something that will bring a much cleaner and painless death than downing an entire bottle of painkillers; i.e. more like a cyanide capsule.

      It's easy to buy a lethal dose of caffeine (fairly cheap!) off Amazon, but going by how having way too much coffee feels, that would be a pretty crappy way to off oneself. Seems to go against that whole "dignity" thing they're aiming for.

    • Re:Question: (Score:5, Interesting)

      by Artraze (600366) on Friday November 02, 2012 @02:31PM (#41857021)

      > Is it really that difficult to acquire a lethal dose of a drug without doctor assistance?

      Yes.
      To elaborate: It's difficult to acquire a lethal dose of a drug that is easy to administer and will result in guaranteed, peaceful death without little to no chance of (partial) survival. Sure you can drink bleach or try to OD on alcohol or acetaminophen/paracetamol or any number of things. But they can be quite unpleasant and/or leave you alive but even worse off.

      > Or is this aiming to legally protect doctors who are assisting patients?

      Less so, I'd wager. Realistically, people rarely ask questions if someone suffering and wishing to die dies in their sleep. Doctor: "They died in their sleep last night". Family: "Ah, well their suffering is over at least". Pretty much never: "I bet you turned their morphine up you bastard!". Of course, that really requires the patient to be literally on their death bed, but either way I think the point of this is entirely a way to reduce suffering of the terminally ill and not really about doctor liability.

      • Re:Question: (Score:5, Insightful)

        by MozeeToby (1163751) on Friday November 02, 2012 @02:43PM (#41857221)

        Doctor: "They died in their sleep last night". Family: "Ah, well their suffering is over at least". Pretty much never: "I bet you turned their morphine up you bastard!"

        Pretty much never isn't good enough. If you're a doctor, are you really going to risk your career on the off chance that you get a family who is so overcome with rage that they demand a toxicology screen on their dead loved one? How about twice? How about 100 times over the course of your career? (sounds like a lot, but if you only practice for 20 years that would be less than one patient every two months). How about we have it nice and legal; so the decision is documented and acknowledged by the family and no one has to risk getting their life destroyed for doing what more and more people are of the opinion is the right thing to do.

        • by h4rr4r (612664)

          What would the toxicology screening find?
          That a dose of morphine that would not have killed a normal person might have done him in? Or that since he was on morphine for so long he was on an unusually high dose?

    • Re:Question: (Score:5, Insightful)

      by mwvdlee (775178) on Friday November 02, 2012 @02:32PM (#41857051) Homepage

      You'd think a country that executes prisoners humanely (as much as I'm opposed to death penalty, atleast they're not tortured) would want the atleast the same humane treatment for it's citizens that actually choose to die.

    • by sunking2 (521698)
      It's to protect the doctors. The truth of the matter is many doctors who have patients in these situations routinely make more than enough medication available for someone who wants to take that option. Most won't go so far as actually assisting, but they typically make the option there. This also means there is a much greater chance of not having things work out as planned and creating a bigger mess of a bad situation. Hopefully this helps that.
    • Re:Question: (Score:5, Insightful)

      by TheCarp (96830) <sjc AT carpanet DOT net> on Friday November 02, 2012 @02:37PM (#41857127) Homepage

      Yes and no. Most people are not medical experts and, shouldn't have to become so just to die with some dignity.

      The thing is, what kills one person may not kill another and most things that you can eaisly get your hands on, and even most prescriptions, are within dosage ranges that are quite safe. Yes, you can kill yourself many ways, but, many of those ways are less effective than you might think.

      I personally knew a guy who tried to off himself with barbituates. He failed, woke up several days later. This is actually fairly common with that route.

      Also many terminally ill patients are in no condition to do that research and administer the drugs without help.

      Which is why, I think we really need the second... Doctors able to help.

      I plan to vote for this one. I have worked among the medical community (at MGH no less), I have been there when my family had to have stern words with doctors who somehow interpreted our grandfather's DNR order as "Recessitate and put on a ventilator".

      This is such an important issue for so many reasons. So many people in ongoing pain that don't need to be, so many families that need to move on. I hate to bring it to money but.... 50% of health care costs are spent in the last 5 years of life.....and for what? The fact that so many doctors opt to not have chemo and opt to die rather than hang on like so many of their patients are made to should say something.

      Don't get me wrong, if someone wants to fight to the biter end, and get as many waking moments as possible, regardless of their quality, more power to them. However, what compassion is there in forcing people to go on living who have nothing to look forward to except deterioration in a bed?

