A Practical Guide to Surviving Your First Legislative Externship
I have done quite a few externships over the years in a variety of fields. However, working at the State House has kept me on my toes. I had so much to learn. I had a great boss and that helped. But looking back, I wish I had prepared a little better. I had no legislative experience and was not from a state that did a lot of state government work. So here are a few tips I would give to those who are new to this environment.
- Learn a little about your state!
When I started my externship, I did not know anything about Massachusetts. I mainly came here to go to school and that was it. However, since working at the State House, I wish I knew more about the state and my senator’s district. I spent a lot of time googling regions of Massachusetts and asking questions. So if you have a legislative externship, feel free to do your research. Learn about the state and who are the constituents. Does a state have a larger rural population or an urban population? What are the industries and demographics of a state? Knowing these things will enhance your experience and give context to your interactions at the state house.
- Understand that state government is different from federal government
Being from Washington, DC, I had no concept of how state government worked. In my area, everything is concentrated in either the federal government or the local government. I had always viewed the federal government as a constant stalemate or arguing about things that did not matter. I thought that senators were inaccessible and expected that from my externship. However, I was wrong. Senators in Massachusetts are generally pretty accessible and enjoy hearing from their constituents. I had no idea that a state senator would be different from a US senator. But while working for a state senator, I felt as though I was actually contributing to tangible changes. This is a super rewarding feeling that you won’t get anywhere else.
- Get familiar with the State House Website and State House News.
I believe this is one of the most important lessons I learned while working at the State House this year. The fastest way to learn about the State House is to read State House News and the State House website. Boston University School of Law provides its students with a free subscription to State House News. If you want to find out anything about what’s happening in the state house, State House News is the place to look. They have information on bills, legislators, and general news. The State House website will hold all of the bill before the legislature and the general laws. I spend most of my time on that website. Feel free to check out the site before you start your externship. That way you are ready to hit the ground running.
- Never miss a meeting.
Some people hate meetings, but at your legislative externship you will learn to like them. One, they are much more fun than normal meetings at the office. Second, they are actually useful. Most of your meetings with either be with lobbyists or constituents. Making sure you are present for these meetings will teach you a lot about your senator’s district and their priorities. This was the forum where I learned the most. So, make sure you are there!
- Be open to saying I don’t know.
This is probably self-explanatory, but just be honest if you don’t know something. Your supervisor knows that this is an externship and that you are here to learn. Be honest about your experience level and don’t be afraid to ask questions. This externship is designed for you to learn so take advantage of it.
Externships are a serious investment of time and your tuition dollars. The Massachusetts State House can be an awesome place to work and to learn. Learn a lot, enjoy the experience, and make the most of it!
Nia Johnson anticipates graduating from Boston University School of Law in May 2019.
Massachusetts’ “Death By Dealer” Bill is the Wrong Opioid Policy
On January 30, 2018, the Massachusetts Joint Committee on the Judiciary heard testimony on S. 2158, An Act Updating Laws Relating to Dangerous Drugs and Protecting Witnesses. Despite its relatively innocuous title, the bill, proposed by Governor Charlie Baker, represents a substantial scaling up of the War on Drugs in the Commonwealth.
Like many other states, Massachusetts is in the midst of a public health crisis. The opioid-related death rate in the state has surpassed the national average, with a nineteen percent increase in overdose deaths between 2015 and 2016. In addition, three-quarters of opioid-related deaths in 2016 involved fentanyl, a synthetic opioid that is roughly 50 times more potent than street heroin. As opioid overdoses decimate local communities, officials are understandably investigating ways to curb the epidemic, and one solution, to which legislatures are increasingly turning, entails drastically increasing punishment for drug crimes that result in death.
For decades, federal prosecutors have been able to pursue stringent penalties in cases of “death by dealer.” Passed by Congress in 1988 in response to the highly publicized death of a University of Maryland basketball star who overdosed on cocaine just days after being drafted by the Boston Celtics, the so-called “Len Bias” law sets mandatory minimum sentences for selling drugs that lead to another person’s death. More recently, twenty states have adopted analogous laws, and several others have “McGyvered” existing homicide statutes—e.g., reckless homicide and felony murder—to prosecute the same offense. With Governor Baker’s bill, Massachusetts joins a number of additional states with pending legislation that would allow prosecutors to charge drug sellers with murder or manslaughter.
While these laws may seem like a good idea at first—as a way to cripple the organized drug trade and to give prosecutors new tools to attack upper echelon drug traffickers—the criminalization of accidental overdose has a number of possible unintended consequences. Massachusetts legislators should carefully consider these effects that may backfire and exacerbate an already dire situation.
Although proponents argue that drug-induced homicide law will prevent future drug trafficking, there is broad consensus that harsh sentences have minimal, if any, deterrent effect. Contrary to conventional wisdom, studies have found that, among individuals facing drug-related charges, variations in prison and probation time have no impact on recidivism rates. The focus on supply reduction also seems misplaced: many studies suggest that market demand for drugs drives a continuous “replacement effect,” such that incarcerating drug dealers simply “open[s] the market for another seller.” Instead, such policies may inadvertently increase drug-related violence and lead to dangerous fluctuations in the contents of street drugs.
