-The Big Lebowski, 1998
“She had a good death.”
-traditional Irish Catholic saying
On Nov. 6 Massachusetts will vote on two medically related referendum questions: Medical Marijuana and Physician-Assisted Suicide. In the spirit of transparency and to offer a break from mind-numbing candidate debates, I offer this short commentary on the two…and a proposal to combine them.
Ballot Question 3: “Do you approve of a law that would eliminate state and criminal and civil penalties related to the medical use of marijuana allowing certain patients to obtain by a physician’s prescription marijuana produced and distributed by new state-regulated centers,or, in specific hardship cases, to grow marijuana for their own use?”
Short name: Medical Use of Marijuana
A better name: “Marijuana by request of certain consenting adults”
Street spin: Very positive
Who’s against it: AMA and Mass Medical Society – Concerns: “The slippery slope” What’s next? Legalization of marijuana?
Local police very concerned about increased cost of investigating and enforcing multiple backyard plots.
When Congress passed the Marijuana Tax Act in 1937 making it illegal for anyone, including doctors, “to move cannabis without proper documentation”, the AMA opposed the bill! (1)
Who’s for it: Lester Grinspoon, MD (2), most people under 50, and anybody who answers to the name, “Dude.”
What does the data show: Illegal marijuana is currently a bigger cash crop in Kentucky than tobacco. There are more medical marijuana shops in Denver than Starbucks. It IS (is NOT) a “gateway” drug…take your pick of positions…data supports both. 17 states have legalized medical marijuana.
Worst case scenario: Prescriptions for marijuana surpass number of prescriptions for SSRIs, Ritalin, and Oxycodone… or maybe that would be an improvement?
Economic implications: Could be a significant economic stimulus… in Kentucky, at least. The price of medical marijuana in California and Colorado is half the price that illegal marijuana was.
Possible future headline: “Legal Marijuana Aids Economic Recovery, Second Only to Casino Development.”
Ballot Question 2: “Do you approve of a law that would allow a physician licensed in Massachusetts to prescribe medication, at the request of a terminally ill patient meeting certain conditions, to end that person’s life?”
Short name: Physician Assisted Suicide
A better name: “Death with Dignity by request of certain consenting adults.”
Street spin: How can anything be positive about the term “suicide”? “Physician-assisted dying” is closer to the reality.
Who’s against it: AMA and Mass Medical Society; incompatible with the “curative and healer” roles of physicians – Concerns: “The slippery slope” What’s next? Lethal injections for psoriasis?
We can’t always be certain of which months are “the last 6 of my life”, but about 83% of hospice patients were right in one study.
Who’s for it: Many members of Ethics Committees in acute care hospitals who have helped patients and families endure prolonged, high-tech deaths.
What does the data show: Since its passage in 1997 less than 100 Oregon patients per year have requested end-of-life medications. In 2011 only about one-half of the people getting such prescriptions in Oregon actually took the pills. (Maybe it IS a question of patients’ desire for lost autonomy and control) In Oregon 90% of requesting patients were enrolled in a hospice program and nearly 90% had cancer.
Worst case scenario: Patients may desire more power over their medical life as well as their medical death.
Economic implications: May have positive impact on medical care costs if people choose not to go into hospitals and be admitted to ICUs in the last 6 months of their life.
Possible future headline: “AMA Admits Physicians Can’t Cure Everyone, Calls For More Dignity In Dying”
Proposed Ballot Question 4: “Do you approve of a law that would allow physicians to prescribe marijuana to end the life of a terminally ill patient?”
Short name: “Physician Assisted Dying by Marijuana”.
Street spin: It will never happen. Marijuana is the ONE drug that can NOT cause a lethal overdose (unlike alcohol, aspirin, and the others). Dr. Grinspoon described it as “remarkably non-toxic”. He initiated his intensive research into the effects of marijuana when he observed its benefits in his son undergoing chemotherapy. (His wife got the marijuana for Danny in the parking lot of a local high school because Dr. Grinspoon was initially so skeptical of its effects).(1)
1. “Where’s the Pipe?”, Casey Lyons, Boston Magazine, October 2012
2. Marijuana Reconsidered, Lester Grinspoon,MD; 1971 and Marijuana:The Forbidden Medicine; 1997