      I honestly think Bill Hicks described the situation best in his comical suggestion that we use terminally ill people as stunt doubles in action films. "Do you want your grandmother to die in a sterile hospital bed, he translucent skin so thin you can see the last beat of her heart, or do you want her to meet Chuck Norris?.... wow Chuck just kicked her head clear off, my grandma is no longer in pain...this is the best movie ever!"

      • Re:Question: (Score:5, Informative)

        by Mysticalfruit (533341) on Friday November 02, 2012 @03:39PM (#41858095) Homepage Journal
        As a resident of Massachusetts, I plan on voting for this as well. The reason? When I was a kid, a friend of my parents died of inoperable brain cancer. In the end, he suffered terribly and even at age 10 I could see needlessly. He didn't die with dignity, he died in misery. I would think if I ever found myself in that situation that once the doctors told me, "Look, the seizures are going to get worse, everything is going to get really bad" that I would while I still had my facilities I could say, "That's not how I want to go, I don't want my children to remember their father like that."

        With that all said, I hope to never be there, but I want the option and more over I want to give the option to others.
  • Drone (Score:4, Funny)

    by Anonymous Coward on Friday November 02, 2012 @02:09PM (#41856613)
    Predator drone attacks for everyone now.
  • What drug would they prescribe? And what if a person starts taking it and then changes their mind after half of it? Ideally it would be a drug that does not damage the person if it doesn't kill them. Otherwise botched self administrations might just harm people or make them worse off but still alive. I'm not sure how much of an issue this is, but it seems worth considering.
    • by h4rr4r (612664)

      Why not just barbiturates?

      Quick and can easily be given in such high doses that survival is no concern.

    • by ByOhTek (1181381)

      It will probably be in single pill form - i.e. you can't take half of it unless you are seriously trying to screw yourself or the system.

      • Pills won't work for many of these patients, many are intubated or have a feeding tube, others are physically incapable of swallowing a pill because of the very diseases and disorders that are making their lives a living hell. A simple injection of morphine or something simple. Almost impossible to screw up and virtually guaranteed to produce painless death.

    • What drug would they prescribe?

      Weed, of course. Not only is it the cheapest and easiest to acquire, but it's obviously fast acting and effective considering the reported accounts of overdose.
      /sarcasm

  • How is this term at all antiquated or even at all inaccurate for this situation?

  • by crazyjj (2598719) * on Friday November 02, 2012 @02:17PM (#41856733)

    At least this will allow someone to go with their family around (and without the mess).

    Of course, doctors have been doing this sort of thing "off the books" forever. When I was a kid and a certain person I knew was dying, his doctor gave him a orders not to let his nurse inject him with this particular syringe of morphine (wink, wink).

  • I wonder what life insurance companies have to say about this. Specifically, does exercising your right to "die with dignity" automatically cause you to forfeit any life insurance that you might have? If so, that's going to doubly suck for the family you leave behind, especially if you have unpaid debts that'll be passed down to them...

    • by theNetImp (190602)

      I would hope anyone seriously considering that would weigh all the options and outcomes.

    • by plover (150551)

      Some insurance policies have specific suicide language in them, barring a claim for a suicide for a policy in force for less than a year, for example. That prevents someone from buying a million dollar policy today and killing themselves tomorrow so their family can pay off their debts.

      In a way, I suppose it's like a waiting period for guns: it interferes with you doing something regrettable in a heated response to a bad situation.

    • Re:life insurance (Score:4, Informative)

      by Anonymous Coward on Friday November 02, 2012 @02:36PM (#41857107)

      Per the act: "The attending physician may sign the patient’s death certificate which shall list the underlying terminal disease as the cause of death." So the insurance company might not even get to know.

      Link to the 2012 Ballot Questions (pdf). This question is #2:
      http://www.sec.state.ma.us/ele/elepdf/IFV-2012.pdf

  • Do terminally ill witches get to die with dignity too now or do they still get hanged?

    • by Nyder (754090)

      Do terminally ill witches get to die with dignity too now or do they still get hanged?

      Hanged? We burn witches in these parts. Tie them up to stake, and bust out the smores. Witch burning tonight!!!

    • only 'athiest witches for abortion'.

      (stupid flanders...)

    • by plover (150551)

      Do terminally ill witches get to die with dignity too now or do they still get hanged?

      No, they are given the dignity of a funeral pyre. It's just that they get preferential seating at the event.

  • We'll be able to recycle all those old phone booths into suicide booths!

