Guest column: Assisted-suicide bills in Mass. present risks to patients, public
The Massachusetts Legislature’s Committee on Public Health is considering two bills that would legalize physician-assisted suicide in the commonwealth. As a Massachusetts physician, as a psychiatrist who treats persons with mental health problems, and as a daughter who has dealt with the loss of a parent to a debilitating illness, I am concerned by flaws in these bills that present risks to individual patients and the public.
Trust in the health care system would likely be damaged for many, but especially for communities that have experienced health care inequity who have not been consulted on these bills. Disparities already exist in end-of-life care so that Black, Hispanic and LGBTQ patients are less likely to receive palliative care or hospice care. Black families are more likely than white families to report that family members in hospice had inadequate pain control, less documentation of their treatment wishes, and greater financial barriers to care.
A study shows that Black patients deliberating on end-of-life choices report fear that using advance directives, palliative care or hospice may cause providers to deliver inadequate care.
Despite use of the term “counseling,” the legislation does not provide counseling, mental health care or palliative care for terminally ill individuals thinking of suicide. It requires that “feasible options” for treatment and palliative care be described, not provided.
What is feasible is limited by a person’s resources. This affects their end-of-life options. In Oregon and Canada, where medically assisted suicide is legal, the use of physician-assisted suicide is higher for patients with less financial resources, less medical insurance coverage and less access to adequate disability and social support. Massachusetts should not introduce physician-assisted suicide as a solution for inequitable end-of-life care.
Legislators are wrong if they think that Massachusetts physicians will uniformly comply with the bills’ requirement to either provide lethal prescriptions to their patients or refer to someone who will. The physician shortage will be exacerbated when physicians who are already burned out and struggling to provide meaningful care in the current health care environment refuse the additional demand to practice unethically. The American Medical Association provides us with guidance that “physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”
The public should be aware that these bills require creation of a monitoring system that lacks transparency, oversight or independent monitoring. Death certificates would be recorded in a way that violates Massachusetts Department of Public Health and CDC guidelines. Lack of automatic pharmacy reporting of medical aid in dying prescriptions would prevent monitoring of prescribing practices and of unused lethal doses left in the community.
Oregon and Canada, which have stronger monitoring systems than proposed by these bills, nevertheless have chronic problems of missing data on physician-assisted suicides, and inadequate oversight. Established Massachusetts reporting systems that are essential to public health would be damaged by these bills.
More must, and can, be done to support appropriate, equitable end-of-life care for Massachusetts residents. The physician-assisted suicide bills under current deliberation by the Massachusetts Legislature instead would foster substandard patient care, increase risk to patients and the public, and increase social inequities in end-of-life care.
Dr. Madelyn Hicks is a physician and associate professor of psychiatry at UMass Chan Medical School in Worcester.
This article originally appeared on Telegram & Gazette: Assisted-suicide bills in Mass. present risks to patients, public
