Harvard Students, Professors Split on Physician-Assisted Suicide

This September, Harvard Medical School professor David S. Jones ’92 introduced students to assisted suicide, one of the most publicized ethical dilemmas of modern medicine, in the second lecture for his popular new Gen Ed course Ethical Reasoning 33: “Medical Ethics and History.”

In the course’s syllabus, Jones compared physician assisted suicide to the hot-button topic of abortion, writing that “no issues in medical ethics arouse greater passions.” For Jones’s course, the question of whether doctors can provide life-ending medication to terminally ill patients introduced Harvard undergraduates to basic tools of moral reasoning.

But for Massachusetts voters this year, the question is more than academic.

This Tuesday, voters will weigh in on Massachusetts Ballot Question 2, Prescribing Medication to End Life, a law proposed by initiative petition that is often referred to by its supporters as the “Death with Dignity Act.”

The proposed law would allow Mass. licensed physicians to prescribe medication to terminally ill patients meeting certain conditions that they could self-administer to end their life.

Harvard affiliates have been powerful voices in this year’s debate over physician-assisted suicide—an unsurprising reality, given the effect the initiative could have on those at the Medical School, the School of Public Health, the 17 affiliated hospitals and research institutes, and even professors in the Law School or government department.

Among Harvard professors and students, as with voters across Massachusetts, opinion remains split on both the philosophy and practice of Question 2.

THE 0.2 PERCENT

If passed, Massachusetts would become the fourth state, after Oregon, Washington, and Montana, to legalize some form of physician-assisted suicide in the last two decades.

According to Lachlan Forrow, an associate professor of medicine at Harvard Medical school, Question 2’s presence on the ballot is representative of the changing ways that Americans are relating to their health and health care.

“The fundamental important message is that Americans are deeply dissatisfied and worried about the care that they will receive at the end of life,” Forrow said.

The Massachusetts initiative would apply specifically to terminally ill patients who have been demed mentally competent and have less than six months to live.

Although he has not openly taken a position on the Massachusetts initiative, Forrow—who serves as the director of ethics and palliative care programs at the Harvard-affiliated Beth Israel Deconess Medical Center—has in past weeks written and spoken publicly about the history and real-world implications of assisted-suicide policies. He emphasized that the experiences of Oregon, the first state to legalize the practice in 1994, demonstrate the rarity of assisted-suicide requests.

“In Oregon, out of 1,000 people who die, two request and get a prescription for a lethal dosage of medication,” Forrow said. “That means 99.8 percent of people’s needs of care for end of life have nothing to do with [those who choose that option]. Even if this passes, at best, this would be a 0.2 percent solution for the challenges of caring at the end of life.”

AN ETHICAL DILEMMA

Despite what Harvard Medical School professor Robert Truog called the “vanishingly small” proportion of patients who choose assisted suicide, many of the Massachusetts’ initiatives major supporters and opponents say they are motivated by fundamental moral or philosophical concerns, regardless of the numerical impact of the initiative.

For Marcia Angell, a senior lecturer on social medicine at the Medical School and one of the initiative’s major public proponents, this question of autonomy and choice has a clear answer.

“It seems to me that this most personal and faithful of decisions belongs with the patients and no one else: not the church, not the Mass. Medical Society, not the state, no one but the patient. And it hurts no one if the patient makes this choice,” she said.

Angell said that the experiences of those who have taken advantage of the law in Oregon shows that the availability of this choice is valuable, even if not used by many.

“Good palliative care and assisted suicide—those two things are not mutually exclusive any more than the medical treatment of heart failure and heart transplantation. You use one when the other fails,” Angell said. “Allowing the most desperate of patients to have assisted dying to bring about a slightly faster, more peaceful death, does nothing to the other 99.8 percent of patients.”

But for some of the bill’s opponents at Harvard, the issue holds just as much philosophical weight.

For example, Harvard Right to Life, an undergraduate student group that has focused on issues ranging from abortion to euthanasia, has publicly opposed the initiative.

“Harvard Right to Life stands for the right to life from conception to natural death,” HLR president Matthew R. Menendez ’14 said. “So it is our view that it is never right to voluntarily end a life, and so in that sense we are opposed to [the Death with Dignity initiative].”

A COMPLICATED QUESTION

But for many voters, the debate over the initiative is not a moral question with a simple yes or no answer. Several Harvard affiliates say that the specific wording and implementation of the question is the more important consideration.

Lisa Lehmann, an associate professor of medicine and medical ethics, said that her views on the question are complicated.

“While I’m certainly someone who believes in increasing and furthering and advancing patient autonomy, I think that there are a lot of problems with the current ballot initiative,” said Lehmann.

Primarily, Lehmann stressed the potential problems in having this initiative without any mandate for psychiatric evaluation. Citing data from patients considering assisted suicide in Oregon, Lehmann said, “only 7 percent of patients were referred to psychiatrists for mental health evaluations.” Many patients with terminal illnesses have some form of depression, “but the safeguard of mandatory evaluation by a psychiatrist is not in place in this legislation and I think that raises some concerns” said Lehmann.

A CLOSE VOTE

As Election Day approaches, students and professors on both side of the issue say that divided opinion, both on campus and throughout the Commonwealth, have left the fate of the initiative unclear.

In recent weeks, polling on the question has showed an increasingly narrow margin of support. A Suffolk University/News 7 poll released last week showed 47 percent in support of the bill and 41 percent opposed, a stark contrast to the 37 point spread seen in polls taken in September.

“I think it’s going to be very close,” Angell said. “The polls were overwhelmingly in support of it, but they’re narrowing now as a result of lots of misleading ads that are being shown on television. The opposition to Question 2 has put a lot of money into this and it seems to be having an effect. They seem to be fear mongering.”

At a recent event sponsored by the Harvard Undergraduate Bioethics Society, which does not take a formalized stance on issues, the opinions in the room were as divided as those of voters across the state.

“I just hope that students voting in Massachusetts have the opportunity to engage in dialogue with each other and understand the policies at stake here,” the society’s co-president Gus G. Ruchman ’15 said.