Today in Massachusetts, voters will decide whether that state will become the fourth in the country to give terminally ill residents the option of doctor-assisted death. Patient advocates, physicians and hospitals are paying close attention.

 

I've long felt that if I were terminally ill and in terrible pain, I would opt for so-called death with dignity. But after reading two recent opinion pieces in the New York Times, I honestly don't know which way I'd cast my vote if I lived in Massachusetts.

If you haven't read Ben Mattlin's personal and powerful op-ed piece from Oct. 31, you should. He was born with spinal muscular atrophy and has never stood, walked or had much use of his hands. He shocked many medical experts by living past childhood, and today, nearly 50, is a husband, father and successful writer.

He acknowledges the "noble intentions" behind assisted suicide proposals and that laws like the one on the Massachusetts ballot are carefully written to try to avoid the "slippery slope" of individuals choosing assisted death because they are depressed or coerced. However, here's his take:

"My problem, ultimately, is this: I've lived so close to death for so long that I know how thin and porous the border between coercion and free choice is, how easy it is for someone to inadvertently influence you to feel devalued and hopeless — to pressure you ever so slightly but decidedly into being 'reasonable,' to unburdening others, to 'letting go.'"

He tells of physicians who've felt free to make comments like "How have you survived so long? Wow, you must put up with a lot!" He talks of the exhaustion in loved ones' eyes and of nurses and friends who sigh pityingly when they think he is zoned out in a hospital bed.

"All these can cast a dangerous cloud of depression upon even the most cheery of optimists, a situation clinicians might misread since, to them, it seems perfectly rational," Mattlin writes.

In the Oct. 27 Opinionator blog, Ezekiel Emanuel, M.D., a former White House adviser on medical matters, addressed what he calls the myths about doctor-assisted suicide.

Emanuel disputes the contention that excruciating pain is the main reason patients choose assisted death. In places where it's legal, "the primary motive is not to escape physical pain, but psychological distress; the main drivers are depression, hopelessness and fear of loss of autonomy and control," he writes. "Typically our response to suicidal feelings associated with depression and hopelessness is not to give people the means to end their lives but to offer them counseling and caring."

And whom does legalizing assisted suicide really benefit? Emanuel's conclusion: "Well-off, well-educated people, typically suffering from cancer, who are used to controlling everything in their lives — the top 0.2 percent. And who are the people most likely to be abused if assisted suicide is legalized? The poor, poorly educated, dying patients who pose a burden to their relatives."

These opinions represent just one side of an excruciating debate. It's a debate that is likely to play out in more states as patients live longer and longer with critical, sometimes horrible illnesses. By going to the links provided, you can read responses to Mattlin and Emanuel — including well-considered and heartfelt opposing views — at the end of their columns. And you can click here for more reactions. I'd appreciate hearing your thoughts on an issue that continues to confound me.