A renewed push to legalize ‘medical aid in dying’
Supreme Judicial Court ruling puts issue in hands of Legislature
LEGISLATORS AND MEDICAL CHOICE advocates are taking another run at passing a medical aid in dying bill after the Supreme Judicial Court last year placed the responsibility squarely on lawmakers to consider the emotionally fraught subject.
A Senate bill and its House counterpart would establish a 10-step vetting process for adult patients with a terminal diagnosis of six months or less to live to be given life-ending medication to take if they choose it.
For more than a decade, Massachusetts has grappled with the question of physician-assisted death. Ten years after the narrow defeat of a 2012 ballot question that would have legalized the practice, polls consistently show a solid majority of Bay Staters support medical aid in dying – up from 70 percent pre-pandemic to 77 percent in mid-2022, according to Suffolk University polling. Proponents point to a new governor who has signaled her support and the recent court ruling making it clear that the issue is properly left to lawmakers as signs that the bill may have its best chance yet of becoming law.
“In conversations, this was always a question – should we do this while the court is deciding?” said Sen. Jo Comerford of Northampton, who is co-sponsoring the bill with Rep. Jim O’Day of West Boylston. “When the court returned a verdict saying it’s not our decision, this has to have great study and deliberation, and the court can’t do that but the Legislature can, it was a clear baton pass – a clarion call.”
“The fact is that we’re all going to die,” said Bev Baccelli, a Mattapoisett resident with multiple sclerosis and myeloma, a form of blood cancer, who has become one of the more prominent advocates for the “right to die” in Massachusetts. “How we die and when we die is something we have some control over – this is the legal way to use that control.”
Baccelli and her wife, Liz DiCarlo, both 73, said they began seriously thinking about end-of-life options after years of watching friends and family members die slowly or awfully, and with Baccelli’s diagnoses a ticking clock in the background.
“The more we’ve seen and witnessed, the more we didn’t want our lives to end in pain, surrounded by beeping and strangers,” Baccelli said.
Proponents say the bill includes a number of crucial safeguards. Even after two doctors and a mental health professional agree in separate evaluations that a patient is making informed choices and acting voluntarily, patients can still opt out at any point since the bill requires they consume the terminal medication themselves.
Opponents say the gentler terms being promoted by advocates are euphemisms, and the issue should be considered in line with state interests in preventing suicide.
The Massachusetts Catholic Conference, the policy office representing the state’s four Roman Catholic dioceses, has opposed legislative efforts to legalize medical aid in dying as well as the 2012 ballot measure. A late-breaking push from religious organizations helped opponents narrowly defeat the ballot question, 51 percent to 49 percent.
Physician-assisted suicide “is an affront to life and a dangerous precedent for determining end of life issues,” the Catholic Conference said in a statement last May. “Physicians are trained to care for the ill, not to hasten death.”
Comerford said conversations with those advocates drove many of the protections now in the bill. One such provision ensures at least one of the two witnesses confirming the patient’s decision to seek life-ending medication has to be disinterested in a financial benefit from their estate and also hold no liability for their care. No one who could be unburdened by someone’s death should be speaking in favor of that death, advocates insisted.
Medically assisted death is legal in 10 states, and “fears have not come to fruition,” said Melissa Stacey, New England regional advocacy manager for Compassion and Choices, a nonprofit organization based in Oregon, the first state to legalize the practice. “We have 24 years of experience in Oregon, and there isn’t a single substantiated case of abuse or coercion.”
On Beacon Hill, legislative leaders have yet to signal their views on the issue.
Physician-assisted death was “the subject of active and spirited discussion in the Senate” last session, a spokesperson for Senate President Spilka said in a statement. Spilka “looks forward to this proposal going through a transparent legislative process, and will confer with her members on this and other issues that come before the Senate this session.”
House Speaker Ron Mariano declined comment on this version of the bill through a spokesperson.
