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Assisted Death Law Endorsed by Editor of the New England Journal of Medicine


In a major coup for proponents of the Maine Death with Dignity Act, the editor of the New England Journal of Medicine on Friday voiced her support for the proposed law.

The act, which Mainers will vote on in November, would allow terminally ill patients to end their lives with an overdose of drugs prescribed by a physician.

“I don’t think the Death with Dignity Act is perfect,” said Dr. Marcia Angell, “but it does offer both patients and doctors choices that they don’t now have, and therefore I hope it will be approved.”

As editor of the Boston-based New England Journal of Medicine, Angell holds one of the most prestigious and influential positions in medicine. Her endorsement of the Maine Death with Dignity Act is at odds with the opinions of doctors’ organizations such as the American Medical Association, which have long opposed physician-assisted suicide.

Angell made her comments at a University of New England conference on physician-assisted suicide and end-of-life care. About 130 people attended, many of them doctors, nurses, social workers and clergy.

Doctors, ethicists and hospice workers from both Maine and Oregon — the only state that has legalized physician-assisted suicide — gave brief presentations in Ludcke Auditorium on UNE’s Westbrook College Campus, then debated various details of the proposed law.

At times the discussions became heated, reflecting the tone the public debate is likely to take in the months to come.

Angell said she is supporting the law for two reasons. First, she said, it’s consistent with the physician’s obligation to respect the patient’s right to self-determination.

It’s also a compassionate law, she said, adding that only the patient can ultimately decide whether efforts to ease suffering are adequate.

“I believe it’s callous not to permit the doctor to help them,” Angell said. “After all, it’s not a question of life versus death. It’s a question of a lingering death or a fast and humane one.”

Angell said that while some doctors think the proposal violates the physician’s commitment to honor the sanctity of life, medicine has already modified that commitment by allowing doctors to remove life support from dying patients.

“Sometimes relieving suffering is more important than extending life,” she said.

Dr. Mark Siegler, director of the Maclean Center for Clinical Medical Ethics at the University of Chicago, strongly disagreed with Angell, saying that physician-assisted suicide is “very dangerous for patients.”

Siegler said he believes such laws come with a serious risk of discrimination against the elderly, disabled, uninsured, mentally impaired and other vulnerable people living in a society where many lack access even to basic health care.

He also said that if physician-assisted suicide becomes accepted in the United States, he believes it will quickly progress to euthanasia.

To drive home his point, Siegler showed the audience the controversial “60 Minutes” video of Dr. Jack Kevorkian euthanizing a patient with Lou Gehrig’s disease.

“I think we all find this tape disturbing,” said Dr. Timothy Quill of the University of Rochester School of Medicine, who has been an outspoken supporter of physician-assisted suicide.

But Kevorkian is a just a symptom, he said, an example of the secrecy with which the country handles these problems.

“A lot of what you have to decide is, are you able to better protect people in an open system in which there are second opinions” or through a more secret process, he said.

Angell was asked if she would support voluntary euthanasia as it was depicted in the Kevorkian video. She replied that that is where she draws the line “in this country, at this time.”

She said one reason she supports the physician-assisted suicide law is that it requires the patient to be an active participant. The patient must swallow all of the pills himself and keep them down. Kevorkian’s patient would not have been able to do that.

Quill added that such difficult cases could continue to be handled the way they are now, through “terminal sedation.”

The conference drew a mix of supporters and detractors of the law and many falling in a middle ground.

John Nickerson is pastor at the United Church of Christ in Bristol and serves as chaplain at two midcoast hospitals and two hospices. He said the churches in his community are planning to hold discussion groups before the election, and he came to the conference to learn more about the details of the law.

“It’s not a black-and-white issue,” Nickerson said. “People want to make it a black-and-white issue, but there’s a lot of nuances.”

Nickerson said he agreed with an ethicist at the conference who is generally in favor of the idea but feels it’s perhaps too early to pass such a law in Maine.

“It’s an issue the churches ought to discuss,” he said. “The tendency is to sweep any conversation about death under the rug. Who wants to talk about it? But we ought to talk about it.”

Staff Writer Meredith Goad can be contacted at 791-6332 or via email

(This article was brought to our attention by various sources, including friends on the nonprofit ERGO! electronic mailing list who read LEXIS-NEXIS.)