Massachusetts court explains why assisted suicide should be prohibited.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A Massachusetts Superior Court decision that was released on Friday, January 10 concluded that there is no right to assisted suicide in Massachusetts.

• Massachusetts court rules there is no right to assisted suicide (Link).

This is not the first decision of its type in the United States, in fact there have been several cases that were simply dismissed by the court, while others were heard and also found that there is no right to assisted suicide.

In its decision, the Massachusetts court explained why the Commonwealth prohibition on MAID meets the rational basis for both due process and equal protection. Starting on Page 20 of the decision, the court explains why assisted suicide should not be legalized. The decision states (edited):

First, the Legislature could rationally conclude that difficulty in determining and ensuring that a patient is "mentally competent" warrants the continued prohibition of MAID. There is expert testimony in the record that many patients faced with a diagnosis of terminal illness are depressed, that this depression and accompanying demoralization may interfere with their ability to make a rational choice between MAID and other available alternatives, and that most Massachusetts physicians are unaware of the best practices in responding to requests for MAID given this context... There is also evidence that the problem of competency is particularly acute at the time at which a patient self-administers the medication because patients may be alone or accompanied by those who support his or her end-of-life decision... In such a situation there is a great risk that temporary anger, depression, a misunderstanding of one's prognosis, ignorance of alternatives, financial considerations, strain on family members or significant others, or improper persuasion may impact the decision. The concern that the decision will be motivated by financial considerations are potentially heightened when MAID is being used by members of disadvantaged socio-economic groups.

Second, the Legislature could rationally conclude that predicting when a patient has six months to live is too difficult and risky for purposes of MAID, given that it involves the irreversible use of a lethal prescription. The Commonwealth put forward expert testimony that while doctors may be able to predict death within two or three weeks of its occurrence, predictions of death beyond that time frame are likely to be inaccurate. 

Third, the Legislature could rationally conclude that a general medical standard of care is not sufficient for those seeking MAID. The Commonwealth put forward expert testimony that MAID "is neither a medical treatment nor a medical procedure and thus there can be no applicable medical standard of care" and that "the legalization of MAID is an attempt to carve out a special case outside of the norms of medical practice"... The Commonwealth also put forward evidence that regulating MAID is difficult even where statutory standards, such as those in Oregon, are in place. Its expert opined that: "Data collected in Oregon paints a picture of patients receiving MAID for whom alternative approaches have not been exhausted. Psychological referrals are scant. The cited basis for requests largely consists of problems that are manageable via palliative care and hospice. What Oregon officials do not do is monitor the actual process for terminating patients yet the data that is available is troubling.

Finally the Commonwealth produced expert testimony that the permissible end-of-life alternatives potentially involve far less risk than MAID because they occur in hospitals or other institutions devoted to medical treatment and involve numerous physicians and staff personnel, which together provide an environment that lends itself to oversight and responsibility... MAID, on the other hand, potentially takes place in an uncontrolled environment, without assurance that the patient will administer the medication when close to death and without physician oversight.

The Massachusetts court decision recognized the difficulty in accurate patient assessment to approve MAID, which is an irreversible decision. The court decision challenged the concept that MAID is a form of medical treatment and pointed out that, even in Oregon the oversight of the law is questionable at best.

Finally, the Massachusetts court found that oversight and control of assisted suicide laws are lacking. The risk related to assisted suicide is great.

The assessment by the Massachusetts court should be taken seriously by legislators who are considering assisted suicide bills. Assisted suicide is neither safe nor effectively controlled.