Drug-induced homicide laws also risk undermining Good Samaritan policies. As overdose deaths skyrocket, 37 states, including Massachusetts, have enacted laws to reduce the legal barriers to calling 911 in the event of an emergency. Most of the laws are limited to drug possession, however; they do not encompass drug selling or homicide. Although popular imagination places drug users and drug sellers in separate buckets, reality proves far blurrier: drug users frequently participate in the supply side of the market—whether by actively selling drugs or by helping in some way, such as acting as a lookout—in order to support their habits. Ostensibly intended to prosecute high-level drug suppliers, in practice, these statutes often ensnare family, friends, and acquaintances who supplied the drugs and who themselves may have a substance use disorder. In Wisconsin, an analysis of the 100 most recent drug-induced homicide prosecutions found that “nearly 90% of those charged were friends or relatives of the person who died, or people low in the supply chain who were often selling to support their own drug use.”
While prosecutors talk about “aggressively prosecuting those people that peddle the poison in our community,” users counter that “every drug-induced homicide charge that is made sends a ripple through the using community to not call 911 and might result in somebody else's death.” In fact, a recent study found that a majority of surveyed drug users feared calling 911 during an overdose due to concerns about criminal repercussions. Overall, then, treating overdose deaths as crime scenes and prosecuting overdose witnesses as perpetrators of murder or manslaughter limits the potential benefits of Good Samaritan legislation and other efforts to reduce overdose deaths.
Finally, punitive approaches, which place the blame for overdose deaths on drug sellers, focuses on the wrong problem. Criminal sanctions have the benefit of immediate visibility—they make it appear to constituents that policy makers are doing something. Public health approaches, on the other hand, are virtually invisible because, if successful, the harms that they target will never materialize. This “prevention paradox” often leads policy makers towards individualized, instantly tangible solutions to complex problems such as drug-induced homicide laws.
The opioid crisis is, fundamentally, a structural issue, rooted in poverty, lack of opportunity, and social isolation. Structural issues require structural solutions. Legislators are understandably grabbing at any and every straw to quell what seems like an intractable problem, but, at a time when much of the country seems poised to approach problematic substance use as a health issue, rather than a criminal one, it is critically important that Massachusetts policy makers carefully consider the ways in which S. 2158’s drug-induced homicide provision might backfire.
Rather than focusing on misguided “quick fixes” that further criminalize vulnerable populations, legislators should, instead, redirect their energies towards public health strategies with demonstrated effectiveness in reducing fatal overdoses. These include implementing comprehensive, evidence-based addiction prevention initiatives; increasing overdose education and naloxone access; promoting the use of medication-assisted treatment for opioid use disorders; and expanding and maintaining insurance coverage for addiction treatment. The United States has been trying to arrest its way out of substance use and addiction for decades, and today’s crisis attests to the futility of that approach. If our policy makers are serious about ending the opioid epidemic in the Commonwealth, they need to shift their focus from policing and prisons to people and public health.
Alexandra Arnold anticipates graduating Boston University School of Law in May 2019.
The End of Dams: Removal and River Restoration
America has a love-hate relationship with dams. As a nation, America has built “on average, one dam per day since the signing of the Declaration of Independence.” Individually, dams have existed in America since long before the states revolted against Great Britain. Massachusetts has the oldest dam listed in the National Inventory of Dams, the Old Oaken Bucket Pond Dam (see slide 21) in Plymouth County, which was built in 1640. The dams started small, as mill dams on small streams for specific towns, but have grown in size to hundreds of feet tall, damming some of the largest rivers in America. Dams are often used (see slide 14) for hydroelectric power, irrigation, flood control, and the vaguely defined “recreational use.” Despite this love of “biggering and biggering”, America has failed to maintain many of the dams constructed, leading to the dangers we now face on a local, state, and federal level. Dams are also harmful to rivers, causing a depletion of fisheries, degradation of river ecosystems, and degradation of river water quality. This article will briefly discuss what Massachusetts has done to address these issues, mainly by removing dams that are a hazard.
In Massachusetts, a failure to maintain dams has led to crises where towns have been evacuated at the threat of a dam bursting. An example is the Whittenton Pond Dam, in Taunton, Massachusetts, where in 2005, after days of rain, the 170-plus-year-old dam nearly collapsed. Close to 2,000 residents were evacuated due to fears of a six-foot high wall of water rushing through the town. Thankfully, the local government and the state were able to mobilize an emergency response team that stabilized the dam; at a cost of over $1.5 million. If the dam had collapsed, the damage, physically and financially, would have been far greater.
