April 9, 2018

As public sentiment changes, some Mass. docs say 'no' to assisted suicide

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Dr. Mark Rollo, a Fitchburg family practice physician, said patients may be at risk of insurers not covering treatments if physician-assisted suicide is legalized in Massachusetts.

When the Massachusetts Medical Society (MMS) voted in December to rescind its longstanding opposition to physician-assisted suicide, it appeared to be an important turning point for those who believe the option should be legal for the terminally ill.

But the debate among members about whether adopting a position of "neutral engagement," which neither favors nor opposes the practice, has continued to swirl in the months following the decision by the professional organization's policy-making body, known as the House of Delegates.

In an interview in February, Dr. Henry Dorkin, president of the MMS, was adamant the doctors hadn't voted to embrace proposed legislation to make it legal for doctors to prescribe a lethal prescription for terminally ill patients with a life expectancy of six months or less.

"We are neither for it, nor are we taking a position against it," Dorkin said.

Rather, Dorkin said by being neutrally engaged, MMS doctors can provide physician insight to lawmakers as they mull two bills, one filed in the House and one in the Senate, to legalize the practice.

Similar legislation and ballot measures have been brought forward in Massachusetts numerous times over the last eight years, without successful passage. Proponents came close to victory in November 2012, when the ballot initiative known as "Death with Dignity" was narrowly defeated, with 51.9 percent of voters opposing it.

Mounting support

Since it narrowly failed to pass muster in Massachusetts, U.S. public opinion on physician-assisted suicide has grown more favorable. According to a May 2017 Gallup Poll, 73 percent of Americans said it should be legal at the request of terminally ill patients. That was the highest level since 2005.

Over the decades, there has been a seachange in public opinion on the practice. In 1951, just 36 percent of Americans were favorable, according to Gallup. That percentage climbed to 53 percent by 1975, before peaking at 75 percent in 1999 and 2005. For the last 13 years, favorability has ebbed and flowed but remained relatively steady.

A survey of MMS members conducted in September showed the majority, or 60 percent, of Bay State doctors favor the option, and 62 percent say they favor the pending legislation. However, only 13 percent of the MMS' roughly 25,000 members responded to the survey.

Coalition rejects new position

As Dorkin noted in his interview, there are many physicians who are staunchly opposed to the idea of legalizing assisted suicide.

They maintain it directly contradicts the moral obligation of physicians to care for their patients, and that it makes patients vulnerable to a host of issues that proponents might not anticipate, such as problems getting coverage for treatment if insurance companies believe patients will not survive an illness, or being taken advantage of by family members who stand to gain in the event of the patient's death.

One of those physicians is Dr. Mark Rollo, a Fitchburg-based family practice physician and MMS member who is among about 25 doctors who have banded together in opposition of the MMS's new position of neutral engagement. The doctors announced their position during a press conference at the Massachusetts State House in January.

Rollo, who has been involved in pro-life causes in the Fitchburg area over the years, including opposing the opening of a Planned

Parenthood clinic on Main Street in Fitchburg because the organization provides abortion services, said the MMS' "neutral engagement" position is a euphemism.

"It's a cop out, and it is wimpy, weak wording," Rollo said.

According to Rollo, his opposition and that of other doctors transcends religious affiliation, and there are non-religious people behind the same cause.

"It's much broader than that. It's a moral issue that affects people's lives," Rollo said.

Rollo cited two well-known cases in Oregon where Medicaid patients Barbara Wagner and Randy Stroup were denied coverage for drugs that doctors thought might extend their lives because the state-run health plan determined that survival odds weren't great enough. Instead, Wagner and Stroup were reportedly told that they could receive coverage for prescriptions to end their life. Assisted-suicide has been legal in Oregon since 1994, making Oregon the earliest adopter of the practice. Since then, Washington, Montana, Vermont, California, Colorado and Washington, D.C. have legalized it, in that order.

Is Mass. the new frontier?

Rollo said the national end-of-life options advocacy group Compassion & Choices has been promoting passage of an assisted-suicide law in Massachusetts for years, but he said despite changing public opinion, advocates still face an uphill battle in Massachusetts.

"I don't think it's a slam dunk that either side is going to prevail," Rollo said.

Rollo believes that legalizing assisted suicide will make low-income and minorities vulnerable, actually decreasing their end-of-life options rather than adding one more to the list. He said the focus should be on treatment to improve quality of life and palliative care for those nearing the end, and he doesn't think the proposed bills being considered by legislative committees have adequate safeguards to protect people from coercion into assisted suicide.

On the other side of the issue is Rep. Louis Kafka (D-Stoughton) a longtime proponent of legalizing assisted suicide and the sponsor of the House bill.

"I look at it as [an option] for the person who chooses to end their life because of an illness that is terminal, and in their minds could be very painful, and under best circumstances will only allow them six more months," Kafka said in an interview in March.

Kafka has been trying to get a bill legalizing assisted suicide passed since a terminally-ill constituent brought the issue to him eight years ago. Kafka said he hasn't been made aware Rollo's concerns that some may be coerced into choosing assisted suicide, and he said if that became a reality, he would respond.

"If that should happen, I would immediately file legislation that would fine any insurance company that would make that decision," Kafka said, though he added to write that into the bill now may confuse the issue.

Both the House and Senate bills have been referred to the Committee on Public Health. This spring, they are expected to either be sent for further study by a committee or go to the floor for a vote. According to Rollo, the opposing doctor, there are also rumors the issue will go to the ballot in 2020, if it doesn't pass in the Legislature.

(Editor's note: The Committee on Public Health voted to send the House and Senate bills to a study, effectively killing them this legislative session, according to a March 29 report by State House News Service. It is the fifth consecutive session in which bills have failed to proceed to a vote.)

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