’m a doctor with incurable stage 4 prostate cancer. When my suffering becomes intolerable, I hope my doctors will permit me the option to end it peacefully with medical aid in dying — something I have been working to get explicitly authorized in Massachusetts, where I live. Medical aid in dying gives mentally capable, terminally ill adults with six months or less to live the option to request a prescription medication they can choose to take in order to end unbearable suffering by gently dying in their sleep.
When I was in my 40s, I watched my mother and my father-in-law suffer agonizing deaths from cancer. I remember thinking, “That’s not the way I want to die.” As an internist, I have treated patients in the office and the hospital, including intensive care units. I took over the primary care of patients who were terminally ill when specialists were no longer able to help them. I passionately believed that my professional responsibilities included caring for my patients at the ends of their lives.
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I was involved in most aspects of pain control and hospice care. For some patients, I provided palliative sedation to unconsciousness, which means giving intravenous morphine to someone who is terminally ill and has excruciating, uncontrolled pain, essentially putting them to sleep until death occurs. I have had discussions with patients about putting them on a ventilator and later disconnecting it to end prolonged dying processes. I helped patients decide whether or not to undergo treatment when the alternative was death. However, when a terminally ill patient with cancer asked me to help him die peacefully to end his suffering, I was afraid that I might lose my license or, worse still, end up in prison. I’m embarrassed to say that I declined to give him a lethal prescription, as I put my needs ahead of his. That is a morally compromised position.
Sixteen years ago, at age 50, I was diagnosed with prostate cancer. After undergoing surgery to remove my prostate, I was told that the cancer had been contained in the gland and that I was “cured.” Five years later, I found myself undergoing radiation and hormone treatment, once again trying to cure the cancer. No dice.
I am, by nature, a private man. I initially shared my diagnosis with just my family, my medical partners, and a few patients of mine who shared the same cancer. The disease continued to progress and the treatments took a tremendous toll on me, forcing me to do something I didn’t want to do: retire shortly before my 63rd birthday in 2015. Being a good internist requires you to be on your A-game — anything less can be dangerous for your patients — and I wasn’t.
A week after retiring, my wife and I attended a lecture about medical aid in dying, sometimes referred to as physician-assisted suicide. This end-of-life care option is explicitly allowed in the District of Columbia and six states, California, Colorado, Montana, Oregon, Vermont, and Washington. Together they have had 40 years of collective experience without a single documented case of misuse.
That night my wife and I looked at each other and decided to work to bring this option to Massachusetts. My days of being private were over.
I began to volunteer for Compassion & Choices, a national nonprofit organization whose mission is to improve care at the end of life and expand end-of-life options. At the time, the organization was trying to convince the Massachusetts Legislature to pass a bill, the End of Life Options Act, to authorize medical aid in dying. In early 2016, I testified in support of the legislation before the Massachusetts Legislature’s Joint Committee on Public Health. At the time, one of the largest roadblocks to medical aid in dying was opposition by my fellow members in the Massachusetts Medical Society (MMS).
Not long after that, I started to experience pain as the cancer ate away at my pelvis. It was an ominous sign that my treatments were no longer working. I underwent palliative radiation and, later on, immunotherapy.
Then, with other Massachusetts physicians and colleagues at Compassion & Choices, we began trying to persuade the medical society to drop its decades-long opposition to medical aid in dying. We knew that polls of physicians nationwide had shown growing, widespread support for this end-of-life care option, and we reasoned that Massachusetts physicians likely shared this viewpoint.
At the same time, Compassion & Choices filed suit on behalf of me and another physician against the state’s attorney general and local district attorney, asserting that the Massachusetts Constitution and existing state law already authorize medical aid in dying and no statute specifically criminalizes the practice. Our goal is for the court to rule that mentally capable, terminally ill adults who can take medication on their own have the option to get a prescription for medical aid in dying. We also asked the court to protect physicians from criminal prosecution for writing prescriptions for aid-in-dying medication. Compassion & Choices won a similar suit in Montana in 2009; ours is still pending.
It took a year for the MMS to develop, distribute, and tabulate the results of its own survey on medical aid in dying. Released in early December, it showed that physicians supported medical aid in dying by a 2-1 margin, endorsed legislation that would authorize it, and wanted the society to withdraw its opposition in favor of a supportive (41 percent) or neutral (19 percent) stance. The next day, the House of Delegates met and discussed a resolution my colleagues and I had written. We asked the medical society to drop its opposition to medical aid in dying and establish a policy of “neutral engagement.” That means if the state authorizes medical aid in dying because of our court case, legislation, or ballot initiative, the society will train its doctors about the practice of medical aid in dying and other end-of-life care options, including hospice and palliative care.
While nine constituent societies of the American Medical Association — eight states and the District of Columbia — previously had changed their position from opposition to neutral on medical aid in dying, I am proud to say the Massachusetts Medical Society is the first one to adopt a policy of neutral engagement.
I believe that the time is coming when all terminally ill people be able to get the help they deserve when they ask their physicians to be able to die to end intolerable suffering.
Roger Kligler, M.D., a retired internist, lives in Falmouth, Mass.