Massachusetts to decide on "death with dignity" law

The Boston Globe may or may not let non-subscribers click through to the full article, depending on its mood, but here's the summary:

Under the Massachusetts proposal, which is virtually identical to the laws in Oregon and Washington, terminally ill, mentally competent adults deemed to have six months or less to live would have the freedom to obtain a fatal prescription. They could qualify only after going through a process designed to ensure that they are not being coerced and that they fully understand what they’re doing. They would administer the drugs themselves. Any doctor opposed to the practice could opt out of writing the prescription.

Given the parameters that a person is required to have six months or less to live and has to be mentally competent, I am in favor of this. I think this is a decision that an individual should have the freedom to make along with his or her family (legal or chosen), treatment team, and spiritual adviser if applicable.

What I do think is important is to make the distinction that it is not ethical for someone other than the individual to make this decision, nor is it ethical to assist in suicide when the individual does not have a terminal illness. I think that if this passes, it will be really important for physicians to use an accurate definition of terminal illness so that we don't end up with an ableist practice of killing people with disabilities. If someone has a condition in which s/he can live indefinitely using, say, a ventilator, that person does not have a terminal illness. We don't allow the killing of people who are born with lung issues and who use ventilators from the beginning, so why would we allow this just because someone has the past experience of being a person without a disability?

Not Dead Yet is a great organization for resources on this issue. At least from their website, it seems that their position is a bit unclear between whether they oppose any euthanasia or whether they mostly oppose it except in cases where the individual has a terminal illness and is competent of making the decision. Either way, I think their information is useful for looking into how these laws do result in the killing of people who have severe disabilities, but not terminal illness, and people who are not competently making their own decision.

There used to be an article they linked to that I can't find since they redid their website, which gave statistics around how a high percentage of people without disabilities said that they would want to take their lives if they acquired quadriplegia, if they became dependent on a ventilator, if they became unable to eat orally, etc. And of course, nearly all people who have acquired these conditions and have adjusted to them say that their quality of life is good, and people with disabilities report about the same quality of life as people without disabilities. For this reason, we shouldn't allow assisted suicide for people who cannot consent at the moment, because this isn't something people can know in advance. I'm not allowed to sign an advance directive saying I want to be euthanized if my spouse dies or my house burns down, so why would I be able to sign one saying I want to be euthanized if I acquire a disability that similarly suddenly changes my life?

What doesn't seem to be written into the law, and which could be helpful, is some sort of training for physicians around what exactly constitutes a terminal illness versus a disability with which one can live with adaptive equipment. It's pretty well known among people with disabilities and people who work with people with disabilities that the medical community is really ableist. I do like that there's the timeframe of six months or less to live; this distinguishes, say, untreatable cancer from neurodegenerative diseases that people live with for decades.

I am really concerned though about the ability of physicians to distinguish between something that's really not treatable and something that requires adaptive equipment, but that people can and do live with. This even gets tricky with laws around the right to refuse medical treatment. We as a society and as healthcare providers generally try and stop someone who is actively trying to take his or her life, right? A young adult who gets depressed and tries to overdose on pills? We take away the access to the pills and mandate that he be in treatment. A young adult who has used a ventilator all her life with no issues and gets depressed and disconnects herself? We would similarly mandate that she receive treatment. Otherwise, we would be discriminating against her, but helping the other guy, because she has a disability, right?

So what about an adult who previously didn't use a ventilator and now suddenly needs one (and then would be fine as long as she uses a ventilator)? Can this person refuse it? Many physicians would permit this. Many such physicians also have never met a competent, normal-old adult who uses a ventilator, and would be thinking of this under the umbrella of terminal illness and major lifesaving interventions, rather than just that some people need to take medications or use adaptive equipment in order to be alive and healthy. Many physicians would say that this person has less than six months to live, since she'd live a few minutes without the ventilator (but can work, raise a family, live for decades with it).

Again, these situations are clearly really different from someone who has aggressive cancer eating his brain. I know this, and hopefully you know this, but there are a lot of people who don't know a whole lot about people with disabilities, and a lot of these people are healthcare provider or are kind, thoughtful people who someone might be turning to for advice. If this law passes, we really need to be keeping these things in mind, and we need to be raising awareness around the difference between a disability and an actual terminal illness so that we as healthcare providers (and friends and family members) aren't inadvertently suggesting that it's acceptable to kill people with disabilities.

EDIT: It's become pretty clear to me that there are a lot of holes in this law and just too much possibility of killing people because they have disabilities. I'm going to vote no.