“Right-to-die” advocates have mounted a high-profile initiative campaign in what might seem to be unlikely territory: heavily Catholic Massachusetts.
On Election Day, voters in the Bay State will consider whether to approve the “Death With Dignity Act,” a measure that would make Massachusetts just the third state in the country to formally approve physician-assisted suicide. The proposal, identified as Question 2 on the ballot, is nearly identical to laws passed in Oregon in 1994 and in Washington in 2008.
But the politics is very different. The looming vote has split the state's medical community and mobilized opposition from the politically powerful Catholic Church, which will be heavily involved in the final two months of the campaign.
How Massachusetts voters decide could have national implications. Those on both sides of the issue say the state could either pave the way for increased acceptance of physician-assisted suicide or stifle its advance.
“It will be the first eastern state, the first heavily Catholic state,” says Dr. Marcia Angell, a former editor of the New England Journal of Medicine and the first signer of the petition that put the issue on the ballot this fall. “This will be a big, big advance in compassionate medicine, I think, and then probably there will be dominoes around the country.”
The actual debate has been relatively quiet so far. The presidential election and a high-profile U.S. Senate contest have made for a crowded political environment. But there will be an intensive media and personal campaigning blitz as Election Day nears.
If polls are any indication, the proposal's opponents face the taller task. A Public Policy Polling survey released in late August showed 58 percent of the state's voters supported Question 2, while just 24 percent did not. Nearly one in five were undecided. Another survey from Western New England University in May showed similar results.
But those numbers obscure underlying differences in the electorate, differences that Question 2 opponents hope to exploit on Election Day. Polls have shown the division of opinion to be much closer among Catholics than among the rest of the state's voters. Massachusetts has been estimated to be about 44 percent Catholic.
Over the years, the Catholic Church has made no secret of its opposition to physician-assisted suicide. And the role of the Church on Question 2 may be the most significant distinction between this year's campaign and the past ones in Oregon and Washington. “In the northwest, [the Church] provided money and structure,” says Peg Sandeen, executive director of the Oregon-based Death with Dignity National Center. In Massachusetts, she says, “Catholics are being the face of the opposition. That's really the big difference right now.”
There is no question that the Church has lost some of its credibility in the state following sexual abuse scandals involving the priesthood; still, it remains a force to be reckoned with. Church leaders plan to speak out directly against Question 2 and mobilize churchgoers in the coming weeks.
But the Church is just one element of the campaign against Question 2, says Rosanne Bacon Meade, chair of the Committee Against Physician-Assisted Suicide in Massachusetts. Her group has stitched together a broad coalition, including a number of health care organizations, and plans to raise several million dollars for its efforts. The Massachusetts Medical Society, which is opposing Question 2, is sending its members information on the issue and offering material that doctors can hand out to patients as well.
“Once you start talking to people about what actually is happening,” says Bacon Meade, who has been involved in ballot question campaigns in the past and was once president of the state teachers' union, “they start to take a second look, and that's what's going to happen in the next 60 days.”
Taking to the Airwaves
When right-to-die was before the Legislature, opponents provided a steady stream of testimony that led lawmakers to balk at endorsing it. Among those opponents were doctors and the disabled, not just pro-life advocates and religious figures. The bill went nowhere, leaving supporters to pursue an initiative, eventually gaining nearly 80,000 signatures to put the issue on the ballot.
That experience in the statehouse could provide a roadmap, and Fred Bayles, director of Boston University's State House Program, says other initiative campaigns have started out with a lead in polls only to fall victim to well-run opposition. “This is one of those subjects that people don't think about a lot unless it touches them,” he says. “Once advertising starts on this, you may see the polls shift.”
The measure's supporters, of course, are determined to avoid that, and plan to take to the airwaves as well. A state-based coalition called Dignity 2012 is backing Question 2 and national groups such as Compassion & Choices and the Death with Dignity National Center are lending support as well. Those two groups have a history of partnering with state-based activists in supporting physician-assisted suicide laws, and have been working in Massachusetts for a number of years.
But beyond the political calculations in the Question 2 campaign, there are the health care implications, and that is where the significance of Massachusetts lies.
“We're the medical capital of the world,” says John Kelly, director of Second Thoughts, a group that focuses on people with disabilities opposing assisted suicide. “The proponents see this as a prize.”
But more than a prize, the approval of physician-assisted suicide could be a decision that would resonate around the country. As the national health care leader, Massachusetts could play a significant role in the developing debate over physician-assisted suicide. “Massachusetts is a bellwether for the nation on many issues, take same-sex marriage,” says Kris Mineau, president of the Massachusetts Family Institute. “What happens in Massachusetts has reverberations.”
And so the campaign and divisions over Question 2 are destined to grow only more intense as November nears. “My worry is that what's going to come out of this debate is a 51-49 polarized fight,” says Dr. Lachlan Forrow, director of the ethics and palliative care programs at Boston's Beth Israel Deaconess Medical Center. In that case, Forrow says, “no matter how it turns out, the rest of the country is going to say, ‘See, these are divisive issues.'”