Last June, polling found 77 percent of Massachusetts residents said a mentally sound adult with an incurable, terminal illness should have the legal option of asking a physician “to prescribe aid-in-dying medication to end their suffering.” However, Mariano told the Boston Globe at the time that there was not that level of support for a bill in the House. “We have a very divided House of Representatives,” he said. “There’s not a 77 percent affirmative vote in the House right now.’’
Neither the House nor the Senate has voted up or down on an aid in dying bill, with prior versions stalling in committee. In the 2021-2022 session, the bill advanced through the Joint Committee on Public Health, which Comerford co-chaired, but the Joint Committee on Health Care Financing did not act on it in time for it to be considered by the full House or Senate.
Comerford is no longer co-chair of the public health committee, but the new Senate chair, Sen. Julian Cyr, representing the Cape and Islands, signed on as a cosponsor of the bill. Rep. Marjorie Decker remains House chair of the committee, and the bill so far has about 50 cosponsors across both chambers.
Former Gov. Charlie Baker’s position on the subject was always murky – he never definitively shot down the proposal, since it never made it to his desk, but made reference to the failed 2012 ballot measure when the legislative subject came up in 2015. Gov. Maura Healey, however, has said she supports the effort to craft a bill legalizing the practice.
“Gov. Healey supports legislative action to allow medical aid in dying, provided it includes sufficient safeguards for both patients and providers,” said spokesperson Karissa Hand. “She will review any legislation that reaches her desk.”
Proponents call Healey’s backing a potential game changer. Support from the governor would mean a bill only needs majority approval in the House and Senate, not the two-thirds margins needed to override a veto.
The issue now rests entirely with the Legislature after the Supreme Judicial Court ruled in December that the state Constitution does not protect a right to physician-assisted suicide. Justice Frank Gaziano made clear, in a 64-page decision on behalf of a majority of the court, that the issue must be decided through the legislative process.
“The desirability and practicality of physician-assisted suicide raises not only weighty philosophical questions about the nature of life and death, but also difficult technical questions about the regulation of the medical field,” he wrote. “These questions are best left to the democratic process, where their resolution can be informed by robust public debate and thoughtful research by experts in the field.”
Legislators will once again weigh the safeguards and other details in the bill’s language, but the debate will inevitably also raise questions about palliative care options that could serve as alternatives to aid in dying. If there were better access to quality end-of-life care, the argument goes, there would be less of a case to be made for medically assisted death.
Advocates for aid-in-dying say legalizing the option could lead to improvements in palliative end-of-life care for patients who end up not pursuing medically assisted death, though the research so far is not definitive about a connection. Doctors in California report some upsides to palliative care because of the physical and mental health evaluation requirements in the assisted dying law.
While Baccelli and DiCarlo think passage of the bill in Massachusetts would encourage more frank discussion of end-of-life choices within a home, they say such conversations won’t necessarily be easy. “It took a while to feel comfortable with the fact that Beverly wanted me to help her die when the time came,” said DiCarlo, a retired nurse and community activist.
Once a person figures out how to have that conversation, “the biggest hurdle for many people is not going to be talking to their family members about this,” Baccelli said. “It’s going to be finding a doctor or convincing their doctor to go along with this, to respect my wishes as the patient.”
The proposed legislation does not require individual physicians to participate.
Conversations around end-of-life choices and the proposed new law come with the reality that patients currently are not entirely without options when it comes to ending their own lives.The SJC noted last year that, under current law, “competent adults who are terminally ill may elect to stop eating or drinking, may agree to the withdrawal of life support, or may choose to pursue palliative sedation.”
Comerford said she had an aunt who lived in Massachusetts and ultimately chose to stop eating to hasten her death. If the Legislature chooses not to pass a medical aid in dying bill, we have to “look really steely-eyed at this,” Comerford said. “We have to be okay with knowing we’ve left people very few safe, full of dignity options.”