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Death with dignity and medical marijuana on the ballot

Posted by Dr. Suzanne Koven  October 31, 2012 06:24 AM

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vote button.jpgOn November 6th, Massachusetts voters will have some important choices--other than Brown vs. Warren and Obama vs. Romney. Two questions, one concerning a terminally ill person's ability to end his or her own life and the other regarding medical use of marijuana, will be on the ballot. In both cases complex issues that medical professionals, policy makers, and ethicists have struggled with for years will be put before voters in dense summaries that many, realistically, will skim while standing on line at the polls.

I won't tell you how to vote on these questions, but maybe I can help you make your own decision by providing some details about the choices and summarizing their opponents' and supporters' points of view.

young woman_death_bed_hi.jpg Question 2: The "Death With Dignity" Initiative would allow a person determined by doctors to be terminally ill (having less than six months to live) to request drugs to end his or her own life. Details about the question and links to pro and con arguments about it may be found here. Opponents have expressed concern that the new provision might be a step on the slippery slope towards euthanasia of people "unfit" to live, or that relatives who stand to benefit from the person's death might be coercive. Supporters claim that the question very specifically addresses the autonomy of dying patients who are competent to make their own choices. Recently, physicians on both sides of the issue have eloquently expressed their views. Dr. Marcia Angell, Harvard Medical School faculty member and former editor of the New England Journal of Medicine, spoke movingly on NPR about her father's death from prostate cancer. When he was in severe pain and unable to walk without falling, he shot himself rather than continue living in misery. Angell, a strong proponent of Question 2, wishes her father and others like him had the option of ending their lives peacefully. On the other hand, Ezekiel Emanuel, a physician and medical ethicist recently wrote an editorial in the New York Times arguing against "doctor-assisted suicide" (a term not favored by supporters of Question 2). In that editorial, Emanuel listed what he calls "myths" about the issue, including the idea that severe pain most commonly causes terminally ill patients to wish to end their lives--he thinks treatable depression is more common--or that an assisted death is necessary a "good" death.

According to the wording on the ballot, A YES VOTE on Question 2 would enact the proposed law allowing a physician licensed in Massachusetts to prescribe medication, at the request of a terminally-ill patient meeting certain conditions, to end that person’s life. A NO VOTE would make no change in existing laws.

medical marijuana.jpg Question 3: The Massachusetts Medical Marijuana Initiative would legalize marijuana for use in certain medical conditions. Details about the issue and summaries of the pros and cons can be found here.

Question 3 is supported by patient advocacy groups such as Committee for Compassionate Medicine. They argue that patients suffering with chronic pain, nausea, muscle spasms, and other conditions are being unfairly and unnecessarily denied the full range of treatment options available because marijuana is illegal for medical use in Massachusetts. They cite the success of medical marijuana programs in several other states and express confidence that Massachusetts could tightly control marijuana dispensaries and prevent abuses.

The Massachusetts Chiefs of Police Association and The Massachusetts Medical Society both oppose Question 3. The chiefs of police express concern that abuse of medical marijuana might, in fact, be widespread and difficult to control. The MMS, which also opposes Question 2, believes that more research needs to be done before the safety and efficacy of medical marijuana is established.

According to the wording on the ballot A YES VOTE would enact the proposed law eliminating state criminal and civil penalties related to the medical use of marijuana, allowing patients meeting certain conditions to obtain marijuana produced and distributed by new state-regulated centers or, in specific hardship cases, to grow marijuana for their own use. A NO VOTE would make no change in existing laws.

These aren't easy questions, and they don't have easy answers but, nevertheless, we voters are being asked to decide them. Let's all give them some thought before we enter the voting booth.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

Suzanne Koven, M.D. practices internal medicine at Massachusetts General Hospital in Boston. She writes a monthly column for the Globe's G Health section and her essays have appeared in the More »


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