Massachusetts has approached dam removal in multiple ways. After the Whittenton Pond Dam emergency, the Office of Dam Safety was rejuvenated and given funding to evaluate the nearly 3,000 dams, in varying states of disrepair, spread across the state. Massachusetts passed “An Act Further Regulating Dam Safety, Repair and Removal”, emergency legislation to increase dam safety and encourage dam removal, in late 2012. The Act passed with support from multiple parties and interests, including the Nature Conservancy, municipal associations, water suppliers, engineering professionals, and other conservation organizations. This law gave various commissions and agencies more authority to respond to dam repair and removal issues, and set up ongoing funding for the repair or removal of dams, seawalls, and other water infrastructures. The various authorities must submit an annual report on the status of the dams in the state. The Massachusetts Office of Dam Safety, the Division of Ecological Restoration, and other agencies are required to assess dams, ensure dam owners have emergency action plans (EAPs), ensure that dam owners address safety issues, establish an inspection process and schedule for dams, and assess fines for noncompliance. Massachusetts provides grants for design costs of removal projects, which is an additional incentive to encourage dam owners to remove dams in noncompliance or that no longer perform the function for which they were built.
Massachusetts G.L. c. 29, §2IIII established the Dam and Seawall Repair or Removal Fund, which operates under the Secretary of Energy and Environmental Affairs and offers grants to local government bodies, charitable organizations, and private dam owners to finance inspection, repair, and removal projects for dams, seawalls, jetties, revetments, retaining walls, levies, and other means of flood control. Often, it is less expensive to remove an old, dilapidated structure than to repair it, so owners will perform removal projects rather than repair projects. Along with removing the dam, the legislature has delegated power to administrative agencies to help encourage restoration of the river after the dam is removed. One of the earliest dam removal projects in Massachusetts (see page 118) was intended to increase public safety and river accessibility for recreation, but also to increase bordering vegetated wetland on the river and to improve and restore access to cold-water habitat.
So far, Massachusetts has avoided removing dams that were built for flood control purposes, opting instead to encourage repairs. However, Massachusetts considers dams built for nearby industrial use, other hydropower purposes, irrigation, or recreational use as fair game for removal. This decision is consistent with policy for many states and the federal government. This policy is especially relevant when the use has been abandoned, public safety is at risk, or the dam is in disrepair and the owner either cannot be found or refuses to pay to maintain the dam.
Thankfully, Massachusetts is well on its way to removing the more problematic dams and restoring its rivers and streams. The Division of Ecological Restoration has assisted multiple dam owners with the removal and restoration process, including the Whittenton Pond Dam that nearly collapsed in 2005. After the passage of the Dam Safety Act, the Whittenton Pond Dam was removed in 2013-2014 as part of an initiative by the Division of Ecological Restoration and the Mill River Restoration Project. The Morey’s Bridge Dam had a fish ladder constructed rather than have the dam removed. Two other dams on the Mill River, the Hopewell Mills Dam and the West Britannia Dam, have either been removed or are in the process of being removed. Upon completion, over 50 miles of stream habitat and 400 acres of pond habitat will open up, rejuvenating the cold-water fisheries and allowing river herring (an endangered species), American eel, and other migratory and resident fish to enter the ecosystem. Although there are objections to the removal of these historical dams, as some communities consider the dam an inherent feature of their town, objections can be assuaged by the preservation of portions of the dam that do not interfere with the river system.
The Division of Ecological Restoration’s actions are an important change to Massachusetts’ environmental policy. Most of the environmental protection laws are focused on maintaining the status quo, and on protecting the water resources from impacts. Removing dams, however, has a proactive and positive impact on water resources by changing the river or stream. The process of permitting the dam removal still takes longer than it should. The Division of Ecological Restoration and other agencies have proposed changes to the state permitting process, allowing aquatic restoration projects like dam removal to go through a permitting process that is easier and more streamlined, which can reduce costs and shorten permitting timelines. This is needed so that dams are removed before they become a hazard to the surrounding area. A faster permitting process will also help dam owners who cannot afford to maintain their dam for an indeterminate amount of time.
Dams have been an integral part of America’s history, however, the time has come to end the era of dam construction. Dams do not have an eternal lifespan, and often no longer serve the purposes for which they were originally built. The costs of maintaining degraded dams often exceed those of removing the dam and restoring the river system. The benefits of dam removal go beyond just the immediate area of the dam, and removing a dam, when planned in conjunction with removing or updating other dams on the river system, can help bring river ecosystems back to life. Massachusetts’ legislature began the process with the Act Furthering Dam Safety, Repair, and Removal, and should continue to fund the grants for removing dams around the state.
Rachel Watsky graduated from Boston University School of Law in May 2018 and plans to practice environmental law.
States’ Efforts for Veterans Should Be Models
Supreme Court justice Louis Brandeis once called America’s states “laboratories of democracy;” state legislatures can tinker with public policy and, in theory, see what works and doesn’t work. One area where these laboratories are in full swing is in the area of state-level veteran’s benefits.
