By Anne Fox, President of Massachusetts Citizens for Life
Mark Rollo, with the help of Massachusetts Alliance Against Doctor Prescribed Suicide, organized an amazing Doctors' Day at the State House on January 31. Mark; Dr Thomas Sullivan, Past President of the Mass. Medical Society; and Dr Laura Petrillo, a palliative care doctor and teacher at Mass General, addressed legislators and aides and then held a press conference. The speeches are found below.
After that, the 22 doctors in attendance visited with members of the Joint Health Care Committee to explain that the recent decision of the Mass. Medical Society to go "neutral" on doctor-prescribed suicide does not represent many doctors and to tell the members of the problems with the bills.
It was an amazing group of doctors who are to be thanked for coming out in the middle of the day for such an important cause.
Statement of Dr. Mark Rollo in Opposition to H 1194
My name is Mark Rollo and I am a family physician of 30 years and for most of that time I have practiced medicine in Fitchburg, MA. I am strongly opposed to physician assisted suicide (PAS). With me today are many likeminded physicians and advanced practitioners who all share in this opposition to assist patients to kill themselves.
Regrettably, with its decision to withdraw opposition to PAS, the Massachusetts Medical Society (MMS) is turning back the clock to a time when physicians weren’t trusted. Hippocrates, who practiced medicine 2500 years ago when physicians could choose to heal their patients or to kill them, realized that situation caused physicians to be mistrusted and so he penned the Hippocratic Oath. That oath states in part, “I will neither give a deadly drug to anybody who asks for it, nor will I make a suggestion to this effect.” This past December, the MMS decided that this time honored patient-protecting oath was obsolete when delegates voted to abandon their long held opposition to physician assisted suicide. It was only six years ago that the MMS voted strongly to reaffirm its long standing opposition to PAS.
The MMS House of Delegates adopted a position of “neutral engagement” regarding “medical-aid-in-dying,” which is the current euphemism for physician assisted suicide. But true assistance to people who are dying already exists. The Commonwealth’s wonderful hospice and palliative care programs help alleviate pain and suffering so as to enable patients to die a natural painless death in nearly every single case.
Sanctioning the currently illegal practice of a physician writing a prescription for suicide pills is a mistake. In this scenario, a patient can bring home a bottle of 100 sleeping pills and take them without medical supervision or supervision of any kind. There have been cases, in states where this is legal, where patients don’t actually die after taking suicide pills but are severely harmed and more suffering ensues. Family can walk in and find their loved one dead because there is no requirement for family notification. Malevolent individuals could potentially coerce family members to request and then take the suicide pills in order to obtain an inheritance. Elder abuse is already a significant problem in Massachusetts, and PAS will only exacerbate the problem. Empowering doctors to be the means of suicide disempowers patients and will lead to even more abuse.
Legalizing PAS is not about giving a patients aid in dying, it is about giving doctors the right to kill. It also gives doctors the right to lie on the death certificate by mandating that the underlying illness be indicated as the cause of death rather that the true manner of death; suicide.
Perhaps the most hideous outcome of the legalization of physician assisted suicide would be the fact that once legalized, the practice becomes a “medical” procedure and a cheap one at that. Cash strapped governments and profit minded insurance companies will increasingly rely upon PAS to save money. Physicians and patients alike are keenly aware of the tendency of insurance companies to refuse to cover expensive treatments. As is too often the case, the well-heeled get another option, but it is the poor, people of color, and people with disabilities who will subtlety, or not so subtlety, be steered toward suicide. This has already occurred in states where PAS is legal and is well documented. Barbara Wagner of Oregon received a letter from Medicaid of Oregon indicating that her expensive chemotherapy for lung cancer would not be covered but her suicide pills would be covered. Randy Stroup of Oregon received a similar letter regarding his metastatic prostate cancer. There are many more examples.
Moreover, due to suicide contagion, there is a correlation between states that allow PAS and higher overall suicide rates. In Oregon, for example, the general suicide rate is 40% above the national average. Do we really want to invite the tragedy of an even higher suicide rate than we have already in Massachusetts?
People come from all over the world to Massachusetts to receive lifesaving care from world renowned, trusted physicians and medical institutions.
