Legislation seeks to legalize medical aid in dying

When community activists Bev Baccelli and Liz DiCarlo saw loved ones painfully gasping for breath while waiting to die, they started to think about options to end the suffering.

Baccelli and DiCarlo, who are married to one another and live in Mattapoisett, are among those who believe a proposal giving those on their deathbeds the option to end their lives through medication will allow them to die with dignity, and avoid unbearable pain.

During a legislative webinar held earlier this month, state Sen. Jo Comerford, D-Northampton, said more than 900 people from her western Massachusetts district have reached out to voice support for the Act Relative to End of Life Options.

The act would grant terminally ill, mentally capable adults who have a prognosis of six months or less to live the option to request, obtain and ingest medication to end their lives peacefully.

"It speaks to the passion and the organizing that's happening statewide to move this bill forward," Comerford said. "It has been proven in other locations and it's time Massachusetts residents had the pathway embodied in this important legislation."

As of 2021, 10 states and the District of Columbia have enacted laws to permit some form of physician-assisted death.

"The Massachusetts bill is very similar to the bill in California and other states," said Dr. Sunita Puri, director of the hospice and palliative fellowship at UMass Memorial Medical Center in Worcester. While working at the University of Southern California, she wrote the medical center's policy on the California End of Life Options Act.

"I do think that the bill provides adequate safeguards for physicians and patients," Puri said.

'One of the strictest proposals'

People eligible for medical aid in dying medication must be able to self-ingest the medication and be approved by a licensed mental health professional, among other requirements.

Those other requirements include the patients making two separate requests — one oral and one written — for medication with a 15-day waiting period in between, as well as the right to withdraw or change their minds at any point.

Attending physicians must also inform patients of all end-of-life care options, including hospice, palliative or symptom management. Individuals are ineligible for medical aid in dying simply due to age or disability.

"What we're proposing, if it passes, would be one of the strictest proposals in the country," said state Rep. Ted Philips, D-Sharon, in an interview. "Most states actually don't require the mental health evaluation that we require."

According to a Suffolk University and Boston Globe poll conducted last May, nearly 77% of those surveyed supported the idea of medical aid in dying.

"Every year, we've added more and more co-sponsors and supporters to the legislation, and that momentum continues to go and grow," said Melissa Stacy, a regional advocacy manager for Compassion & Choices Action Network, a nonprofit that advances freedom at the end of one's life.

The bill, filed in both the House and Senate this session, has more than 50 co-sponsors, including state Sens. Becca Rausch, D-Needham, and Jamie Eldridge, D-Acton, and state Rep. Jack Patrick Lewis, D-Framingham.

Philips said this is the eighth time the bill has been refiled since his predecessor, state Rep. Lou Kafka, first proposed a medical aid in dying bill in 2008. In the last legislative session, the bill made it out of the Public Health Committee, but it was not cleared in the Health Care Financing Committee.

"Every time we filed, the language gets stronger and more improved," Philips said. "I'm optimistic now, because we have a new administration and a new governor. When Charlie Baker was governor of the commonwealth, he was noncommittal on the bill."

Gov. Healey indicates support

Gov. Maura Healey endorsed medical aid in dying medication last March, saying the option should be decided by the Legislature rather than the courts. She indicated that if the proposed bill, with its current safeguards, reaches her desk, she would sign it.

While the Supreme Judicial Court upheld the state's ban in 2022, it also ruled that the ultimate decision lies within the Legislature. Since then, the idea has been backed by numerous supporters.

Over the years, the bill has faced opposition from disability rights groups such as Second Thoughts Massachusetts.

"The end-of-life concerns show that people are upset about depending on other people, and they are feeling like a burden," said John Kelly, director at Second Thoughts.

Kelly said innocent people are at risk of losing their lives due to misdiagnosis, coercion, insurance denials and lack of access to necessary services, with no safeguards in place to prevent this from happening.

"It's insurance companies who decide whether you get your treatment covered or not, and assisted suicide will always be the cheapest so-called 'treatment,'" Kelly added. "It wreaks havoc on people's lives because death cannot become a benefit to people — because once you make it a benefit, there is no way to contain eligibility to one narrow set of people."

Philips said there is no instance of abuse of coercion in the past 25 years since the Death with Dignity Act was passed in Oregon.

"We have argued very vehemently against that this could in any way be discriminatory because of how narrowly we have carved the pool of people who would be able to request this medication," he said.

An option to avoid 'extreme pain'

Proponents of the bill believe it will give people options to avoid suffering extreme pain from terminal illnesses.

"I am humble enough to say that there are types of suffering that even my extremely skilled practice cannot relieve," Puri said. "And I think for those who are going through this level of suffering, it's a really important option to have."

Puri said when eligible patients choose to end their lives through medication, it is a "very hard" decision.

"It is generally a very hard and emotional process to decide that you would rather take medications to end your life when you're terminally ill on your own terms than to wait for death to come because the suffering is just too much. These are not decisions that people make lightly," she said.

Baccelli and DiCarlo said if the bill passes, the first thing they will do is contact their primary care physicians and have a conversation with them about the process of getting medical aid in dying medication.

"I think having the law will promote conversations amongst family members and friends and that will be the beginning of the change in how people can die with dignity in the Commonwealth," Baccelli said.