Many states provide basic benefits, in addition to benefits provided at the federal level, for veterans who serve the nation honorably and meet eligibility criteria. Things like: free admission to parks, hunting and fishing licenses at low or no cost, reduced rates for education at state funded colleges and universities, tax reductions and rebates, and veteran’s preferences for hiring in state jobs, are relatively common. Some states experiment with veteran’s policy by pushing well beyond these common state programs. Texas for example, through the very generous Hazelwood Act, provides up to 150 hours of exemption from tuition for veterans at state colleges and universities, or, if the veteran doesn’t use the benefit, for their spouse or child. Quite a few states (including Massachusetts) fund veteran’s nursing homes and are working to tackle veteran’s homelessness.
All of these programs are impressive and necessary and, they couldn’t be more important. Current veteran suicide rates are staggeringly high. More than seven thousand veterans took their lives in 2014. Of those veterans 70% were not enrolled in the federal VA system. That crisis, coupled with high veteran homelessness rates, poses significant risks to veterans living on the border of, or in, poverty. States address these challenges among their veteran populations in a variety of ways, but it is the way that Massachusetts offers commonwealth veterans in need assistance that show its progressive roots. Roots that stretch back to the Civil War.
During the Civil War, Massachusetts passed Mass. General Law Chapter 115 (Chapter 115). The statute has grown since then, but it has always provided a veteran’s agent in every Commonwealth municipality and assistance with veteran burials and grave services. Today, Chapter 115 benefits still provide a veteran’s agent (now referred to as a veterans service officer or VSO) and cemetery services, but the statute also provides a comprehensive benefit that truly seeks to serve those who have served.
This benefit is probably one of the most effective income-assistance benefits in the nation. It is funded through a city/state partnership where the city’s employee, the Veteran Service Officer (certified and trained by the state Department of Veteran’s Services), uses the regulations promulgated by the state Department of Veteran’s Services (108 Code of Massachusetts Regulation) to makes a determination about the eligibility of the veteran. Initially, if a veteran is eligible for Chapter 115, the veteran’s benefit is paid from the city’s budget. This process makes the Veteran Service Officer accountable to their respective Mayors, City Mangers, and City Councils.
In addition to being accountable to the municipal leadership, when a VSO approves Chapter 115 benefits auditors at the state Department of Veteran Services also reviews the veteran’s file to ensure that eligibility criteria are met and statutory guidelines and obligations are followed. If a VSO denies chapter 115 benefits, or removes a veteran from the program for failure to comply with job searches or income reporting mandates, the veteran can appeal that decision to the state Department of Veteran’s Services (and to higher administrative courts if necessary).
Throughout the veteran’s participation in the Chapter 115 program the Veteran Service Officer has statutory obligations to help the veteran file any and all VA claims and applications for healthcare and other social safety net benefits and to ensure that veterans that are able to work are actively seeking employment and reporting their income to the VSO. Commonwealth VSOs become, throughout this process, the veteran’s advocate, mentor, and coach. Finally, at the end of the fiscal year, 75% of the Chapter 115 benefits that the city pays out are reimbursed by the state Department of Veteran’s Services.
Are Chapter 115 benefits a perfect solution to all the challenges that commonwealth veterans face? Of course not. No government program, non-profit, charity, or business can address all of the complex issues that American veterans deal with. The challenges in transitioning from service in our all-volunteer military to civilian life are serious, but they are surmountable. Examples like the Hazelwood Act and Chapter 115 benefits are just two examples of how to create a net of support for veterans. Other states should look to Texas and Massachusetts to create similar programs, while continuing to experiment.
Kenneth Meador was an Army combat medic who graduated from the University of Oklahoma and Boston University School of Law (2018). He plans to focus his legal career on helping our nation's veterans.
Ballot Initiatives as a Fourth Branch of Government?
The Massachusetts Marijuana Legalization Initiative was a consistent conclusion to the State’s foray into cannabis regulation. Massachusetts decriminalized and legalized cannabis for medical use through ballot initiatives in 2008 and 2012, preparing the public for a controversial and protracted path towards legalization. The success of Question Four raised a multitude of familiar policy questions; what are the legal risks legalizing a federally prohibited substance, or how to entice investor confidence in a cannabis market given the Trump Administration’s regressive cannabis policy? There is also a more democratically existential question: what is the role of the voter initiative, and should this role be celebrated?
The Commonwealth of Massachusetts provides for such direct participation through four ballot initiative forms: law petitions, constitutional amendment petitions, referendum petitions, and public policy petitions. Law petitions, the mechanism most widely understood through the public, are governed by surprisingly straightforward rules. Ballot petitions begin their lives as petitions of law to be adopted by the Legislature. Massachusetts first requires a minimum of ten qualified voters to draft and sign a petition containing the full text of the proposed law for submission to the Attorney General, who returns the petition with a concise summary following confirmation that the subject of the proposal has not violated any Constitutional or procedural requirements. Petitioners then file the proposed law and summary with the Secretary of the Commonwealth, who in return provides signatory forms containing the law’s summary for the gathering of signatures. Assuming that this summary and petition form are returned without challenge, an achievement it its own right, petitioners may then move to acquire the requisite signatures, quantified as “at least . . . 3% of the total vote cast for all candidates for Governor (excluding blanks) at the last state election.”
