I

’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.

Read the counterpoint: Physician-assisted suicide won’t atone for medicine’s ‘original sin’

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.

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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.

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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.

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  • As a Brain Tumor survivor, I have faced my own mortality. Doing so has made me think of the care that I want if/when treatment did not work. Thank you for your work in helping to ensure each person has a dignified death. I am a proponent of allowing natural death. I have made this clear in my advance directives and with my family.

  • I share your same feelings about PAD. Every dying patient/person has their own unique experience and degree of suffering. After 35 years of anesthesia practice, some of my closest physician colleagues have asked for my assistance in the future, if and when they feel the time has come to where they want to end their own suffering. I too, as you mentioned, fear being punished for assisting a fellow physician carry out his request. I believe it is time to add to “palliative sedation” and “voluntary withdrawal of food and water”, a third option for a patient to end suffering with PAD.

  • This is one of the laws that need to bypass the states and go right directly to the Federal Gov. This state to state nonsense pits a person in one state against another in a neighboring state at a time that really matters.
    If you are so sick that you want to die then moving to another state to be then tested retested and all new doctors hired to ensure you are stable enough to make the decision is far too high a pole to climb up
    We need federal legislation that dictates that this is OK. ALL the drugs used are regulated on a federal level. So with that even if ALL the states agreed and made statewide approval the Fed can walk in and turn on the DEA to take away the doctor’s license to prescribe as the prescription is for taking a life and that is currently illegal
    We need to ALL get our pens and keyboards out and tell our state representatives and senators that it is time they introduce a federal bill that allows PAS or whatever more politically correct wording will get it passed
    Take a look at the situation with pot and you will see what happens when you by-pass the Fed. The DOJ has stated that they will enforce pot laws from the federal position since it is still federally illegal in all of the USA regardless that 8 states allow it and another 20 or so allow it for medical reasons
    This bill should not be a big deal. It doesn’t mandate that any doctor has to participate and I think that is essential since some simply do not agree with assisting but the fact is that as long as we open a window there will be someone flying thru and into our time of need
    PLEASE don’t force people to buy party balloon kits and suck off the helium in order suffocate. Yes, it is relatively painless but it is not as good as narcotics with amnesiacs and anti-emetics. The drug combos work seamlessly in all but the craziest cases.
    The MOST pathetic part is we have NO problem helping our pets to cross the bridge when we realize they have had enough and are suffering but we see it as murder if we do it with our human best friends and family! What a screwed up mentality we carry around as facts.
    Dr. Dave

  • Doctors and very wealthy have slways been able to die on their own terms. Thank you to this Doctor for speaking out. It is one thing for Compassion and Choices to fight for our right to death with dignity, it is another for ALL American doctors and nurses to speak up for it. If a doctor or nurse feels people should linger while dying , concious or not , that is their right. I would like all those who believe we have a RIGHT to die on our own terms , including people with dementia and Alzheimers , to SPEAK Up NOW . Thank you.

  • Thank you Doctor, for speaking up and for telling your Story. Your voice helped make that change and now you have the option available. For yourself and many in Massachusetts. I applaud and commend you.
    I live in Ohio and have written 2 State Senators, sharing my Wishes and Story as a 59 yr. young woman with Stage IV incurable, inoperable Colon Cancer. May you now have Peace all the way to the end. You and Your Life, truly made an impact.

  • I support this concept. I have been at the bedside of many dying patients. It is our sacred duty to prevent suffering and provide solace.

  • Please listen to Dr Kligler with his stellar note on Compassion and Choices. We need this Bill passed in Massachusetts. It is every persons God given Right to Choose what their end of life will be; I want that Choice! Don’t think of it as suicide. Dr. Kligler didn’t stand on a corner and ask for cancer. He had surgery, treatment and follow up and now there is nothing. No new drugs to stop this insidious disease. Let him make his own choice as he sees fix.

    By the Grace of God we will get this Law passed for people like Dr Kligler and me.

  • I Stand with You for Providing the Voice others can’t. I am not Terminally ill but, Chronically for most of My Life. The Voice Starts Here. 👊🏻

  • Roger, I am so sorry to hear about your need to even consider this for yourself and not on behalf of your patients. I to am in the same boat but with me, unfortunately, the cancer took my ability to practice a LONG time before yours did you. As a surgeon, I need to be both mentally and physically fit to practice and although the mind is still quite fine the hands back legs and neck are too progressed to allow me to function for 8 or 12-hour shifts
    The issue of the medical community getting in the way of someone’s otherwise personal desire is tantamount to slavery. We enslave our patients to life because we are too afraid to holster some potential that some governmental hack will task us with liability for our actions.
    Instead of falling for that threat we all need to step up and make it nationally legal for someone to request PAS and if they meet the set criteria then should by all means given that option rather then to suffer day in and day out not because of some ethics sub-committee or ethics class taught in University but because the leadership is simply too cowardly to place their signatures on the proper bills to make it legal
    I TRULY think if the House generates it the current Senate and surely the current POTUS will sign it into law
    The pathetic part is that the majority of states are refusing to allow it and California allows it. Being the concrete encrusted anchor of the entire nation in terms of getting in the way and pretending to support advancements California is NOT a benchmark we should wave proudly and more states need to step up so this is a universal position
    As you have said there is PLENTY of history that abuse is not an issue and plenty of supportive evidence here as well in the EU that a society that kills anyone who doesn’t meet a set of criteria is NOT going to happen
    With that time is up we need to allow this in all 50 states
    BTW going back as far as school I refused to sware to the Medical Oath as did many of my classmates for this EXACT reason. We all knew that someday there would be a time that patients needed to end their lives peacefully and that swearing to that nonsensical oath would make it very hard to find parties who could assist without violating their own personal honor and commitment
    First do no harm is NOT a valid term. First do the patient’s bidding then the rest can follow
    Dr. Dave (head and Neck Surgical Oncology)

    • Thank you for your words. Tjey are perfect . I wish you well. I did not know it was an option to not say the Oath, and am do proud to know there are Doctors who are voting their conscience for the sake of all humanity. God bless . Penny

  • I passionately agree with you about end-of-life choices.
    In the early 1990s I was a plaintive for women’s right to choose in Utah aided by the ACLU in the Center for reproductive line policy. I am a good witness and have been president of most of the nail pinnacle moment organizations in my state.
    I have been dying for the last two years have excruciating advanced are very and cancer. I so wish that euthanasia was an option and I will do anything that you like me to do if I am able to. I had to and my job after the extreme surgery in January of 2016 and chemo followed by intense palliative chemo an irrational trip to Tijuana for some immunotherapy that was a desperate move on my part.
    I was a very active supplier chest with a fabulous career, a lecture on psychotropic medications for 15 years and he just started doing some no other research and finally because I was frugal, having enough money saved to take some trips with my friends and family. All that with Navin possible by my extreme pain and disability which is constant not to mention the discomfort. I am on Avastin and Opdivo with little chance that they will do much help. If I knew I could choose to get with your name physician-assisted suicide for youth in Asia whatever you choose to call and it will give me such relief. I feel that I am a burden to my two daughters. Everyone has been good to me but now I can barely pain and sometimes the loneliness in a long day and accompanied by the pain and disability, has eroded my buoyant personality.
    I have no purpose in life I would like to offer myself to you movement. I can still write well and I would feel perhaps less help us if I had the drive to help on your mission. But it is a mission that I have strongly believed in even though I thought it would never happen to me.

    Rhonda Lehr M.D. cell phone number 801-710-8375

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