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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Massachusetts could become the next state to allow aid in dying

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Happy Monday, and thanks for reading. We’re planning to rewatch “Everything Everywhere All at Once” ASAP after the offbeat multiverse movie dominated at the Oscars last night. 

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Today’s edition: The Texas judge who could undo government approval of a key abortion drug delayed public notice of the first hearing in the case. Black babies experienced the highest rate of sudden unexpected deaths in 2020. But first … 

Lawmakers have introduced medically assisted suicide laws in nine states this legislative season

When the suffering becomes too much to bear, Roger Kligler — a retired physician with incurable, metastatic prostate cancer — says he wants the option of going out on his own terms. Kligler is one of thousands of patient advocates fighting for the legal right to take life-ending medication in his home state of Massachusetts and across the nation.

Lawmakers have introduced bills about medical aid in dying in at least nine states this session. But efforts to legalize the practice have been met with powerful resistance in the past. Since Oregon passed the first Death with Dignity Act in 1997, just 10 states and D.C. have followed in suit.

This morning, we’re diving into the political battle to legalize medical aid in dying — as well as the fight raging in Massachusetts for over a decade, and why supporters think they might get legislation passed in the next year.

What it is

Most aid in dying laws allow mentally capable adults with a terminal illness and a prognosis of six months or less to live to get a lethal prescription from their doctor to help them end their life — also known as medically assisted suicide.

The issue remains controversial. Those who support what they call a right to die argue it’s a compassionate option for patients seeking to end their suffering. Those who oppose the practice cite religious beliefs and concern for potential exploitation of vulnerable people such as those with disabilities.

In states where the practice is legal — such as Montana, New Mexico and Washington — there are strict eligibility requirements and safeguards that a patient must meet to qualify for aid in dying. For instance:

  • Two physicians must confirm the patient’s mental capacity and terminal diagnosis. Individuals do not qualify solely based on age or disability status.
  • A physician must inform the patient about other end-of-life care options, including hospice and palliative care.
  • Patients must make an oral and written request for life-ending medication witnessed by at least two individuals, one of which cannot be a relative, who can attest that they are making the request on their own volition. There’s also a mandatory waiting period in between requests that varies by state.
  • Patients must be able to self-administer the prescribed drug.

Death with Dignity, a national nonprofit advocating for medical aid in dying laws: 

In Massachusetts

Massachusetts lawmakers have filed measures in both chambers of the state legislature seeking to legalize medical aid in dying during the 2023-24 legislative session, teeing up a highly charged lobbying effort from both advocates and opponents.

So far, aid in dying measures in Massachusetts haven’t had success at the ballot box or in the statehouse, with voters narrowly rejecting a 2012 ballot question and bills languishing in committees. But a December decision by the state’s supreme court set off a new push in the state legislature, after justices ruled that the practice isn’t protected by Massachusetts’ constitution and punted the issue to lawmakers.

Shifting tides: State Rep. Jim O’Day (D), who introduced the House bill, said he’s optimistic the measure will succeed this year. O’Day cited growing support for medical aid in dying among Massachusetts residents as well as his colleagues in the House, where his legislation has 60 co-sponsors. “I don’t think this is a political issue. I really see it as a matter of quality of life and autonomy of one’s own body,” he said.

Gov. Maura Healey (D) also endorsed such legislation last March when she was the state’s attorney general. In an email, Healey’s office confirmed her continued support for legalizing medical aid in dying, though she didn’t specify whether she’d sign O’Day’s bill. “She will review any legislation that reaches her desk,” a spokesperson wrote.

  • Why is that significant? Healey’s comments could mean supporters have a lower threshold to clear than they had under former governor Charlie Baker (R), whose position on the issue was unknown. If Healey signed the bill, the legislature would only need a simple majority to pass the measure rather than a veto-proof supermajority.
  • As for doctors … In 2017, the Massachusetts Medical Society rescinded its long-standing opposition to medical aid in dying and adopted a position of “neutral engagement” on the issue.
The political fight

Medical aid in dying still faces fierce opposition from groups including the Roman Catholic Church, which called the practice “an affront to life and a dangerous precedent for determining end of life issues.” James Driscoll, executive director of the Massachusetts Catholic Conference, said a better alternative is to provide more widely accessible palliative and hospice care.  

Other objections come from groups like the National Council on Disability and the American Association of People with Disabilities, who argue the legislation is a slippery slope. They contend that members of vulnerable groups could be coerced into ending their own lives — especially if family members view them as an emotional or financial burden.  

There’s little evidence of abuse of aid in dying laws in states where it’s been legal for many years. In 2019, Bob Joondeph, who was the executive director of Disability Rights Oregon at the time, confirmed in a letter that, to his knowledge, the group has never received a complaint that a person with disabilities was coerced or being coerced into using the state’s Death with Dignity Act.