The ballot initiative process is not designed to circumvent the legislature – at this stage, the legislature considers the petition, without opportunity for amendment, and may ultimately vote for engrossment and delivery to the Governor for final signature. Even at this stage, the democratic power of ballot initiatives is compelling, regardless of whether enactment follows. The legislature may feel increased pressure to address the subject through independent legislation, responding to a newly recognized mandate from the public will, while avoiding the drafting and policy deficiencies sometimes associated ballot initiatives. These responses are not direct responses to the initiative petitions, however. The legislature may only take four actions: enactment, disapproval, inaction, or proposal of a substitute. Any action beside enactment returns the initiative to its petitioners, who upon gathering the requisite number of signatures, puts the question to the voters at the next state-wide election.
Democracy in Action, or a Breakdown in Lawmaking?
The utility of ballot initiatives is more than the results they may yield. Substantive results aside, the evaluation of ballot initiatives is multifaceted. First, ballot initiatives provide an opportunity to spur reactionary legislation, by presenting to legislatures with a choice between engrossing the initiative law petition themselves, pursuing independent legislative action on the matter, or rejecting the measure and resigning its fate to the public’s will.
Second, ballot initiatives provide a path for citizens to democratically express their ideas. Of course, the democratic nature of ballot initiatives says nothing of morality: initiatives range from the laudable measures calling for statewide universal healthcare to the morally insolvent represented by acts like the “Sodomite Suppression Act”, a reprehensible initiative calling for statewide execution of members of the LGBTQ community.
The range of subjects covered by ballot initiatives is nearly limitless, and while most initiatives do not survive long enough to receive a vote from the general public, ballot initiatives remain procedurally significant merely in that they are introduced into the marketplace of ideas. This procedural significance exists regardless of the substantive merits of the initiatives, with democratically compelling state ballot initiative questions like: “should we give $1 million to one random voter?”, “should Denver set up a commission to track aliens?”, and “should we stop selling the Europeans our horse meat?” Regardless of the content of the initiatives, their consideration is itself a democratic virtue and strong argument for the continued use of ballot initiatives.
Third, while ballot initiatives are democratic,they sometimes produce substantively imperfect results. Despite being the will of the people, the substantive terms of the Massachusetts Marijuana Legalization Initiative were short-lived. Towards the end of July 2017, Massachusetts Governor Baker signed into law House No. 3818, An Act to ensure safe access to marijuana. This law amended the voter approved cannabis laws by raising taxes on cannabis from 12% to 20%, altered the scheme in which municipalities could ban legal cannabis sales, and restructured the newly formed Cannabis Control Commission. As a result, although legalization advocates were able to achieve their goal of legalizing cannabis, the regulatory structure was significantly different than originally envisioned.
Ballot Initiatives: The People’s Branch of Government – Truism, or Absurdity?
The debate over the place of ballot initiatives within democracy is ongoing. On one hand, ballot initiatives can be construed as a “fourth branch of government” (or perhaps fifth, for those readers who may also delegate such status to administrative agencies).
Ballot initiatives allow citizens to circumvent special interests and legislative roadblocks to see their will materialized. Alternatively, although ballot initiatives support the free expression of ideas, they fail to provide an opportunity for consideration and compromise with dissenting views, which is substantially undemocratic. Rather than circumventing special interests, this shortcoming may make ballot initiatives the epitome of special interests, allowing the loudest voices in the room to acquire funding and support on the public sphere, regardless of their relative merits and detractors.
The cannabis ballot initiative saga in Massachusetts presents a compromise between this dichotomy. Ballot initiative lawmaking may indeed represent a new “fourth branch of government” – but a fourth branch that is weaker in its power. As Massachusetts has shown, voter approved laws remain subject to the check and balance of subsequent legislative action, which in turn is checked by traditional balance of powers built into state and federal constitutions. The ballot initiative process has a demonstrable capacity to force legislative action, a democratic strength in its own right.
Connor Mullen anticipates graduating from Boston University School of Law in May 2018.
Massachusetts’ End of Life Options Bill Elicits Emotional Arguments
“An Act relative to end of life options” is currently being considered in the Massachusetts State House. Six states, including California, Colorado, D.C., Oregon, Vermont, and Washington, have legalized physician-assisted suicide (“PAS”). Massachusetts Representative Lou Kafka and Senator Barbara L’Italien introduced identical bills in Massachusetts’ legislature (H1194 and S1225, respectively) on January 27, 2017. According to Death with Dignity, a 501(c)(3) nonprofit organization and proponent of Massachusetts’ bill, “[t]he 2017-2018 session is the eighth time a Death with Dignity bill is under consideration in the Massachusetts legislature.” A “Death with Dignity” initiative was also voted down by Massachusetts citizens in a November 2, 2012 ballot measure.
