By Matt Murphy
State House News Service
BOSTON -- Reprising the emotional debate of 2012 when voters rejected a ballot question that would have legalized the prescribing of lethal drugs to terminally ill patients, a legislative committee on Tuesday heard testimony from supporters and foes over whether lawmakers should reconsider.
The Committee on Public Health, co-chaired by Rep. Jeffrey Sanchez and Sen. John Keenan, presided over a hearing on Rep. Louis Kafka's bill (H 1998) that would give terminally ill adults with less than six months to live the option to request medication to end their own life.
With supporters and opponents filling two hearing rooms, lawmakers heard from a mix of people, including doctors and civil rights activists, as well as individuals with disabilities and those who have had to make end-of-life decisions for family members and loved ones.
The hearing was cut short after more than three hours of testimony due a snowstorm moving into the Boston area that prompted Acting Governor and Secretary of State William Galvin to release non-essential employees early. Sanchez called it "an emotional morning" and a debate worth having in the Legislature, regardless of the 2012 vote.
"It's wholly appropriate and right for us to have that discussion. Is this bill the vehicle? I don't know," Sanchez said. He continued, "Do I take it seriously that voters voted against it? Yes. But at the same time, with all the time we spend on health care, I think it's good for us to talk about in a deliberative manner. We should be talking about it within health care and our communities and with our families and friends and those who take care of us or who we expect to take care of us."
Renee Meshel, a therapist at the Charles River Counseling Center, recalled her mother, who she described as a "knockout," being diagnosed with Stage 4 lung cancer. Meshel moved to Florida to care for her ailing mother, where her mother asked her to help her end her life.
"I don't think she ever asked me for anything before...," Meshel said. "I wanted to give her the same dignity in death that she had in life." Because Florida did not have a law like the one proposed, Meshel said she cared for her mother through diapers, hallucinations and having to watch "black bile bubble on her lips."
Voters in 2012 narrowly rejected a ballot question similar to the bill filed by Kafka, of Stoughton, with 51 percent opposed and 49 percent in favor, a margin of 67,891 votes.
The bill would authorize doctors to voluntarily prescribe life-ending medication to terminally ill patients with less than six months to live, provided they are determined to be "of sound mind" when making the decision. In most cases, a consulting doctor would affirm the attending physician's diagnosis and prognosis, and those with mental disabilities or depression could be referred for a psychiatric evaluation.
Christine McMichael, executive director of the Hospice and Palliative Care Federation of Massachusetts, said the non-profit opposed the legislation on the grounds that it is "inconsistent with the philosophy of hospice, which is neither to hasten death nor prolong life."
"The debate about physician-assisted dying suggests that the only choices are end-of-life suffering on one hand, or death on the other. We offer another option," McMichael said in testimony submitted to the committee.
Per the state's health care access reform law of 2006, Gov. Deval Patrick four years ago convened an expert panel to examine end-of-life care in Massachusetts. The panel acknowledged gaps in the system, including the lack of discussions with patients about options, and recommended a combination of advance care planning, palliative care and hospice.
"We believe the question should not be whether the state has an interest in allowing a person to ask a doctor to assist with their dying, but whether the state has an interest in shaping public policy that allows residents the chance to live out their final days with comfort and dignity," McMichael said.
Mickey MacIntyre, chief program officer of Compassion and Choices, suggested a "misinformation ad blitz" in the final days of the campaign helped doom the ballot question, and he welcomed the chance to come before the Legislature "in spite of" the vote taken in 2012, not "despite" it.
"This law helps give peace of mind to many, but few ultimately need it. Massachusetts residents should enjoy freedom both in how they choose to live and, when the time comes, how they choose to die," MacIntyre said.
With experience working on the law in Oregon, MacIntyre said the instances of elder abuse have been non-existent. In the 15 years since the law's enactment in Oregon, 673 people have self-administered the life-ending medication, or less than one quarter of 1 percent of total deaths, while 157 people have done so in Washington.
Carol Rose, executive director of the ACLU of Masschusetts, also cautioned lawmakers against putting too much stock in opponents' concerns about the terminally ill and individuals with disabilities being "coerced" into making a decision to end their life.
"I urge you not to be put off by the scare tactics," Rose said, suggesting the bill was full of protections and safeguards for patients.
Opponents said the bill differs from similar laws in Oregon and Washington because it allows for attending physicians to forego a second opinion if it would create an "undue hardship" for the patient, and does not mandating a referral of a mentally ill or depressed patient for a psychiatric evaluation.
"Many people in the disability community have been assigned a terminal diagnosis, some of us our entire lives. It's actually a joke among us," said John Kelly, director of Second Thoughts Massachusetts, adding that one in six hospice patients will get discharged without dying.
Second Thoughts Massachusetts circulated an op/ed written in 2012 by Sen. Edward Kennedy's widow Victoria Kennedy in opposition to the ballot question that recalled how Kennedy received a prognosis of two-to-four months to live when he was diagnosed with brain cancer. Kennedy lived 15 months, long enough to cast key votes in the Senate and speak at the Democratic National Convention in Denver.
"I don't believe the state ought to be getting into encouraging suicide. Isn't that what we're doing?" said Rep. Jim Lyons, an Andover Republican who challenged supporters throughout the hearing. "What if we're wrong? What if the doctor makes a mistake and the person is able to survive?"
Lyons also objected to the characterization of opponents spreading "misinformation" and using "scare tactics." "So you're saying the majority of voters in Massachusetts were fooled?" he said, prompting Sanchez to interject. "Let's keep the level of dialogue high," Sanchez said.
Rep. Carl Sciortino, a Medford Democrat, said he didn't take a public position on the ballot question last year, but also asked that opponents of the bill not use language that suggests supporters lack "compassion" for the terminally ill.
"This is a very delicate matter," Sciortino said.
Rep. Cory Atkins testified in favor of the bill, arguing that it would give terminally ill patients the opportunity to die on their own terms and say goodbye to loved ones without having to endure uncomfortable and unwanted medical procedures or medications that can "cloud the mind" and limit their ability to communicate.
Co-sponsors of Kafka's bill include Reps. Atkins, William Galvin, Kathi-Anne Reinstein, Anne Gobi, Cleon Turner, John Keenan, Josh Cutler, Tom Sannicandro, Ellen Story, Lori Ehrlich and Thomas Conroy and Sens. Michael Barrett, Patricia Jehlen and Jamie Eldridge.