Health

HEALTH • Spring 2017 21 "This is just one little piece that may affect a very small number of people that are near the end of life," he said. Patient perspective Michael Adams, a Pepperell resident who died of terminal cancer in March, was one of those affected people. Adams offered his perspective just days before his death, when he was receiving hospice care at home. The 69-year-old Adams was happy with the care he was receiving from Framingham-based Brookhaven Hospice, and said people who are fac- ing terminal illness should strongly consider hos- pice care; it allowed him to live out his final days peacefully, surrounded by family and his beloved dogs. But, noting that he had been able to keep his pain mostly in check and had support from his wife and daughter — both nurses — Adams said people ought to be able to choose physician-assist- ed death, too. "We should have that option," Adams said. Central Massachusetts health professionals who work with patients near the end of their lives are split on the question of medical aid in dying. But people on all sides of the question agree that the debate points to something bigger: the need for all of us to confront questions about our own deaths. To Michele Clayborn, director of operations for Brookhaven Hospice, the goal of end-of-life profes- sionals is to help patients reach a natural death without intense suffering. Clayborn said some people facing unbearable symptoms, repeated hospitalizations, and intense, unpleasant medical interventions may see ending their lives as a better option. To her, though, the kind of death that would be legalized by the pro- posed state legislation is inhumane—letting people end their lives by swallowing pills, perhaps alone with no support. In contrast, she said, hospice care can almost always allow terminally ill patients to end their lives in a place of their choosing, with loved ones around them, without symptoms like intense shortness of breath or excruciating pain. In these scenarios, she said, families are often able to share meaningful last moments with their loved one. "It's amazing to be witness to, regardless of your faith tradition," she said. Should physician-assisted suicide or physician-assisted dying be allowed for terminally ill patients? Public opinion Source: Medscape U.S. ethics report 2016: Life, death, and pain 0 10% 20% 30% 40% 50% 60% 2010 2016 Yes No It depends 46% 57% 41% 29% 14% 14% Death with Dignity laws allow adults with terminal illness to request prescription medication to hasten their death. As of Feb. 20, these states had such statutes: States with assisted suicide • California • Colorado • Washington D.C. • Oregon • Vermont • Washington • Montana* *Physician-assisted dying is legal in Montana by a state Supreme Court ruling Source: www.deathwithdignity.org Suzana Makowski, a hospice and palliative care physician at UMass Memorial Medical Center in Worcester, sees physician-assisted suicide as a mat- ter of individual choice, something she saw up close when her father, whom she described as a "pragmatic" European immigrant, died last year. When he was diagnosed with pancreatic cancer, Makowski said, he was already living with a pace- maker, and he decided to have it turned off rather than face a slow death from the cancer. "He was very clear about 'I love life, but I don't want to live in a way that for me robs me of my dignity, my integrity, my personhood,'" she said. Makowski said that in Oregon, which legalized medical aid in dying in 1997, fewer than half the people who receive a prescription for fatal drugs end up using them. She said simply having the option available tends to encourage conversations that don't happen here. "What I've seen happen now between patients and doctors is patients are sometimes afraid to ask the doctor out of fear that they're asking them to be complicit in something illegal," she said. Growing support The question of physician-assisted suicide became the subject of national conversation in 2014, when Brittany Maynard, a 29-year-old California woman diagnosed with brain cancer, became a spokeswom- an for the issue. She ended up moving to Oregon so she could legally end her own life. The following year, California legalized the process. Even if the MMS survey finds that physician opinion has shifted within Massachusetts, it's not clear how the issue will play out in the Legislature. Rep. Anne Gobi (D-Spencer) supports legalizing the process. Her position is part of her pro-choice orientation, she said. But Gobi said she doesn't know if the Legislature, which has voted down these kinds of laws in the past, will change. To some opponents of the law, the notion of sup- porting choice for the terminally ill is complicated by societal judgements. Paul Spooner, executive director of the MetroWest Center for Independent Living in Framingham, said he sees the language of "death with dignity" devaluing people who need help with basic functions like using the bathroom. He said he worries that the attitude that death might be better than indignity, or being a burden to others, can create a slippery slope. Spooner said he thinks encouraging people to work through the aversion that many have to the idea of declining health as we reach the ends of our lives is crucial. "It's fear, it's loss of dignity," he said. "We don't talk enough about death in our current country." H Michael Adams steps out of his home in Pepperell, where he received hospice care during the final months of his life.

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