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BOSTON -- Over 130 people, among them doctors, nurses, caretakers, and disabilities advocates, testified before Massachusetts lawmakers about controversial bills that would legalize "medical aid in dying," known to opponents as physician-assisted suicide.
The bills in question, H2381 and S1384, "An Act relative to end of life options," would allow physicians to prescribe lethal drugs for terminally ill patients who are expected to have less than six months to live.
The hearing before the Joint Committee on Public Health took place in a virtual format on Oct. 1. Each person testifying had three minutes to speak, though they could also submit written testimony, which the facilitators assured would be read by all members of the Senate and the House of Representatives.
People on both sides of the issue shared heart-wrenching personal stories and made impassioned pleas to the committee members. Supporters of the bill included people with terminal diagnoses as well as those who cared for relatives who wished to end their own lives, some of whom used painful, drawn-out methods, such as starvation. Opponents included those with disabilities or chronic diseases, and people who outlived or witnessed someone outlive their terminal diagnosis.
The bill's supporters spoke of the desire of patients to end their suffering when the pain of an illness cannot be alleviated by hospice or palliative care. But opponents cited polls showing that the most common reason for requesting "medical aid in dying" is not pain, but the fear of dependence and indignity.
Concerns raised by opponents included the potential negative impact on the disability community and the elderly, disparities between different economic and racial demographic groups, and the message that the legislation would send to the public about the acceptability of suicide.
"Soothing words and comforting catchphrases in these bills can disguise but they cannot change their grisly and dangerous reality. The goal is to normalize intentionally ending a human life," Massachusetts Citizens for Life executive director Patricia Stewart said in her testimony.
Catholic Church officials also testified against the bills. Jim Driscoll, executive director of the Massachusetts Catholic Conference, spoke about the Church's opposition to suicide. On the same panel, MC Sullivan, the Archdiocese of Boston's chief healthcare ethicist, spoke about improvements in healthcare and palliative care.
Not all of those testifying were Massachusetts residents. Some participated from as far away as California, Oregon, and Washington, states where physician-assisted suicide is legal, and shared their experiences related to it. There were multiple reports of people with a terminal illness or disability being denied insurance coverage for life-sustaining treatment while qualifying for life-ending drugs.
Supporters argued that the bills have enough safeguards to prevent abuse. A person requesting lethal drugs must have at least one mental health consultation to determine whether they have a psychiatric or psychological disorder. A written request must have two witnesses, at least one of whom is not related to the patient, has no financial responsibility for them, and would not be entitled to any part of their estate upon their death. The patient is not required to use the drugs, and supporters said that one-third of patients who obtain them do not use them, but have peace of mind knowing that they are available to them.
But opponents insisted that these measures are not enough. Several questioned the definition and qualifications of a "mental health professional," who may not have any experience or training relevant to end-of-life issues. Some testified to the inaccuracy of some terminal diagnoses and warned of the danger of unnecessarily cutting one's life short. They also decried the practice of listing the cause of death as the terminal illness rather than ingesting the lethal drugs.
It was also pointed out that, according to the text of the bills, individuals familiar with a patient's manner of communication could request the drugs on behalf of patients unable to communicate independently. Andrew Beckwith, president of Massachusetts Family Institute, said that this raises "very concerning" potential for abuse of people with dementia.
Lindsey Baran, policy director for the National Council on Independent Living, said that the safeguards touted by the bills' supporters are "truly insufficient when it comes to protecting vulnerable people."
"When coupled with problematic monitoring and a lack of meaningful oversight and enforcement mechanisms, they may as well be nonexistent," she said.
Although proponents say that abuse of such laws is rare, Baran said the system was not set up to find such abuses. As an example, she said that when such concerns were raised in Oregon, Dr. Katrina Hedberg of the Department of Human Services said they did not have the resources or legal authority to investigate.
"Where assisted suicide is legal there is no doubt that some people's lives will be ended by coercion and abuse. We've seen it happen. It will happen again. And until we can be sure that it won't, assisted suicide laws are dangerous for patients and bad for the Commonwealth of Massachusetts," Baran said.
William Densmore, a former journalist originally from Worcester, spoke in support of the bills, but also expressed a desire to look into opponents' concerns.
"It really will be important, if this becomes law, for there to be close monitoring of how it's used so that, if there are abuses, they can be addressed," he said.
Another suggestion was made by Paul Spooner, executive director of MetroWest Center for Independent Living in Framingham. Speaking on a panel opposing the bills, he said that if they go forward, the committee ought to include a provision for advocates to provide community options counseling to individuals seeking assisted suicide, to make them aware of all the forms of help available to them.
In addition to criticizing the bills as a matter of policy, many opponents expressed concern about the message that the bills would send to society at large, which is already suffering from high rates of suicide. They shared statistics indicating that the overall suicide rate in Oregon increased after that state legalized physician-assisted suicide.
Anne Fox, former president of Massachusetts Citizens for Life, spoke about the important role of the legislature in making laws that reflect a society's values.
"Our laws say what we think is important. They tell us what are the primary things that we're most concerned about. If we pass this law, what we are saying is that we as a society have one group of people whom we will do anything to keep from committing suicide, but another group of people who somehow aren't as desirable or something, and we will not only allow them to commit suicide, we will facilitate it and encourage it," she said.
Jackie Bieber shared the story of her daughter, Shawn, who committed suicide in 2019 at the age of 25. Suffering from depression and social anxiety, Shawn was active on websites promoting suicide and learned how to order ingredients to make a lethal drug cocktail. She talked to people in the chat room as she took the drugs, and they encouraged her when she said she felt "terrified."
Bieber talked about how people link mental suffering to physical suffering and conclude that the means for a peaceful death should be available to them as well.
"Our message should be consistent and of one voice. Suicide should not be promoted for anyone who has terminal or mental illness," Bieber said.
The Massachusetts legislature has until the end of the current legislative session on July 31, 2022, to decide whether to act on the bills.