Massachusetts Voters Reject Physician-Assisted Suicide

November 07, 2012

A ballot proposition in Massachusetts that would have legalized physician-assisted suicide was narrowly defeated Tuesday after leading in the polls by a 3-to-1 margin in late September.

Supporters of the so-called Death with Dignity measure attributed the turnaround to a last-minute flurry of ads by opponents who outspent them roughly 5 to 1.

"Before this barrage of misleading, frightening ads, the polls showed the public was overwhelmingly in support," said Marcia Angell, MD, a senior lecturer in the Division of Medical Ethics at Harvard Medical School and a leading proponent of the ballot measure. "The ads implied there was something scary."

Of course, opponents such as the Massachusetts Medical Society (MMS) contended that there indeed was something scary about physicians prescribing a lethal dose of a narcotic at the request of a terminally ill patient with less than 6 months to live.

"We are pleased that the majority of voters agree that a physician's role is to heal and comfort, not to aid in death," said MMS President Richard Aghababian, MD, in a press release issued by the society.

The Death with Dignity law before voters was modeled after those in Oregon and Washington, the only other states that have explicitly legalized physician-assisted suicide. In Montana, the state supreme court has ruled that state law and public policy do not prohibit the practice.

A Boston Globe poll in late September found 68% of state residents in favor of the proposition and 20% against it, with the rest undecided, numbers that reflected other surveys at the time. However, a month later, the Boston Globe reported the level of support falling to 47% and opposition rising to 37%.

On election day, opponents outnumbered supporters 51% to 49%.

Catholic Groups Helped Fund Negative Ad Campaign

Massachusetts campaign finance records show that supporters of the law raised roughly $980,000 in 2012, mostly from individuals, although aid-in-death organizations such as Compassion and Choices and Death with Dignity wrote some five-figure checks. In contrast, opponents anted up almost $5 million. The biggest contributions came, by and large, from Catholic groups and leaders from all over the country — dioceses, archdioceses, religious orders; bishops, the Knights of Columbus, St. John's Seminary in Boston, the Catholic Health Association, and the Boston Catholic Television Center, which gave $1 million.

Another $250,000 came from the American Family Association in Tupelo, Mississippi, an evangelical Christian group that describes itself as being "on the front line of America's culture war." Right-to-life groups, notably Massachusetts Citizens for Life, also were significant contributors.

Individuals who helped pay for the campaign against the ballot proposition included John Howland, MD, a family physician in Southbridge, Massachusetts. He chipped in $11,125, according to state records.

Dr. Howland told Medscape Medical News that he was thrilled by news of the proposition's defeat. "The most amazing part is that it was a come-from-behind victory," said Dr. Howland.

It's antithetical to what it means to be a healthcare professional. Dr. John Howland

He agrees with the position of the state medical society that physician-assisted suicide is incompatible with the physician's role as healer. "It's antithetical to what it means to be a healthcare professional," said Dr. Howland, adding that he was engaged in a considerable amount of end-of-life and hospice care.

The ad campaign against legalizing physician-assisted suicide, Dr. Howland said, focused in large part on "flaws and dangers" in the law. One is the assumption that anyone can accurately predict that someone has less than 6 months to live, which he said is false. He also faulted the proposed law for not requiring a psychiatric evaluation for someone who requests a lethal dose of medication, or that someone else be present when it is finally swallowed.

Critics such as Dr. Howland generally have argued that these and other supposed shortcomings of the law would not protect the weak and helpless from greedy relatives who might encourage or pressure them to request physician-assisted suicide. Hence, the tagline for one negative ad read, "It's out of control."

Supporters of the law respond that the sparing use of physician-assisted suicide in Oregon and Washington indicates that the practice has not been abused. In both states, the typical terminally ill person who has died from a physician-prescribed lethal medication is well-educated, covered by health insurance, and receiving hospice care.

Dr. Angell told Medscape Medical News that the proposition's defeat in Massachusetts "was very disappointing."

"It will deny dying patients the option of a more peaceful death..." Dr. Marcia Angell

"It will deny dying patients the option of a more peaceful death if they find their suffering unbearable," said Dr. Angell, a former editor of the New England Journal of Medicine. "It's also a giant step backward. It's placing misguided paternalism above a patient's right to self-determination."

Dr. Angell read one encouraging sign in the outcome.

"About 50% of the people were convinced enough to withstand the barrage of ads and vote for [the proposition]," she said. "That tells me that it could have a chance in nearby states such as Maine.

"Maybe that will happen."