The Massachusetts bill would allow a fully-informed “adult of sound mind” with “a terminal illness or condition which can reasonably be expected to cause death within 6 months” to end their life with medication prescribed by a physician. Massachusetts legislators heard “emotional appeals” regarding the bill in a September 2017 joint hearing.
Proponents include Compassion and Choices, “the nation’s oldest, largest and most active nonprofit organization committed to improving care and expanding options for the end of life.”
Compassion and Choices argues:
- Medical aid in dying has strong support from people living with disabilities and offers “autonomy, independence and self-determination.”
- It is a “safe and trusted medical practice” that requires two doctors to confirm a patient is fully informed before providing a prescription for medication.
- Existing laws are overseen by state agencies and “have sound oversight and investigation processes in place.”
- A similar law in Oregon showed improvement in overall end-of-life care.
- The New England Journal of Medicine reports “there are no substantial cost savings,” so there is no financial incentive for insurers to pressure terminally ill patients to end their lives.
- Gallup and The Harris Poll found Americans supported medical aid in dying at a rate of 68 and 74 percent, respectively. Additionally, six states have authorized medical aid in dying.
- A growing number of healthcare professionals have endorsed or accepted medical aid in dying.
Other organizations, such as Second Thoughts Massachusetts and Not Dead Yet, opposed the legalization of PAS, which they consider “a deadly form of discrimination against disabled people.” John Kelly is the director of Second Thoughts and regional director of Not Dead Yet. Proponents, according to Kelly, tend to be those who have been treated well by the healthcare system: white, non-disabled, higher social class—the same types of people who tend to make up the majority of the legislature. In the 2012 Massachusetts ballot measure which voted down PAS, Cambridge and Northampton voted roughly 68 and 73 percent, respectively in favor of PAS. Springfield and Lawrence, however, voted 65 and 69 percent against PAS, respectively. Kelly, who prefers the term “assisted suicide” instead of “medical aid in dying,” offered five additional arguments against the Massachusetts bill:
- Once it becomes one person’s choice, it becomes everyone’s choice; a family can engineer the decision rather than it being solely the decision of the individual.
- Assisted suicide is the cheapest treatment for insurers and, where legal, there are examples of insurers covering suicide, but not treatment.
- The Massachusetts bill requires those seeking PAS to have “a terminal illness or condition which can reasonably be expected to cause death within 6 months.” However, some patients expected to live only six months actually live much longer. According to Kelly, “thousands of people graduate from hospice every year.”
- Those assisting in death are immunized from liability; doctors can write prescriptions with little to no knowledge of the patient; and without a witness requirement, “anyone could take action with impunity.”
- Bias: Suicide requests from people with terminal illness are usually based on fear and depression.” Unlike in the case of a suicidal teenager who is offered suicide prevention services, a terminally ill patient may instead be offered suicide assistance. This is a “deadly” form of discrimination.
Massachusetts’ bill neither confirms nor contradicts Compassion and Choices’ arguments. The bill addresses some, but not all of its opponent’s concerns:
“Once it becomes one person’s choice, it becomes everyone’s choice.” The bill addresses this concern a few ways. First, the bill requires witnesses, the patient, the patient’s attending physician, and a consulting physician to verify the patient is acting voluntarily. See §§ 3(2)(b), 4, 6(1)(a)(iv), 6(1)(c), 7(1)(c)(ii). Next, section 14(1) invalidates any estate provisions hinging on “whether a patient may make or rescind a request for medication.” The bill also provides criminal sanctions and civil liability for misconduct: “[p]urposely or knowingly altering or forging a request. . . without authorization of the patient . . . is punishable as a felony . . .”; “[a]n individual who coerces or exerts undue influence on a patient to request medication . . . shall be guilty of a felony”; and “[n]othing in this act limits further liability for civil damages resulting from other negligent conduct or intentional misconduct by any individual.” §§ 16(1)-(3). It could still be argued, however, that it is difficult to detect “undue influence” as it is sometimes difficult to tell whether an idea is a patient’s or someone else’s.
“Assisted suicide is the cheapest treatment for insurers.” The bill does not appear to address this concern.
Patients diagnosed with a terminal illness can get better. The bill does not appear to address this concern.
The law immunizes from liability those assisting in death. The bill protects the actions of “health care providers and patient advocates supporting a qualified patient” from being construed as “elder abuse, neglect, assisted suicide, mercy killing, or homicide under any civil or criminal law or for purposes of professional disciplinary action.” § 14(4). However, the law also protects against negligence and intentional misconduct, as noted in section 16(3) above.
Bias: a depressed teenager is offered suicide prevention, while a depressed disabled individual may be offered suicide assistance. Section 8(1) requires patient speak to a counselor to “determine that the patient is not suffering from . . . depression causing impaired judgment.” This appears to potentially address Kelly’s concerns; however, this could also be interpreted to allow someone with depression that does not impair judgment to seek life-ending treatment.
