SJC: Doctors in Mass. could face manslaughter charges if they help patients die by suicide

The highest court in Massachusetts ruled it is illegal for doctors to help terminally ill patients end their lives.

In a ruling issued Monday, the state Supreme Judicial Court said doctors can be prosecuted for involuntary manslaughter if they help patients die in a process often called "medical aid in dying." However, the ruling also said the issue is better decided by lawmakers, not the judiciary.

"Although we recognize the paramount importance and profound significance of all end-of-life decisions, after careful consideration, we conclude that the Massachusetts Declaration of Rights does not reach so far as to protect physician-assisted suicide," Justice Frank Gaziano wrote in the ruling. "We conclude as well that the law of manslaughter may prohibit physician-assisted suicide, and does so, without offending constitutional protections."

The two plaintiffs are both Massachusetts doctors. Dr. Roger Kligler, of Falmouth, was diagnosed 21 years ago with Stage 4 prostate cancer and sought the ability to end his own life if death became imminent. Dr. Alan Steinbach said he wanted to help his terminally ill patients if he would not be prosecuted for his actions.

The ruling also said the high court recognizes the limits of the judiciary in deciding such questions, which it says are best left to lawmakers.

"The desirability and practicality of physician-assisted suicide raises not only weighty philosophical questions about the nature of life and death, but also difficult technical questions about the regulation of the medical field," the ruling stated. "These questions are best left to the democratic process, where their resolution can be informed by robust public debate and thoughtful research by experts in the field."

Kligler, one of the plaintiffs, said he was disappointed by the ruling, but plans to work with state lawmakers on a bill that would allow doctors to help terminally ill patients die. Legislation has stalled at the State House, he said, adding the delays are frustrating for very sick patients and their families.

"I'm just going to continue as best I can to urge lawmakers to respect the bodily autonomy of dying Massachusetts residents," Kligler said. "I believe that the government should not have any interest in making mentally capable, terminally ill adults die with intolerable suffering."

Kliger also explained that in his role as a physician he has given patients a form of palliative care that allows doctors to sedate patients to the point where they cannot eat or drink; they die of dehydration or starvation. Kligler, who is undergoing treatment for his prostate cancer, said legislation could help all dying patients.

"So this is personal for me with my cancer and also for friends of mine who have died with too much suffering," Kligler said. "We all die. This could help every person in the commonwealth."

Massachusetts voters rejected a 2012 ballot question that would have allowed "physician-assisted suicide."

Opponents say doctors should not be allowed to help patients die. They promise to fight against any future measures that would permit that. They argue that people who are disabled or vulnerable could be harmed.

"The Kligler case was nothing more than a brazen attempt to skip the political process and ignore decisions by the public and elected officials to reject assisted suicide law proposals," said Matt Vallière, executive director of the Patients' Rights Action Fund.

The national advocacy group Alliance Defending Freedom, a faith-based nonprofit, praised the SJC ruling saying the government's role is to protect life, regardless of disability or illness.

"Physician-assisted suicide radically degrades the practice of medicine. Patients should be able to trust their doctors to support and care for them. Offering terminally ill or disabled patients a ‘quick exit’ through death-inducing drugs destroys that trust," Chris Schandevel, the group's senior counsel, said in a statement.

In Massachusetts, other religious groups welcomed the decision.

The Massachusetts Catholic Conference applauded the ruling in a statement from its executive director, James Driscoll. He wrote that the group was "prepared to join a diverse group of individuals and organizations in opposing any future legislation that would legalize Physician Assisted Suicide."

The SJC ruling was unanimous, but Justice Dalila Argaez Wendlandt also wrote that the court may have to consider these issues in the future. She pointed to doctors already being permitted to offer terminally ill patients palliative sedation near the end of their lives.

"Allowing this subset of patients to choose to die with dignity as their final act while death is looming and inevitable would not result in harm to the public welfare," she wrote.

Governor-elect and Massachusetts Attorney General Maura Healey has indicated that she could support physician-assisted death, if there were appropriate safeguards.

“We are pleased that the Court has affirmed our position that the Legislature is the most appropriate place to have a discussion about this important public policy issue," said AG spokeswoman Jillian Fennimore in an emailed statement. "AG Healey has said she supports legislative action to allow medical aid in dying, provided it includes sufficient safeguards for both patients and providers.”