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Voters in two states - Oregon and Washington - have passed measures that legalize physician-assisted suicide. Soon, voters in Massachusetts will decide on the issue in their state, on the so-called "death with dignity" ballot question. It would let terminally ill patients get a lethal prescription if they've been told they have six months, or less, to live.

As we hear from Sacha Pfeiffer, of member station WBUR, the outcome of the vote could change the landscape for legalized suicide nationwide.

SACHA PFEIFFER, BYLINE: When Dr. Marcia Angell was editor of the prestigious "New England Journal of Medicine" back in the 1990s, she startled many of her colleagues by arguing that dying patients should have a legal right to kill themselves. She took that stance partly because of what her father did when he was suffering severe pain from prostate cancer.

DR. MARCIA ANGELL: He took a pistol from his bedside table, where he had kept it all of my life. He took it out that night, and he shot himself and died instantly.

PFEIFFER: She believes her father wouldn't have resorted to a bullet, if he could have had a fatal medication by his bedside.

ANGELL: If it was something that was legal and accepted, I think he would have lived longer. And I think it would have been much easier, for the family.

PFEIFFER: Terminally ill Massachusetts adults will have that option, if Question Two on the state ballot becomes law. Dr. Angell is one of its primary backers, as well as the ACLU - although she says the term "physician-assisted suicide" is a misnomer.

ANGELL: It is not a choice between life and death. It's a choice of the exact timing, and the manner, of death - because these patients are dying.

PFEIFFER: Disabilities rights activist John Kelly is ardently against the measure; as are the Massachusetts Medical Society, and several religious organizations.

JOHN KELLY: My major concern is that this bill is a recipe for abuse.

PFEIFFER: The two sides disagree on whether the initiative has adequate safeguards. But Kelly fears that sick people with treatable depression, could feel pressure to end their lives from family members eager for an inheritance, or because they feel like a burden.

KELLY: Here, I think about people with psychiatric histories, people with dementia, people who are subject to coercion. These people will be impacted.

PFEIFFER: Kelly is quadriplegic, and he says legalized suicide sends a damaging message that certain lives aren't worth living. He's also concerned that death-by-prescription will appeal to a health-care system focused on the bottom line.

KELLY: We're always hearing about the incredible expense, in the last year of life. And this is a way to save that money.

PFEIFFER: Massachusetts is considered a pioneer in health-care reform. So Dr. Lachlan Forrow, the director of ethics and palliative-care programs at Beth Israel Deaconess Medical Center in Boston, says this vote is particularly noteworthy.

DR. LACHLAN FORROW: If Massachusetts takes the step of legalizing physician-assisted suicide, I think that would have a major, transforming effect on national conversations. And a lot of people will say it's even a heavily Catholic state, so maybe this should be emulated elsewhere.

PFEIFFER: But he regrets this issue is on the ballot. Dr. Forrow says the money, and energy, that's gone into it would have been better spent expanding and improving end-of-life services, like hospice and palliative care. So whether or not Massachusetts legalizes physician-assisted suicide, he hopes supporters, and opponents, will work together after Election Day; to make dying a gentler process, for terminally ill patients.

For NPR News, I'm Sacha Pfeiffer in Boston.

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