Massachusetts may join ten other states and the District of Columbia that make it legal for terminally ill adults to request medication to end their lives. This could happen either by a decision of the state’s highest court or through legislation.
For many, like me, the notion of Medical Aid in Dying (MAID) sparks a negative visceral reaction. My reaction is perhaps surprising because I have been studying how we can plan for the end of our lives by specifying what life-sustaining treatments we would want, and not want. I have been advocating for personal choice about whether we want things like artificial breathing and feeding tubes. Is having the option to decline life-sustaining treatment substantially different from having the option to choose life-ending treatment?
Previously, I rejected MAID because I assumed that patients would not want to end their lives if they had quality palliative care and pain control. But that is not true. The data show that the majority of individuals who request and obtain MAID are enrolled in hospice services.
There is growing support nationally for the right of people who are terminally ill to end their lives on their terms. In Massachusetts, public support for MAID has increased dramatically in the ten years since a 2012 ballot question that would have allowed the practice was defeated 51% to 49%. A 2022 poll of Massachusetts residents found that nearly 77% believe a mentally sound adult with an incurable, terminal illness should have the legal option of asking a physician to prescribe medication to end their suffering. (Nearly 16% opposed and 7 percent were undecided.)
If the Massachusetts Supreme Judicial Court legalizes MAID, it will join Montana in allowing the practice via court decision. The ten other jurisdictions that allow MAID have done so either through a ballot initiative or legislation.
The case pending before the court is Kligler v. Healey. It was filed by retired physician Roger Kligler and his doctor Alan Steinbach. Kligler has terminal, metastatic prostate cancer and Steinbach is willing to help him end his life. Kligler asked the court to declare that MAID is not criminal in Massachusetts.
Eight parties filed amicus curiae (friend of the court) briefs in the Kligler case, including the Massachusetts Medical Society and the Hospice and Palliative Care Federation of Massachusetts. The medical groups do not oppose MAID, but filed a brief to advocate for guidance and standards to implement it safely and avoid the potential for abuse.
The court heard oral arguments in March. On July 7, the court asked the parties to submit supplemental briefs to address whether the United States Supreme Court’s decision overturning Roe v. Wade should impact their decision. Kligler had argued that he had a right to end his life in line with a constitutionally protected zone of privacy established in Roe. The supplemental briefs are due August 8, 2022.
In opposing Kligler’s request, the Massachusetts Attorney General’s office argued that MAID is an issue better left to the legislature, not the courts. The Massachusetts state legislature has taken up the issue. The Massachusetts End of Life Options Act (H.2381/S.1384) would create a process for adults with six months or less to live to request medication to end their lives. It is similar to legislation enacted in other states. The request must be made twice: once orally and at least 15 days later in writing. To qualify, a patient must have a terminal diagnosis and be approved by a mental health professional. And the medication must be self-administered. Introduced in February 2022, the bill had a large number of co-sponsors yet appears stalled in committee, As of July 12, the legislature had not voted on it. The current legislative session ends on July 31.
MAID is a difficult, complex issue. If we truly believe that the terminally ill should have a choice about how and where they die, then we need to consider the legalization of Medical Aid in Dying. Massachusetts may be the next state to allow MAID, but stay tuned for other states to follow suit; legislation is pending in Arizona, Delaware, North Carolina, New York, Pennsylvania, and Rhode Island.