Massachusetts’ End of Life Options Bill has additional protections to ensure the informed consent of terminally-ill patients seeking medical aid in dying. For example, the bill requires that such patients make an oral and written request and get approval from four health and counseling professionals, among other requirements. John Kelly, however, argues that the state needs to more-substantially fund mental health and palliative care programs instead. Thus, while this bill may achieve many of the goals of its proponents, it does not do enough to alleviate its opponents’ concerns.
Kara Morris anticipates graduating from Boston University School of Law in May 2019.
WHO LET THE DOGS OUT? CALIFORNIA BANS USE OF PUPPY MILL
In October 2017, California became the first state to pass a law to deter the use of puppy mills by potential puppy buyers. Under the new law, pet stores must work with animal shelters and other rescue operations to obtain dogs, cats and rabbits, and are prohibited from using breeders. However, private and individual customers can still use puppy mills, and nothing in the act adds direct regulations on domestic animal breeders in the state.
Over the past several years, there has been a nationwide conversation among pet lovers about the ethics of puppy mills. At the center of the debate is the competition for owners between adoption/rescue groups, and breeders. According to the American Pet Products Association (APPA), 34% of currently owned dogs were raised by a breeder, as opposed to 23% coming from an animal shelter or other humane rescue group. Origination data is not entirely clear however, as the American Humane Association (AHA) and the American Veterinarian Medical Association (AVMA) put breeder-acquired ownership figures at less than 20%. Shelter-based ownership figures vary even more, with the AVMA putting the adoption population at 84.7% and the AHA estimating a 22% adoption population. Available figures for breeder-acquired cats are below 5%. While it is difficult to claim that adoption and rescue agencies are at a disadvantage for owners strictly because of breeder competition, the sheer number of pets in shelters (5-8 million dogs and cats) and getting euthanized every year (3-4 million dogs and cats), makes many wonder why people use breeders at all. Proponents of laws like California's believe that people who buy breeder-bred animals could have instead adopted an animal from a shelter.
Another facet of the “puppy mill” debate is the living conditions in breeder facilites. Claims of animal cruelty plague the reputation of breeder businesses. Though breeder operations are governed by Federal USDA regulations and inspections, irresponsible breeders can evade these oversights and sell animals that have been bred improperly, leading to pets with physical and psychological ailments. Many times, these irresponsible breeders will focus on quantity, instead of quality of the animals (hence the term “mills”) possibly leading to poor health, abandonment, or even death of the animals. Since these disreputable breeders often sell to pet stores, instead of directly to screened buyers, laws like the one California just passed will likely serve as a significant deterrent for negligent breeders. However, some detractors of the bill say many cities statewide (including LA, San Diego, and San Francisco) already ban “mass breeding” and other unhealthy practices, so this new law is more likely to constrain the breeders who do not engage in these poor practices, yet sell to pet stores, than the irresponsible breeders.
Aside from animal welfare, steering potential pet owners and pet shops to animal shelters should benefit the state’s taxpayers. Publically run animal shelters cost the state approximately $300 million a year. If this law has its intended effects and decreases overcrowding in animal shelters, the state can accordingly decrease spending on housing, feeding, and servicing shelter animals. While California may pinch some pennies with decreased animal shelter populations, the breeding community may suffer economically under this bill. California has roughly 800 active breeders selling animals in the state. Even if only a small percentage are fully reliant on pet stores for income, that is still dozens of California’s workers being effectively forced out of a job under this law. However, some of this job loss may be offset by impacted breeders selling to out-of-state pet stores who do not have similar laws.
Though California’s new law was a key win for anti-puppy mill and animal welfare advocates, there are still some detractors. For example, this law may present challenges to those seeking specific breeds for their pet. Consumers may no longer easily get breed specific animals in pet stores, and specific breeds may become more costly. This might be particularly cumbersome for someone looking for a service animal of a particular breed best suited to help manage a condition. The American Kennel Club released a statement saying the law “not only interferes with individual freedoms, it also increases the likelihood that a person will obtain a pet that is not a good match for their lifestyle and the likelihood that that animal will end up in a shelter.” Further, this legislation may have the unintended consequence of increasing animal deaths and abandonment at puppy mills, because the mills no longer have access to their main customers. If the mills have not sold off all their animals by the 2019 effective date of this law, the animals may have nowhere to go. Breeders whose business is hurt as a consequence of this law may spend even less money on the care of the animals, or be forced to surrender the animals to a shelter. But given the delayed effective date of the law and the continued legality of breeder use by individual parties, the foreseeable issues will likely be negligible in light of the positive changes.
Since California passed this law, a Massachusetts lawmaker has also proposed a similar bill that would deter the practice of commercial breeding. Though California is the first state to pass this kind of prohibition, cities all over the country have been passing similar ordinances, so it is likely that states will follow suit if California’s law works as intended.
Andrea Ogechi-Okoro anticipates graduating from Boston University School of Law in May 2018.
