In 2012, Massachusetts residents came close to legalizing medical aid in dying.

Voters narrowly defeated a ballot question on the practice by a vote of 49% to 51%. In 2024, polling from a University of Massachusetts Amherst/WCVB poll indicated that, 12 years later, 67% of Bay Staters are in support of medical aid in dying, and another 22% are neutral toward it.

Medical aid in dying was first legalized in the United States in 1994, with Oregon passing a “death with dignity” measure that allows physicians to prescribe medication that will end a patient’s life. After a court battle, the law went into effect in 1998. But even before it was legalized in the United States, the idea of ending a life to alleviate suffering has existed for millennia.

In the 1990s, the medical pathologist Jack Kevorkian, nicknamed “Dr. Death,” helped about 130 terminally ill patients end their lives through assisted suicide. He was a major advocate for the right of the terminally ill to choose how they die, and spent eight years in prison for helping a man die in 1998. When he was released from prison in 2007 after promising not to conduct another assisted suicide, medical aid in dying was legal in Oregon, and was legalized in Washington the following year by ballot initiative.

About 22% of Americans now have access to medical aid in dying; it is legal in Oregon, Washington, Montana, Vermont, California, Colorado, Hawaii, New Jersey, Maine, New Mexico and the District of Columbia. On May 20, Delaware became the 11th state to legalize medical aid in dying. Additionally, on June 9, the New York State Senate approved a bill legalizing medical aid in dying, which passed the State Assembly earlier this year, but Gov. Kathy Hochul has yet to sign it into law.

Only Vermont and Oregon allow out-of-state patients to access medical aid in dying within their states.

In U.S. jurisdictions where medical aid in dying is legal, patient choice and control is central to the process. If the doctor were to administer the medication through a syringe or otherwise, that would be euthanasia, which is prohibited throughout the United States.

Doctors may prescribe life-ending medication, but the patient must self-administer it. Notably, almost one-third of U.S. patients who are prescribed the medication never use it. For some, just knowing they have the option to take the medication is enough.

Massachusetts bill

Last Tuesday, July 1, the current Massachusetts bill allowing for medical aid in dying was released from the Joint Committee on Public Health, which held a hearing on it April 2. The proposed legislation follows the outline of the U.S. laws that preceded it, with similar rules and restrictions.

“This bill is about individual autonomy and patient directed care. This is legislation that is really focused on people who are dying, and they know that they are dying, all of the curative treatments that are available to them have been tried, and they want the option to take that control back, that their terminal illness is taken from them,” said Melissa Stacy, the northeast regional advocacy director for Compassion & Choices Action Network, a nonprofit that advocates for improving and expanding end-of-life options. “The peace of mind that this brings patients, whether they actually utilize it or not, is incredible.

The Massachusetts bill states that patients who want medical aid in dying must make an oral request to their physician, and also submit a written request no less than 15 days after making the oral request. The patient must be a mentally capable adult, a resident of Massachusetts and their physician must determine that they have a terminal illness that can reasonably be expected to cause death within six months.

The written request must have two witnesses, one of whom is not a relative of the patient, not entitled to any portion of the patient’s estate, not financially responsible for the medical care of the patient and not an employee of the health care facility where the patient is receiving treatment.

“No one wants to be made to feel that dying is a better option than living because they’re a burden on their family or because their care might be expensive, and so there’s a lot of protections on this bill to make sure that people are not coerced and no one can profit from someone making this decision, and that this is really only available for people who are truly at the end of life and with very serious illness,” said state Rep. Lindsay Sabadosa, D-Northampton.

After receiving the request, the attending physician must verify again that the patient meets all criteria. The physician must fully discuss the patient’s end of life options and treatment alternatives with them, and refer the patient to a consulting physician to medically confirm the diagnosis, prognosis and determine that the patient is mentally capable and acting voluntarily.

The patient also must see a mental health professional to review for psychiatric or psychological disorders or depression causing impaired judgement.

Finally, the attending physician must counsel the patient about the importance of having another individual present when the patient takes the medication and not taking the medication in a public place. They inform the patient that they may rescind the request for medication at any time and verify that the patient is making an informed decision.

“As end of life conditions can present themselves in a variety of different ways, people want to be able to have the option to not necessarily have to go through indescribable loss of functionality, loss of independence, loss of dignity,” State Rep. James O’Day, D-West Boylston, who filed the bill in the House, said. “There are those safeguards that make sure that this is your wish, and what you need to do in order to be able to fulfill the actual protocol contained within the bill to have an end of life that has some dignity and choice.”

Since its first introduction in 2008, bills that would legalize medical aid in dying in Massachusetts have gone through changes to further strengthen the law. In response to concerns from the disability community, the waiting period has been clarified in the legislation, and restrictions on witnesses have been added. No physicians can be required to participate in providing medical aid in dying.

In an April 2 hearing of the Joint Committee on Public Health, State Sen. Jo Commerford, D-Northampton, who filed the bill in the Senate, said that it is “known as the strongest, by far, hands down, bill in the nation.”

The end-of-life options bill has been released from the Joint Committee on Public Health, and will likely continue to the Committee on Healthcare Financing and the Committee on Ways and Means, both of which are committees the bill was referred to last session, before it can be voted on in the Legislature. Nine of the 11 representatives in the public health committee supported the bill.

O’Day, the bill’s sponsor in the House, was optimistic about getting the bill passed in light of the April 2 hearing early in the 2024-2025 legislative session.

O’Day also referenced Gov. Maura Healy’s support for the bill last session, and the Massachusetts Medical Society’s position of “neutral engagement” on medical aid in dying, a 2017 position change from previous long-standing opposition to what they then called “physician-assisted suicide.”

“The momentum really was on the move last year, and to have the committee have a hearing this early in the session, I think says an incredible amount about all of the things that have been sort of percolating over the last four or five years,” O’Day said. “For it to be heard before the end of the summer would be tremendous, which would still give us an entire year to manage to have this approved and made into law.”