Massachusetts also has a proud tradition of protecting the vulnerable. We must not allow this so called “engaged neutrality” from the MMS to lead to the legalization of physician assisted suicide and thereby sully Massachusetts’s great tradition of providing quality and compassionate care.
Statement of Dr. Thomas Sullivan in Opposition to H.1194, Legislation to Legalize Assisted Suicide in Massachusetts
I am Dr. Thomas Sullivan, a board-certified cardiologist with 44 years of direct patient care experience. This especially included those patients with chronic cardiovascular and other chronic diseases, that are usually fatal, in spite of the fact that I have helped prolong the lives and well-being of hundreds of patients over the years.
I am a past president of the Massachusetts Medical Society and have been very active in leadership and policy roles at the American Medical Association as well as my local hospital on the North Shore.
I was present during the debate and the voting in December when the medical society changed its long-standing opposition to physician assisted suicide and adopted a position of neutrality.
I want to make it clear that the great majority of physicians during that meeting in December were not in favor of suicide. However, it’s clear that the vote was in favor of neutrality, neither supporting nor opposing the current legislative language.
I spoke against the change in position where we had strongly opposed a legislative bill only six years ago that has several similarities to the pending legislation.
None of the other five or six past presidents including the current president of the Massachusetts Medical Society were in favor of assisted suicide, and most spoke out against the change.
I’d also like to point out that the World Medical Association, the American Medical Association, the American College of Physicians and an overwhelming majority of the other physician associations around this country are all strongly opposed to changing an ethical position that has endured for more than 2,500 years.
On another point, both in the scientific literature and in my personal experience, it is difficult to accurately predict life expectancy in a terminal illness, especially with a non-cancer diagnosis. Many of those with 6-month prognosis estimates live long beyond that term. In addition, novel treatments when discussed with patients may offer a better outcome if this option is allowed or covered by insurance.
Taking care of patients with chronic diseases is particularly challenging, especially if there is considerable disability, pain, suffering and often depression. Listening attentively and responding with compassion is always necessary and sometimes is more helpful than the medications and other treatments we prescribe. Regular follow-up visits to assess and manage changes builds a relationship and a bond of trust between patient and physician that is unique. Some would even describe it as "sacred".
When death approaches, it is this special trusting relationship that assures the patient his or her physician will do everything in their power to facilitate a peaceful and dignified end of life, based on the wishes of the patient and usually the family or close friends.
The proposed Massachusetts law does not protect the conscience of physicians and medical facilities. It requires that we disclose written policies informing patients and their families that we will not prescribe lethal drugs. We are further required to refer the patient to a willing provider, essentially forcing us to participate in a practice that violates our conscience.
Finally, in my opinion, it is against the healing nature of mankind and particularly physicians to usurp the practice of healing in favor of what has been considered an unnatural practice for thousands of years – providing lethal drugs to patients and assisting them in suicide.
Statement of Dr. Laura Petrillo Against the Legalization of Physician-Assisted Death
Good afternoon. I am Dr. Laura Petrillo, a palliative care physician who recently moved to Massachusetts from California. From my experience working on California’s End of Life Option Act, I am intimately familiar with the issues that have arisen since that law was enacted. I am here today to share with you what Massachusetts can learn from California.
My first message is that legislators and the public often misunderstand why people actually use physician-assisted death, and if they fully recognized the truth, they would be thinking about different solutions. When California’s Governor Jerry Brown signed the End of Life Option Act into law, he said, “If I were in excruciating pain, I would want this option for myself.”
It turns out, people only rarely use physician-assisted death because they are experiencing physical pain. Rather, the most common reasons people use it are psychological issues related to dying: loss of independence, inability to participate in activities that make life enjoyable, feeling like a burden. Instead of being an option of last resort for physical suffering, as many people imagine, physician-assisted death laws create a double standard in the medical response to psychological suffering. Under most circumstances, when people express feelings of hopelessness, doctors and other healthcare providers are trained to provide safety and support, to address the underlying distress, and prevent patients from harming themselves. By contrast, in places where physician-assisted death is legal, when people with a terminal illness express hopelessness, doctors can give them a prescription to end their distress by ending their lives.