  • by TehCable (1351775) on Friday November 02, 2012 @02:21PM (#41856829)
    I highly recommend Terry Pratchett's 2011 documentary "Choosing to Die." You may watch the full film on youtube here: http://www.youtube.com/watch?v=slZnfC-V1SY [youtube.com] I found the documentary extremely informative and moving.
  • those statements just sound like they want pain relief. "doctor, can you give me something to alleviate this pain and suffering" I'm sure a lot of people say this everyday. They don't want to die and they might get better.
    • by compro01 (777531)

      1. Which they would if we had anything that would alleviate it.

      2. This proposed law only covers terminally ill persons who are expect to live for less than 6 months.

  • People with strong religious convictions are the ones who have opposed Death With Dignity in other states. They should be free to suffer to death in there own excrement, vomit, and drool if they like. They should also not attempt to control how others choose to live or die.

  • some sense at last (Score:4, Informative)

    by thephydes (727739) on Friday November 02, 2012 @02:25PM (#41856897)
    I hope this spreads to other countries. What is proposed is a good step that I would support 100% if I lived there. My wife works runs a palliative care ward and the stories she tells me about patients wanting legislation like this are common.
  • I think we should go all the way here. Let's be honest -- social security and medicare are not going to be there for us and who wants to be old anyway? I propose that at age 65 (or perhaps earlier as needed) all men be issued two bottles of viagra, a key of pure (98% minimum) Colombian flake cocaine, and a week's worth of services from three strippers.

    The advantages should be obvious -- it's cheaper for everyone and certainly more enjoyable. What better way to die than while high as a kite and busting

  • Do I get to watch a movie on a big screen as I die, seeing how beautiful the world once was. Lying in a nice comfy bed with pleasant music as I slowly slip away. Later, they can turn me into soylent green for all you chumps to enjoy!
  • The simple facts (Score:5, Informative)

    by fnj (64210) on Friday November 02, 2012 @03:12PM (#41857711)

    I can't believe what a bunch of ignorant wild speculation is contained in the comments on this page. No one has even bothered to find out what Massachusetts Ballot Question 2 actually proposes [state.ma.us]. But it's simple enough in a nutshell.

    It would be assured that the patient is adult, informed, and competent; ORIGINATES the action HIMSELF; is really facing imminent and certain death as determined by both attending and consulting physicians; confirms his wish three times with plenty of time enforced to think it over; and has to sign a form in the presence of witnesses meeting prescribed qualifications. Medication would be prescribed which would be certain to result in a humane death. I have been told by the opposition it consists of 100 Seconals to dissolve in water and drink promptly[1], but the measure does not appear to specify such. A big overdose of morphine would work just as well if not better (yes, morphine can be taken orally; it just requires more of it). It's what is used now "off the record" in hospitals when a patient is in irreversible unbearable agony and his body is betraying his dignity, if he is lucky enough to have access to a physician or nurse willing to risk everything to REALLY help him the only way that counts. Don't pretend it doesn't and won't happen even without the protection of the law. The law just prevents criminalization of what is one of the kindest and most caring acts it is possible to undertake.

    It is prescribed that the death certificate shall specify the cause of death as the diagnosed disease, NOT "suicide". This is important. The patient is not "choosing death". That is HOGWASH. The patient is choosing the MANNER and TIMING of death. That is all. The death is already ordained.

    The measure would specifically outlaw (and prescribe punishment for) coercing the patient, forging a patient request, or suppressing a recission by a patient of his own request. It would not allow the active participation in the ending of the patient's life. Contrary to the opposition hysteria, it is specifically NOT, repeat NOT, an assisted suicide measure. It is a lifting of sanction against suicide under controlled circumstances, and an above-board way for the patient to acquire the means without the risk of screwing up and having the effort come out badly. It is nothing MORE than this.

    Anyone who opposes this measure is a DAMNED EVIL BASTARD who should rot in hell.

    [1] The opposition expresses horror at this "dangerous" (WHA???) method of self termination, as if falling asleep for the final time is some kind of torture.

  • Good For Them (Score:3, Insightful)

    by wbav (223901) <Guardian.Bob+Slashdot@gmail.com> on Friday November 02, 2012 @03:19PM (#41857813) Homepage Journal
    I've got karma to burn, and this thing is personal to me.

    I take offense to the start of the summary. It is called death with dignity for a reason. There are people out there with very terrible diseases they didn't ask for. For example ALS that robs the victim of the use of their muscles. Over time the diaphragm goes out, and if pneumonia doesn't get the poor soul they eventual die from lack of oxygen, much like drowning. The sick and twisted part is while the person can feel the pain they can't even express their discomfort. My father has ALS. I may have it some day. I live in Oregon and I'm proud that this law gives me and my father a chance to end things on our own terms without saddling our loved ones with even more medical bills.

    To this point my father hasn't asked for this; however, when the time comes he can. There's no reason we shouldn't allow that. It is far less dangerous than eating a bullet and gives family time to prepare. Fuck the submitter. It is about dignity.
  • by shanec (130923) on Friday November 02, 2012 @03:24PM (#41857899)

    One slight item missing from the article...