Massachusetts state Sen. Joanne Comerford (D), the primary sponsor of an aid in dying bill in the Senate, said the latest version of the measure addresses some of their concerns. For example, legislators added a requirement that at least one of the two witnesses present when a patient is making their request for life-ending medication is someone who isn’t going to benefit financially from the patient’s death or be financially burdened by their ongoing care.

Peg Sandeen, CEO of Death with Dignity: 

Patients Rights Action Fund, a national nonprofit advocating against medical aid in dying: 

Reproductive wars

In an unusual move, judge delays public notice of abortion pill hearing

The federal judge in Texas who could undo the government’s approval of a key abortion drug scheduled the first hearing in the case for Wednesday. But in an unusual step, he delayed the hearing in the closely watched case from being publicized, our colleagues Perry Stein, Ann E. Marimow and Caroline Kitchener reported over the weekend.

The details: The hearing will consist of arguments from lawyers for the Justice Department, the company that manufacturers the drug and the conservative group that filed the lawsuit. After arguments, U.S. District Court Judge Matthew Kacsmaryk could rule any time on the case seeking to revoke mifepristone’s approval. 

On Friday, Kacsmaryk held a conference call with attorneys to schedule the hearing in Amarillo, Tex., a move that would usually be quickly placed on the public court docket. 

But the judge said he would delay putting the hearing on the docket until late Tuesday to attempt to minimize disruptions, and possible protests, and asked the call’s participants not to share the information about it before then, our colleagues write. He also told attorneys that he wanted to delay the public notice because courthouse members have received threats in the wake of the lawsuit. 

More from Caroline:

In other news …

A Texas man filed a wrongful-death lawsuit against three women who allegedly helped his ex-wife obtain abortion pills and terminate her pregnancy, Caroline, Joanna Slater and Arelis R. Hernández report.    

It’s a first-of-its-kind case since the Supreme Court overturned Roe v. Wade in June. Jonathan Mitchell, a conservative lawyer who was the architect of Texas’s novel 2021 ban, and state Rep. Briscoe Cain (R) are representing the plaintiff. The lawsuit argues that helping someone obtain an abortion qualifies as murder under the state’s pre-Roe ban on abortion that kicked in this summer.

Data check

Black babies experienced the highest rate of sudden unexpected deaths in 2020, and died at almost three times the rate of White infants, our colleague Frances Stead Sellers reports, citing a federal study released today by the Centers for Disease Control and Prevention.

Researchers found a 15 percent increase in sudden deaths among babies of all races from 2019 to 2020. The study found the rising rates in 2020 could likely be attributed to reclassifying the cause of death, but the causes of the rise in sleep-related deaths of Black infants remain unclear, though it came as the covid-19 pandemic hit.

In other health news

  • On the move: Robert Zirkelbach will serve as the Pharmaceutical Research and Manufacturers of America’s new executive vice president of public affairs and strategic initiatives. Zirkelbach previously led the group’s public affairs department from 2017 to 2020 and will return to PhRMA in early April.
  • On the move: Kevin Munoz, the assistant White House press secretary tasked with handling the Biden administration’s messaging around covid-19 and other public health issues, will leave his post later this month, Betsy Klein reports for CNN
  • A federal requirement that travelers to the United States from China present a negative coronavirus test before boarding their flight was rescinded Friday, in a sign of diminished concern among officials about covid-19 transmission from that country.
  • The House voted unanimously on Friday to declassify all U.S. intelligence information on the origins of the coronavirus, sending the legislation to President Biden’s desk. If the bill is signed, the declassified information would have to be released within 90 days, although the measure does not establish a mechanism for enforcement, our colleague Mark Johnson reports. 


📅 Welcome back, Senate. The House is out this week. Here’s what we’re watching over the next few days:

On tap today: White House Office of Science and Technology Policy Director Arati Prabhakar will lead an event discussing science, technology and innovation in Biden’s fiscal 2024 budget

On Wednesday: Biden will discuss his plan to lower the costs of prescription drugs. The Senate Veterans' Affairs Committee will hold a hearing to examine the VA's electronic health record modernization program. 

On Thursday: The Senate Homeland Security and Governmental Affairs Committee will meet to consider cybersecurity risks to the health-care sector.

Health reads

Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need (By Casey Ross and Bob Herman l Stat)

CDC, FDA send letter to Florida’s Surgeon General warning he is endangering lives with covid vaccine risk advice (By Cindy Krischer Goodman and Caroline Catherman | The South Florida Sun-Sentinel)

Why Hospitals Still Make Serious Medical Errors — and How They Are Trying to Reduce Them (By Laura Landro | The Wall Street Journal)

Sugar rush

Thanks for reading! See y'all tomorrow.