Ballet Question 2 this year in Massachusetts proposes a “Death with Dignity” law, mirroring similar laws which have been enacted in two other states, Oregon (14 years) and Washington (3 years).
Though I support the right of individuals to choose to end their lives at a time of their own choosing, I cannot support the law proposed by Question 2. It has serious structural issues and establishes a precedent which could be used by anti-abortion groups to make it harder for women in Massachusetts to gain access to abortion services, and could be used as model legislation to create similar difficulties in other states as well.
The proposed law does not require a patient requesting the option to end his/her own life to be evaluated by a trained psychologist or psychiatrist. Rather, the law requires counseling only if one of the two physicians signing off on the patient’s request is of the opinion that the “patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment.” This level of protection is entirely inadequate, because there is no reason to believe that either physician will be qualified to make such a determination. Evaluation by a licensed psychologist or psychiatrist should be required before life-ending medication is prescribed.
This is especially important given that at least one of the two physicians signing off on the patient’s request is likely to be one that the patient has not seen before and is unlikely to spend enough time with the patient to accurately evaluate his/her mental health. Furthermore, given that any physician may refuse to participate in the death-with-dignity process, it is entirely possible that neither physician approving the patient’s request will be one with whom the patient has a long-term relationship.
As I just noted, the proposed law allows any medical provider — physician, psychologist, psychiatrist, pharmacist — to decline to participate in the death-with-dignity process. Furthermore, the law allows any institution — medical practice, hospital, pharmacy, etc. — to decline as well, and to have a policy prohibiting its employees from participating. The law allows institutions with such policies to discipline employees who disobey the policy in essentially any way they want, up to and including termination of their employment “for cause.”
I strongly support women’s right to choose to end a pregnancy, and furthermore, I strongly support women’s right to have access to contraception. Both of these rights are under attack in this country, and one of the avenues of attack which has been, to date, moderately successful, is the conscientious objection, i.e., institutions and individual medical providers (doctors, nurses, pharmacists) refusing to provide abortion services, prescribe the “morning-after pill,” prescribe contraceptives, fill prescriptions for the morning-after pill or contraceptives, etc. If you live in a big urban center, you may find this hard to believe, but the fact of the matter is that there are many places in this country where a woman would have to drive several hundred miles to find a facility that performs abortions; there are many hospitals in this country were doctors in the E.R. will refuse to prescribe the morning-after pill to a rape victim; and there are many pharmacists in this country who will simply refuse to fill prescriptions for the morning-after pill and/or other women’s contraceptives.
What do you think will happen when there is a law on the books saying that doctors, pharmacists, hospitals, etc. have a legal right to refuse to provide a legal medical service to their patients and are immunized from any repercussions of such refusal? Before you know it, the anti-abortion movement is going to be pointing at this law and saying, “We want these protections too!”
And there will be no legitimate reason to deny it. If it’s OK to protect in this way practitioners who won’t participate in the death-with-dignity process, then it’s equally OK to protect in this way practitioners who refuse to perform abortions, prescribe the morning-after pill, prescribe contraceptives, or give patients accurate and complete information about these perfectly legal medical treatments.
This is a serious objection to the proposed law, but there is a also a serious counter-argument to this objection: am I saying that medical providers should be legally obligated to participate in the death-with-dignity process even if it violates their moral or religious beliefs? I honestly don’t know.
When it comes to abortion and birth control, I am completely comfortable saying that any doctor who refuses to give patients complete and accurate information about these services and prescribe the morning-after pill or contraceptives when it is medically appropriate to do so, or any pharmacist who refuses to fill a valid, legal prescription for a valid, legal medical treatment, is providing inadequate care and should be sanctioned and removed from practice.
I am far less sanguine about making a similar statement about Death with Dignity. Perhaps my convictions about it are less strong, so I am less comfortable being so hard-nosed about it. Perhaps I find moral objections to assisted suicide to be far more rational and consistent than those against abortion and contraception (this article does a great job of explaining why).
One thing I do know is that there are practical solutions which could sidestep these complex moral questions. For example, if the law required the Department of Public Health to provide Death with Dignity services in parts of the state where there aren’t enough private practitioners willing to provide them, that would be a reasonable counterweight against the concerns I’ve expressed above, and it would ensure access to these services to any resident who needs them. The same requirement, then, could be included in any law codifying the right of medical practitioners to refuse to provide abortion or contraception services or counseling.
I do not know if such a provision would be practical. I do not know if it really is a good answer to this problem. What I do know, however, is that as the law in Question 2 is currently worded, the risk of establishing such a precedent is simply too great to support the initiative.