The last few decades have seen great advances in medical science. New technologies now help people live longer than at any previous time in history. Yet, one can argue that the real advance has been the evolution of the relationship between patients and doctors. While we can still do much better, medicine is more patient-centered than ever before, and physicians have allowed their patients an increasingly prominent voice in their health. Nowhere is that more evident than at the end of life, and no issue embodies this principle more than medical aid-in-dying.
In early December, the Massachusetts Medical Society voted to drop its decades-long opposition to medical aid-in-dying legislation. These laws allow physicians to write a lethal prescription for mentally capable, terminally ill patients with six months or less to live, giving them the option to end suffering and die peacefully by their own accord. The medical society’s House of Delegates voted by nearly a 3-to-1 margin (152-56) to take a stance of “neutral engagement’’ on this practice of medical aid-in-dying, which would be authorized under the Massachusetts End of Life Options Act. The medical society’s definition of “neutral engagement’’ was even more encouraging: “If medical aid-in-dying is legalized, the MMS will support its members with clinical and legal considerations through education, advocacy, and other resources, regardless of whether the member physician chooses to practice medical aid-in-dying.’’ In removing its opposition, the MMS becomes the ninth state medical society to stop opposing medical aid-in-dying within just the past two years.
While the American public has long been supportive of aid-in-dying, physicians have historically provided perhaps the stiffest resistance, and I would say rightfully so. But data from Oregon suggest that aid-in-dying is not being abused and is actually helping raise the quality of end-of-life care for the 99 percent of people who die in those states without using this route. While less than 1 percent of terminally ill adults ultimately utilize medical aid-in-dying, all terminally ill adults benefit from these laws, because they spur conversations with doctors about all end-of-life options, including hospice and palliative care, and better utilization of them. The vast majority of people who seek aid-in-dying are insured, affluent, and highly educated. Oregon’s medical aid-in-dying law has helped spur the state to lead the nation in hospice enrollment, according to a report published in the New England Journal of Medicine. In California, the recent passage of aid-in-dying has brought conversations about end of life out of the shadows and led to improvements in end-of-life care beyond just those using the law.
I was a resident in internal medicine at the Beth Israel Deaconess Medical Center when aid-in-dying was on the ballot in Massachusetts. The opposition to the measure by the medical society was an important reason behind the initiative being narrowly defeated. However, I feel that the MMS’s reversal is a brave and commendable step that should now spur lawmakers to move forward with legislation that allows patients with terminal illnesses to have some amount of control of their death. Even more important, the American Medical Association needs to pay closer attention and accelerate its efforts to reconsider its historical opposition to aid-in-dying, and it needs to do so in a transparent manner.
Terminally ill people should be allowed to die on their own terms. The MMS agrees, and the Massachusetts Legislature and the American Medical Association should too.
Dr. Haider Warraich also is a fellow and clinical researcher in cardiovascular disease at Duke University Medical Center. He is the author of “Modern Death: How Medicine Changed the End of Life,’’ to be published in February.
