‘Death with Dignity’ forum prompts thoughtful debate

Experts at student-organized forum offer arguments for and against Question 2

By Ellie Castano

UMass Medical School Communications

November 05, 2012

UMass Medical School students, joined by faculty and other members of the UMMS community, packed Amphitheatre I on Halloween night to participate in a discussion that has the potential to alter their professional choices. The Massachusetts Ballot Question #2: Prescribing Medication to End Life was the subject of a panel discussion coordinated by a group of concerned students who wanted to hear from their professors and future colleagues about the pros and cons of supporting the ballot measure.

David Clive, MD, professor of medicine, and Suzana Makowski, MD, assistant professor of medicine, spoke in favor of the ballot measure, while Richard Aghababian, MD, professor of emergency medicine and president of the Massachusetts Medical Society, and William Stempsey, SJ, MD, PhD, professor of philosophy at College of the Holy Cross, spoke in opposition. Brian O’Sullivan, MD, professor of pediatrics, moderated and presented an opening overview of the ballot measure as well as a short outline of the legal evolution of the physician’s role in end-of-life decisions.

Following are highlights of the discussion. (Video of the entire discussion is available, courtesy of the event organizers. See links below.)

‘This is not a mandate; it’s a choice.’
Dr. Makowski, who is a palliative care physician, strongly emphasized the element of choice in end-of-life care, saying that patients should be able to choose how they want to die and physicians will be able to choose whether or not to participate in prescribing medication to end life. As an end-of-life caregiver, Makowski bases her support of Question #2 on her experience at the bedside of many patients who wish they had more options when faced with a terminal diagnosis. In addressing a legitimate concern about a patient being sent home possibly alone with a lethal prescription, she again emphasized choice, saying, “A person has a right to choose who is present at their side when they die.” Makowski also objects to the word “suicide” when used with this legislation, saying it misrepresents the reality of the situation. “This is a patient who is terminally ill who wants to choose when and how to die,” she said.

‘When continuing life does not satisfy the needs of the patient.’
Dr. Clive also bases his support for the Question #2 on his experience and his intrinsic values. As a kidney specialist, he has had many patients who choose to end life-saving dialysis because they no longer believe that the treatment is adding to their quality of life. The consequence of ending such treatment is death, usually within seven to 10 days. Currently, Clive said, “There is a distinction between withdrawing of artificial support and providing assistance in dying. This distinction seems dogmatic and archaic. There are times when continuing life does not satisfy the needs of the patient.” He also argued that the best hospice care in the world can’t alleviate all suffering or the diminishment of an acceptable quality of life. “The more I read about the arguments against Question 2, the more solid I feel in my support,” he said.

‘Giving up dealing with something difficult and messy’
Dr. Stempsey, who is not only a physician but a philosopher and a Jesuit priest, fears that legalizing a physician’s participation in ending life may rob patients of the fundamental part of life that dying is. He also fears that doctors may become frustrated at the lack of success in treating a terminally ill patient and turn to medication to end life as an expedient option. He also believes that such an extraordinarily momentous decision as when and how a person dies should not be made by a physician. “For me, [ending life with medication is] giving up dealing with something difficult and messy,” said Stempsey. He also believes that there is dignity in all of life no matter how diminished a person’s capacity may be, saying, “Dignity is not lost when you have to be fed.”

‘Physicians should stand by ethics’
Dr. Aghababian, as president of MMS, represented the official position against Question 2 that the organization’s members voted on, noting that there was considerable debate among members about this difficult issue and that there are numerous problems with the current state of end-of-life care. In opposing Question 2, Aghababian presented four primary concerns: the proposed legislation does not include sufficient safeguards; assisted suicide (a term the MMS does use in reference to the proposal) is not necessary to improve quality of life at the end of life; a physician’s ability to predict end of life within six months is difficult; and a physician’s participation in assisted suicide is fundamentally at odds with his or her duty to be a healer. He added that Massachusetts already has a strong foundation for making end-of-life decisions, and presented a copy of his own advanced directive as an example of how terminally ill patients can make end-of-life choices. “Physicians should stand by the ethics that have been the hallmark of the profession for thousands of years,” Aghababian said.

Once the arguments for and against were presented, the discussion continued and included data related to the Oregon law that was enacted 15 years ago and served as the model for the Massachusetts legislation. Not surprisingly, the panelists disagreed on interpretations of the data and the success of the Oregon law.

End of Life Panel Discussion, Part 1
End of Life Panel Discussion, Part 2

Related links on UMassMedNow:
Clive: Death with dignity a compassionate outlet for suffering
Physicians, ethicists to discuss ‘death with dignity’ ballot question
Morse opposes marijuana measure
Broadhurst, Morse speak out about medical marijuana