Only two states, Oregon and Washington, allow physician-assisted suicide. But there will be a third if Massachusetts voters approve the so-called Death with Dignity ballot question. It would let terminally ill patients with six months or less to live get a lethal prescription. The outcome of that vote could change the landscape for legalized suicide nationwide.
When Dr. Marcia Angell was editor of the prestigious New England Journal of Medicine back in the 1990s, she startled many of her colleagues by arguing that dying patients should have a legal right to kill themselves. She took that stance partly because of what her father did when he was suffering severe pain from prostate cancer.
"He took a pistol from his bedside table, where he had kept it all of my life. He took it out that night and he shot himself and died instantly," Angell says.
She believes her father wouldn't have resorted to a bullet if he could have had a fatal medication by his bedside.
"If it was something that was legal and accepted, I think he would have lived longer and I think it would have been much easier for the family," Angell says.
Terminally ill Massachusetts adults will have that option if Question 2 on the state ballot becomes law. Dr. Angell is one of its primary backers, as well as the ACLU. She says the term physician-assisted suicide is a misnomer.
"It is not a choice between life and death. It's a choice of the exact timing and the manner of death, because these patients are dying," Angell says.
Disabilities rights activist John Kelly is ardently against the measure, as are the Massachusetts Medical Society and several religious organizations.
"My major concern is that this bill is a recipe for abuse," Kelly says.
The two sides disagree on whether the initiative has adequate safeguards. But Kelly fears that sick people with treatable depression could feel pressure to end their lives from family members eager for an inheritance, or because they feel like a burden.
"Here I think about people with psychiatric histories, people with dementia, people who are subject to coercion. These people will be impacted," Kelly says.
Kelly is quadriplegic and he says legalized suicide sends a damaging message that certain lives aren't worth living. He's also concerned that death by prescription will appeal to a health care system focused on the bottom line.
"With cost controls, hospitals losing money, profit-making insurance companies, we're always hearing about the incredible expense in the last year of life. And this is a way to save that money," Kelly says.
Massachusetts is considered a pioneer in health care reform. So Dr. Lachlan Forrow, the director of ethics and palliative care programs at Beth Israel Deaconess Medical Center in Boston, says this vote is particularly noteworthy.
"If Massachusetts takes the step of legalizing physician-assisted suicide, I think that would have a major transforming effect on national conversations. And a lot of people will say, 'It's even a heavily Catholic state, so maybe this should be emulated elsewhere,'" Forrow says.
But he regrets this issue is on the ballot. Dr. Forrow says the money and energy that has gone into it would have been better spent expanding and improving end-of-life services like hospice and palliative care. So whether or not Massachusetts legalizes physician-assisted suicide, he hopes supporters and opponents will work together after Election Day to make dying a gentler process for terminally ill patients.