Who Are We to Control How the Terminally Ill Die?  

In  May  2018, I was a recent  high school  graduate celebrating my college decision. A  week later, I lost my grandfather to cancer. I walked into hospice, walked out, then thought about how I would never want to suffer as he did or  have my family watch me  experience  a drawn-out death.

I’ve recently been thinking more about my grandfather and how it was hard to  witness his  pain in  his last days. Physician-assisted death, or medical aid in dying,  can—and does—help  patients who have less than six months to live. But my grandfather was denied this option, as physician-assisted death is not legal in Massachusetts and 40 other states.

Physician-assisted death gives patients agency over how they wish to end their suffering. For example, a 2019 study in the Journal of the American Medical Association compared physician-assisted deaths in Oregon and Washington and found that out of 2558 terminal patients who chose physician-assisted death, 76.4 % of them had cancer, 10.2% had neurological conditions, 5.6% had lung disease, and 4.6% had cardiac disease. The most frequent reasons for requesting medical aid in dying were loss of autonomy, decreasing ability to participate in pleasurable activities or impaired quality of life and loss of dignity. My grandfather experienced exactly that: he chose hospice to minimize his pain as much as possible, but he was still irritable and uncomfortable; my family felt helpless watching him suffer.

There is a long process that goes into being a candidate for physician-assisted death by virtue of safeguards set in place by legislation in the states that have legalized it. This includes being a legal resident of the state, being capable of making and communicating your decision, being diagnosed with a terminal illness that will lead to death within six months and being able to self-administer and ingest the prescribed medication.

I believe  that the Massachusetts legislature should pass the “Death with Dignity” bill and legalize physician-assisted death in the state. Patients like my grandfather deserve the right to  choose  their care.

The bill includes safeguards to prevent any abuse. The  documentation, psychological  evaluation, and other diagnostics that go into this decision are not light. Patients must make an oral request for medication in person and must be deemed capable of self-administering the medication without assistance. They must also consult a licensed mental-health professional, wait 15 days, and sign a confirmation before two witnesses. The request process will stop immediately if there is any suspicion or evidence of coercion.

Mental health is a key part of the death with dignity process. If the terminally-ill patient is found to have any doubts or mental health issues, including medication fatigue, they will not be able to pursue physician-assisted death. This is important because the decision to end your life needs to be made in full mental capacity and could be influenced by mental health issues such as depression. Massachusetts should also strengthen their mental health programs to address those interested in death with dignity, especially patients in hospitals with terminal illnesses.

Physician-assisted death has significant support. According to a study in the Yale Journal of Biology and Medicine, 60% of randomly surveyed physicians believed physician-assisted death should be legal in the United States. If doctors feel comfortable helping terminally-ill patients in their pathway to dying, why should we not be on board? The doctors do not choose death, but let patients and their families decide for themselves. As my grandfather demonstrated, being terminally ill can be extremely painful, both physically and mentally. If helping others have the last bit of control in their life is an option, we need to take it.  

If helping others have the last bit of control in their life is an option, we need to take it.

Outside of the United States, countries have taken different stances on death with dignity. Israel allows a terminally-ill patient who is cognitively, mentally, and emotionally capable of making informed decisions to decide to cease life-sustaining treatment. Israel does not allow patients to take a drug to end their lives (what the Massachusetts “Death with Dignity” bill proposes) because taking one’s life is regarded as halachically and morally improper. By contrast, Switzerland is the only country that accepts foreign nationals for legal, medically-assisted suicides. They must be suffering from a severe illness, but there is no requirement for the illness to be terminal.

Any discussion of legalizing physician-assisted death must consider the patient first. I watched my grandfather die in palpable pain and discomfort; I hope that if legislators look closer at the cases and stories of terminal patients like my grandfather, they will pass the bill. At a certain point, we should be able to determine how we want to depart. I believe we must legalize medical aid in dying in Massachusetts. We have the information, studies and tools to support this bill. If I ever have to confront this decision, I’d want to make this choice myself.

Lily Sanphy is a student at Providence College.