By Natalie White, Standard-Times staff writer
Should physician-assisted suicide be a patient's choice, or is it just another twist on murder?
The upcoming year may yield some answers, through court decisions or legislation. But first the issue will bring debate. And lots of it.
The recent case of a Pembroke woman who was assisted in suicide by Dr. Jack Kevorkian, a crusader to make doctor-assisted suicide available to some terminally and chronically ill people, has pushed the controversial issue to the fore.
Judith Curran, 42, whose family said she suffered terribly with chronic fatigue syndrome and fibromyalgia, traveled to Michigan earlier this month to get assistance in committing suicide. A bill expected to be filed before the Massachusetts Legislature in December would make doctor-assisted suicide legal in this state.
"Other versions of the bill have been filed before, but frankly, until this happened it wasn't even on my radar screen for this session," said Sen. Mark Montigny, D-Mass. "But this is the case that has frozen the issue in the living rooms in Massachusetts. Now, everyone is focusing on it.
"It's obviously one of the really tough issues we must wrestle with as a society, such as choice, the death penalty. It's very emotional."
Hearings on the bill, which will go before Sen. Montigny's Committee on Health Care, will likely be held before spring, he said.
"It's going to be one of the hot-button issues. People will be coming out of the woodwork on this one," the senator said. "There will be a lot of discussion, a lot of posturing, a lot of lobbying. I expect these will be one of the more jam-packed, controversial hearings of the year."
The case of Judith Curran has the state buzzing. A pathologist has said he could find no signs of illness in her body. Yet reports say her medical records show she was suffering. Some wonder if her judgment was clouded by clinical depression. Others question whether everything had been done to alleviate her pain and even whether she was coerced into the decision to end her life.
Opponents of a law legalizing physician-assisted suicide said this shows how the practice may lead to abuse.
"This is a tragedy. So many of the people who want to die want to die because of clinical depression," said Dwight Duncan, professor of law and bioethics at Southern New England School of Law in Dartmouth. "This case just goes to show that there are a lot of gray areas out there, a lot of questions. But there's no room for mistakes here. This is the choice that ends all choices."
Mr. Duncan of Cambridge recently returned from a two-week speaking tour in Australia, where he lectured on the dangers of a recently passed euthanasia law in that country.
On the other hand, proponents of such a law say that a regulated protocol with safeguards would eliminate all of the questions before the act is done.
"If physician-assisted suicide were legalized and everything was in place, then all of these questions would have been answered before it happened -- not after,"
said Charles Baron, professor of law at Boston College School of Law.
Mr. Baron, a longtime summer resident of Westport, is one of a group of doctors, lawyers, professors and others who drafted the proposed legislation legalizing doctor-assisted suicide.
He said safeguards, such as requiring a second opinion on the illness, a consultation with a psychiatrist and a social worker, or similar professionals, will be required to make sure the patient is not suffering from clinical depression or another mental illness, that everything has been done to treat the patient and alleviate pain and make them comfortable.
"If this had been in place, and there had been a misdiagnosis or there was clinical depression, then the Pembroke woman might still be alive. All these questions raised would have been addressed,"
he said.
Professor Duncan said doctors will go to "rubber stamp" colleagues to get the required opinions.
But the proposed law, Mr. Baron said, provides no protection against malpractice, helping to assure that professionals do not act improperly.
If the state or country were to pass a law that terminally and chronically ill people may get doctors to help them commit suicide, Mr. Duncan said, it would be tantamount to deciding that that group of people have "lives that are not worth living."
Professor Baron sees it quite differently. He said legalizing the procedure puts the patient in control, if the patient's judgment is not impaired.
He said the practice goes on commonly today, but without regulation -- and often without informed consent of a patient. For instance, he said, doctors often step up pain killers such as morphine to control pain, with the knowledge that it will also likely end a person's life. He said doctors routinely also make other life and death decisions for patients, such as not putting them on a respirator or not trying to resuscitate.
"Basically, we have it right now, but everyone winks at it," Mr. Baron said. "A lot of people feel that what we have to do is keep this in the hands of an elite, the doctors, and trust them to know when it's appropriate to give overdoses of morphine under the cover of pain relief. The less the patient knows about it, the better."
"It's being done without consultation with the patient, without consultation with the families. It's considered a medical question, not a question for the patients to make decisions on."
Mr. Duncan said he worries that a law would be abused and encourage genocide.
"The real goal here is to get rid of people who are a burden on society, to get rid of the people who are costing us a lot of money with their care," said Mr. Duncan. "Once you make this legal, it's impossible to limit it to extreme cases. People will start to get pressure, from family, from insurance companies, asking them to exercise their rights and 'do the right thing.' "
Mr. Baron said the law protects people from being coerced into seeking assistance and does not allow for companies to force the issue. He said no one may make the decision for the patient, who must be considered competent before a physician may participate.
Professor Duncan said he would much rather see doctor-assisted suicide as an underground procedure, not a government-sanctioned practice.
"I can live with an underground," he said, adding that many people feel an empathy for the terminally ill, which accounts for the three acquittals of Dr. Kevorkian, who has attended more than 35 suicides and is crusading to make the practice more acceptable.
"If we want to deal with it that way, that's OK with me. But you can't make it law. That's Hitler kind of stuff," he said, likening it to the Nazi's Final Solution.
Professor Baron hopes such a law would be used rarely, and that society will respond by better helping people manage pain and providing better hospice care.
On the contrary, Mr. Duncan said, if it's legal and easy to help someone commit suicide there will be less incentive to provide them with comfort and spend money researching ways to relieve pain.
What both men agree on is that this upcoming year will be key, either way.
"This is a very important year for public policy on this issue," said Mr. Duncan.
"I think in many ways, it will all be worked out in the next year," said Mr. Baron.
In addition to the proposed Massachusetts law, the U.S. Supreme Court has been asked to listen to two cases, pro and con, about doctor-assisted suicide.
The court is expected to announce soon whether it will hear one or both of the cases.
A third case of interest involves Oregon's recently passed law legalizing assisted suicide for the terminally ill. A judge enjoined the law from going into effect, saying it is discriminatory. The Ninth Court of Appeals has heard case but has yet to deliver its opinion.
Also, Mr. Baron said several states are working on similar physician-assisted suicide statutes.
Law professor Charles Baron, above, a longtime summer resident of Westport, has helped draft a proposal to make physician-assisted suicide legal in the Bay State. Law professor Dwight Duncan, at right, has recently returned from Australia, where he spoke against that country's new euthanasia law.