    "Due to the fear of mass suicides from the mental anguish caused by elections, the Death With Dignity Act would be suspended three months prior to all elections. "Not wanting to live like this (being exposed to non-stop presidential advertisements)" would not be sufficient excuse to superseded a very important aspect of the law, said spokesperson Dr. Marcia Angell. Everyone choosing this option must be "deemed capable of making an informed decision." It's well documented that during an election season, this is virtually, if not completely impossible."

  • by Koreantoast (527520) on Friday November 02, 2012 @04:41PM (#41858961)
    I'm neutral on the issue, but I think it's worth looking at an alternate view on the issue: http://www.nytimes.com/2012/11/01/opinion/suicide-by-choice-not-so-fast.html [slashdot.org] (Pay Wall)

    NEXT week, voters in Massachusetts will decide whether to adopt an assisted-suicide law. As a good pro-choice liberal, I ought to support the effort. But as a lifelong disabled person, I cannot.

    There are solid arguments in favor. No one will be coerced into taking a poison pill, supporters insist. The “right to die” will apply only to those with six months to live or less. Doctors will take into account the possibility of depression. There is no slippery slope.

    Fair enough, but I remain skeptical. There’s been scant evidence of abuse so far in Oregon, Washington and Montana, the three states where physician-assisted death is already legal, but abuse — whether spousal, child or elder — is notoriously underreported, and evidence is difficult to come by. What’s more, Massachusetts registered nearly 20,000 cases of elder abuse in 2010 alone.

    My problem, ultimately, is this: I’ve lived so close to death for so long that I know how thin and porous the border between coercion and free choice is, how easy it is for someone to inadvertently influence you to feel devalued and hopeless — to pressure you ever so slightly but decidedly into being “reasonable,” to unburdening others, to “letting go.”

    Perhaps, as advocates contend, you can’t understand why anyone would push for assisted-suicide legislation until you’ve seen a loved one suffer. But you also can’t truly conceive of the many subtle forces — invariably well meaning, kindhearted, even gentle, yet as persuasive as a tsunami — that emerge when your physical autonomy is hopelessly compromised.

    I was born with a congenital neuromuscular weakness called spinal muscular atrophy. I’ve never walked or stood or had much use of my hands. Roughly half the babies who exhibit symptoms as I did don’t live past age 2. Not only did I survive, but the progression of my disease slowed dramatically when I was about 6 years old, astounding doctors. Today, at nearly 50, I’m a husband, father, journalist and author.

    Yet I’m more fragile now than I was in infancy. No longer able to hold a pencil, I’m writing this with a voice-controlled computer. Every swallow of food, sometimes every breath, can become a battle. And a few years ago, when a surgical blunder put me into a coma from septic shock, the doctors seriously questioned whether it was worth trying to extend my life. My existence seemed pretty tenuous anyway, they figured. They didn’t know about my family, my career, my aspirations.

    Fortunately, they asked my wife, who knows exactly how I feel. She convinced them to proceed “full code,” as she’s learned to say, to keep me alive using any and all means necessary.

    From this I learned how easy it is to be perceived as someone whose quality of life is untenable, even or perhaps especially by doctors. Indeed, I hear it from them all the time — “How have you survived so long? Wow, you must put up with a lot!” — even during routine office visits, when all I’ve asked for is an antibiotic for a sinus infection. Strangers don’t treat me this way, but doctors feel entitled to render judgments and voice their opinions. To them, I suppose, I must represent a failure of their profession, which is shortsighted. I am more than my diagnosis and my prognosis.

    This is but one of many invisible forces of coercion. Others include that certain look of exhaustion in a loved one’s eyes, or the way nurses and friends sigh in your presence while you’re zoned out in a hospital bed. All these can cast a dangerous cloud of depression upon even the most cheery of optimists, a situation clinicians
  • by godel_56 (1287256) on Friday November 02, 2012 @05:41PM (#41859647)

    From TFA:

    . . . and patients must make three requests, two verbal and one written. They must self-administer the drug, which would be ingested. The patients must be deemed capable of making an informed decision.

    I can think of a lot of critically ill patients who would be incapable of meeting these criteria. What if you've had your vocal cords removed due to throat cancer, or if you have locked in syndrome or are otherwise paralyzed?

    Where's the option of making a living will where you can lodge a request to be euthanized before your physical faculties fail you? What about the comatose patients who have no hope of cure but are bankrupting their families by massive medical bills while they're taking up a hospital bed?

Stinginess with privileges is kindness in disguise. -- Guide to VAX/VMS Security, Sep. 1984

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