The founder of the modern hospice movement, Dame Cicely Saunders, recognized that pain can take many forms, including emotional and spiritual pain, and that people who are dying need thoughtful, whole-person care. That is exactly what palliative care does. Palliative care is a medical service that provides an extra layer of support to people with serious illness and their families, with the goal of alleviating suffering. The last few decades have seen a dramatic expansion of palliative care in hospitals across the United States, but unfortunately, most people do not have access to high quality palliative care outside of the hospital.
In Massachusetts, families who recently lost a loved one reported in a 2013 survey that the care they received was “good” or “excellent” only half the time. Twenty percent said it was “fair or poor,” which means that about 10,000 people a year in Massachusetts receive grossly inadequate care before they die. We have work to do, and thankfully there are a lot of smart people in the Commonwealth working on this problem. Some people wonder, can’t we do both? Improve end of life care and legalize physician assisted death?
Unfortunately, there is no requirement in the Massachusetts End of Life Options bill that physicians have any training whatsoever in end of life care, so anyone who can prescribe drugs can write a lethal prescription. This means that people are certainly dying sooner than they would if they had access to care that could help them live better in their remaining days. Some people think their early death is justified because it’s their “choice,” but it’s really our shortcoming as a medical system to care for them. What we need is high quality end of life care for all, to help patients live better, not a medically sanctioned route to suicide in the face of existential distress.
The second message is that it is not only high quality end of life care that patients need, but also affordable, accessible health care throughout their lifetimes and regardless of their social standing. We have by far the most expensive healthcare in the world. Sadly, about 20% of cancer patients will skip their medications or take less than the prescribed amount to save money. The pressure to skimp on care is felt disproportionately by the poor, by those who lack social support, and by older adults. People worry about burdening their families with the expenses related to illness and they worry about being able to leave an inheritance when they are gone.
In Oregon, about 5% of patients who ended their lives using lethal drugs to assist death did so because of financial reasons in 2016, up from 3% in the preceding years. Again, if you think that autonomy is the only ethical principle worth caring about, you might say, “well that’s their choice, to end their lives to save money for their families,” but I believe that we can do better than that, and try to increase the value of the care we provide so that people don’t have to choose between bankruptcy and an early death.
And it’s not just individuals who weigh the high costs of health care against the cost savings of a hastened death. Insurance companies have certainly thought about it, and this is evident in the multiple cases where patients received simultaneous denials of their expensive life-extending medications and notification that they could have a cheap alternative of a hastened death.
Stephanie Packer, a young mother with a terminal lung disease in California, was the latest person to be denied chemotherapy by her insurance company and told that assisted death drugs were covered and cheap. Randy Stroup and Barbara Wagner had similar experiences in Oregon. I don’t expect insurance companies to value life and health over profit. But I sure do expect physicians to, and state legislators too. We can do better.
My last message is that if you can imagine scenarios related to death hastening that you find unacceptable, like euthanasia for people who can’t consent, or hastening death for children or people with mental illness, the line needs to be drawn now, at legalization of physician-assisted death for voluntary, terminally ill patients. We often hear that slippery slope concerns are unfounded, that Oregon and Washington have remained stable in the years physician-assisted death has been legal there. That may be true, but the movement to expand death hastening seems to have reached a tipping point, and in California and in Oregon physician-assisted death advocates have moved on from legalization to the next frontier— how to “solve the problem” of dementia, and patients who are suffering but can’t self administer or aren’t dying fast enough.
They are not thinking about whole person care. Instead they are pitching amendments to expand existing physician-assisted death laws, to change the qualifying criteria from 6 months to live to 12 months or more, and to give people the ability to request physician-assisted death by advance directive. Allowing physician-assisted death by advance directive means giving physicians permission to prescribe lethal drugs to patients who can’t consent.
These aren’t distant, far-off scenarios, they are being proposed and debated now on the west coast of the United States. And they are based on the reasonable logic that the lines that are drawn around physician-assisted death are discriminatory against certain groups of people, and it is only “fair” to be more inclusive given that the state and the medical system have condoned death hastening as a medical response to suffering. The best way to prevent us from ending up like the Netherlands, where they use euthanasia for ringing in the ears, or Belgium, where it is legal to euthanize children, is to draw the line at legalization of any kind of physician-hastened death, because it is not a question of whether the practice of physician-assisted death will migrate, it is when.
Thank you for your time and we are all now happy to take questions.