End of Life Options Act

I offered the following testimony on October 20, 2023 for An Act relative to end of life options. You can watch the video here.

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Chair Decker and Chair Cyr:

I am proud and honored to offer testimony in support of S. 1331, An Act relative to end of life options. I have offered this bill in partnership with Leader O’Day and Representative Phillips, who have filed H. 2246, and the 18 sponsors of the Senate bill and 66 House sponsors as well.

I am also grateful to have close Senate partners on this bill in Senators Brownsberger and Moran.

This bill is titled “End of Life Options,” to emphasize that the bill offers a compassionate option  – to allow mentally-capable patients with terminal conditions to choose a peaceful, humane death with dignity. 

At the same time, it establishes rigorous safeguards for patients and physicians to follow in order to protect vulnerable people from coercion.

We should recognize that this committee has been instrumental in developing these safeguards after listening deeply to people from across the Commonwealth and incorporating their concerns.

The bill also respects patients’ autonomy by allowing them to express their deepest personal values and priorities as death approaches, with compassion and respect.

The bill protects the right of an individual to determine what quality of life means to them, and for physicians to support the dying person’s own decision.

The bill sets out a detailed procedure to allow a terminally ill, mentally capable adult with a prognosis of six months or less to live the option to request, obtain and ingest medication — should they choose —  to die peacefully in their sleep if their suffering becomes unbearable. 

These are the steps required by the legislation:

1. The patient must make an oral request to their primary doctor, followed up by a written request within 15 days. 
2. The patient must be 
   1. a resident of Massachusetts;
   2. mentally capable, defined as being able to make an informed decision. The bill specifies in detail how to determine if the person is mentally capable, and 
   3. terminally ill, defined as someone with a disease or condition reasonably expected to cause death within 6 months, even if treatment is provided
3. The written request must have 2 witnesses, with at least one not being a relative or connected with the person’s medical care.
4. The doctor is required to 
   1. discuss with the patient their diagnosis, prognosis, risks and result of taking medicine, alternatives such as palliative care, hospice and pain control;
   2. Refer the patient to a consulting physician; 
   3. Refer the patient for counseling; and 
   4. Record everything required in the medical record.
5. The consulting physician must then confirm the medical diagnosis that the patient is terminally ill and that the patient is mentally capable; is acting voluntarily; and has made an informed decision.
6. A licensed mental health professional must conduct counseling to determine that the patient is not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.  
7. Only after all these steps are followed, the doctor must again verify that the patient is making an informed decision, and can then dispense the medication. 
8. The individual must be able to self-ingest the medication. 
9. The patient can withdraw their request for medication, not take the medication once they have it, or otherwise change their mind at any point. 
10.  Under the bill, no physician, health provider or pharmacist is required to participate.
11.  And, the Massachusetts Department of Public Health is required to issue a publicly available annual report, but identifying information about individual patients and doctors is kept confidential. 

I want to make two important points for the Committee to keep in mind:

First, concerns have been raised by some that the bill could lead to coercive pressure, particularly on people with disabilities.

A Washington Post article from this March looked at the issue, and quoted the head of  Disability Rights Oregon, the leading advocates for rights for people with disabilities in Oregon, which has had its Death with Dignity Act since 1997. He said that in all that time, “DRO has never to my knowledge received a complaint that a person with disabilities was coerced or being coerced to make use of the Act.”

Second, it’s important that public opinion is very, very supportive.

A March 2023 poll found that 73% of Massachusetts voters support a bill to allow terminally ill adults the option of medical aid in dying to peacefully end unbearable suffering. What’s more, that support increases to 79% after respondents are told about the safeguards in the bill. 

I also must mention that Governor Healey is also a supporter of the proposal. 

I believe the time has come, at last, for the legislature to advance this bill. 

This bill is about choice and compassion.

Thank you to the Chairs for your thoughtful consideration of this bill and to the Committee for advancing it favorably in the two preceding sessions. I respectfully request the Committee provide a favorable report on this legislation.