Dr. John Peteet and Dr. Ronald Pies oppose physician-assisted death - Worcester Telegram

In precocious denying Dr. Roger Kligler’s petition for aesculapian assistance successful dying/physician-assisted termination (MAiD/PAS), the Massachusetts Supreme Judicial Court acknowledged the complexity of the decision, noting that the authorities has morganatic interests successful “preserving life; preventing suicide; protecting the integrity of the aesculapian profession; ensuring that each end-of-life decisions are informed, voluntary, and rational; and protecting susceptible radical from indifference, prejudice, and intelligence and fiscal unit to extremity their lives."

Gov. Maura Healey has since expressed hopes for legislative enactment to let MAiD/PAS with “appropriate guardrails,” pursuing the pb of different jurisdictions successful the United States, Canada and Western Europe. 

Fears of dying successful distress oregon babelike connected exertion person understandably heightened the entreaty of arguments for MAiD/PAS based connected self-determination and the alleviation of suffering. Counterarguments are often perceived arsenic unduly abstract oregon based successful religion. However, arsenic a psychiatrist astatine a crab halfway and a psychiatrist-medical ethicist, we spot compelling reasons to reason legalization of MAiD/PAS:

First, cumulative experience with MAiD/PAS successful Oregon has shown that the immense bulk of individuals bash not petition assisted decease due to the fact that of intractable symptom and suffering. Rather, astir are motivated by the fearfulness of “losing autonomy” (90.6%); oregon being “less capable to prosecute successful activities making beingness enjoyable” (89.1%). Some besides fearfulness a “loss of dignity” (74.4%); becoming a “burden connected family, friends/caregivers” (44.8%); oregon “losing power of bodily functions” (44.3%).

These fears, portion understandable, are amenable to bully palliative care. Helpful resources see meaning-centered therapy; dignity therapy; psychiatric, spiritual and hospice care; and the contented contained successful books specified arsenic "The Lost Art of Dying" by Columbia doc Lydia Dugdale, who reminds america that to beryllium quality is to beryllium contingent and interdependent with others.  

A important assets successful dying good is simply a narration with a doc who appreciates the psychological, idiosyncratic and existential aspects of the doctor-patient narration – 1 who tin reassure patients that their last days tin person meaning, that their burdens volition beryllium shared, and that their carnal oregon affectional symptom tin beryllium made much bearable. To connection MAiD/PAS is to convey that the extremity of beingness lacks intrinsic meaning oregon purpose, and to renege connected the physician’s mandate to “cure sometimes, dainty often and comfortableness always.”

We are besides troubled by the European and Canadian experience, successful which the availability of MAiD/PAS oregon euthanasia (the progressive termination of the patient’s beingness by the physician) has led to expanding numbers of individuals dying by these means. Although patient-administered MAiD/PAS successful the United States has not resulted successful akin numbers, successful 2021 much than 10,000 radical died by euthanasia successful Canada, an summation of astir a 3rd from the erstwhile year.

Moreover, determination is an ever-expanding database of reasons, successful immoderate jurisdictions, for allowing MAiD/PAS oregon euthanasia. For example, the Netherlands and Belgium see intelligence disorders, and Canada has done truthful with a precocious announced delay. In the Netherlands, the criteria person expanded to see beforehand directive-based, present incompetent individuals; infants; and those who are simply “tired of living.” Once MAiD/PAS is allowed – usually initially for the terminally sick – it becomes hard for a nine to contemplate life-affirming alternatives.  

Many successful the disablement assemblage question whether MAiD/PAS tin beryllium equitable. Those pressing for MAiD/PAS are overwhelmingly white and privileged, but the instrumentality applies to all. Even Oregon has acknowledged that its “Death with Dignity Act” has not adequately protected patients with intelligence unwellness from receiving lethal drugs.

Notably, past February, aft pleading unsuccessfully for affordable housing, a disabled Canadian woman ended her beingness nether Canada’s euthanasia laws. In specified instances, MAiD/PAS compels individuals who whitethorn already fearfulness being a load to warrant their existence, and legitimates alternatively than discourages deaths of despair.

Finally, MAiD/PAS prioritizes the patient’s “autonomy” implicit the physician’s Hippocratic work to “first bash nary harm.” Massachusetts lawmakers considering legalizing MAiD/PAS should admit that “guardrails” cannot forestall this signifier from distorting the physician’s role; cheapening idiosyncratic life; and abandoning the astir susceptible radical to the “right” to extremity their lives. Surely arsenic a nine we tin bash better, by providing optimal, accessible psychiatric and palliative care.

Dr. John R. Peteet is simply a psychiatrist astatine Dana-Farber Cancer Institute and an subordinate prof of psychiatry astatine Harvard Medical School. Dr. Ronald W. Pies is objective prof of psychiatry astatine Tufts University School of Medicine, and prof emeritus of psychiatry and lecturer connected bioethics and humanities astatine SUNY Upstate Medical University. The views expressed successful this file are their ain and not needfully those of their affiliated institutions.