With Obamacare in peril, the Governors Speak Out
Before the Affordable Care Act (ACA), I did not have health insurance. My home state Florida did not mandate health insurance coverage for residents and my undergraduate university did not require me to have health insurance. In essence, I was a typical American in my early 20s. I did not think I needed health insurance, was not required to carry it, and could not afford it. Cost was the greatest factor: I did not have any income and Florida did not expand Medicaid. To my surprise, the ACA allowed me to have affordable health insurance for the first time as an adult. Now Congress is contemplating major changes to the ACA (or commonly called Obamacare), causing some governors, such as Charlie Baker (R-Massachusetts), to weigh in on the proposals. Despite the recent successful House repeal and replacement of the ACA, the Senate is now struggling to find a path forward under the budget reconciliation rules.
Just a few months ago, it looked as though changes to the ACA were inevitable given the unified Republican control of Congress and the Administration. Despite seven years of discussion of repeal, and more recently the repeal and replace vote, the future is still uncertain. Members of Congress who attended town hall meetings during the 4th of July break heard from many constituents who are deeply concerned with loss of coverage. Former House Speaker John Boehner recently said that Congress would not repeal and replace, but instead “fix” Obamacare. And now, the Senate is spinning its wheels.
The much-awaited House bill, the American Healthcare Act (the “AHCA”), was the first attempt at replacing the ACA. The AHCA would repeal tax penalties for people without health insurance, reduce federal insurance standards, cut subsidies for buying private insurance and establish new limits on spending for Medicaid. In their first attempt, Republicans failed to get their bill to reach the House floor for a vote. In spite of this defeat, the Trump Administration placed renewed pressure on Congress to revise the ACA. Ultimately, the House was able to pass the bill in its second try by adding $8 billion to help cover insurance costs for people with pre-existing conditions. However, the Senate cannot pass the House bill because Majority Leader McConnell must accommodate Republican senators from states that have expanded Medicaid under the ACA. These senators, with a statewide constituency, must consider what their state governors have to say on revisions to the ACA.
Congress' ACA replacement process included a request to the 50 governors for information. In response, Massachusetts Governor Baker sent a letter on the ACA’s impact on Massachusetts. Some commentators believe Governor Baker’s letter could carry extra weight because of his Republican party affiliation and his past work experience as chief executive of Harvard Pilgrim Health Care gives his suggestions and concerns greater authority.
In his letter, Governor Baker discussed the importance of the health sector to the Massachusetts economy; $19.77 billion, making it one of the leading industries in the state. Governor Baker also noted that the ACA was modeled after the Massachusetts system, which was intended to provide close to universal coverage for residents. Massachusetts has the highest percentage of insured residents in the U.S.— 96.4%. Just under 60% of the insured are covered through the employer-sponsored insurance market.
Governor Baker argued that lawmakers should not repeal the ACA, but revise it. One area in need of repair is the ability of individuals with employer provided insurance to switch to tax-payer subsidized health insurance; something half a million Massachusetts residents have done since 2011. As a result, Medicaid now accounts for close to 40% of the state’s budget. Since 2012, the percentage of Massachusetts residents on commercial insurance decreased by 7% while Medicaid enrollment increased by 7% and now insures 28% of the population. The original Massachusetts program did not allow this transfer, but the State was forced to comply with the introduction of the ACA. Now, this particular aspect of the ACA was straining the Massachusetts system and needed to be revised. Although Governor Baker offered reforms, he argued for maintaining several aspects of the law, such as the mandate requiring all residents to carry health insurance, which would allow stability within high-risk pools for insuring people who are sick.
The Governor continues to push the goal of universal health care coverage, but recognized such a goal was in jeopardy because of certain Congressional proposals. For instance, the letter expressed concern over a shift to block grants for Medicaid funding to the states. The Governor argues that a shift to block grants (or “per capita caps for Medicaid) would “remove flexibility from states” as the result of lower federal funding. Under current law, the federal government and state governments share in the financing and administration of Medicaid. According to the Congressional Budget Office, states typically pay health care providers for services to enrollees, and the federal government reimburses states for a percentage of their expenditures. Furthermore, all federal reimbursement for medical services is “open-ended” in other words, if a state spends more because enrollment increases or costs per enrollee rise, additional the federal government matches. Currently, Massachusetts is a 50/50 state, meaning that the federal government and Massachusetts divide the cost of providing health care for Medicaid recipients.
Despite Governor Baker position, the House passed AHCA creates a per capita-based cap on Medicaid payments for medical assistance. The per-capita caps would establish a limit on the amount of reimbursement the federal government provides to states. For instance, if a state spent more than the federally established limit on reimbursements, the federal government would not match the additional costs. The AHCA would punish Massachusetts low income residents and threaten the stability of the MassHealth system. Consequently, the changes to federal grants of funds could impact the Commonwealth’s goal of universal healthcare.
Today, Governor Baker—joined with nine other governors, including Gov. Sandoval (R-Nevada) and Gov. Kasich (R-Ohio) —sent another letter to the Senate urging it to correct the ACA's weaknesses without repealing the law or gutting Medicaid. The Governors wrote, "lasting reforms can only be achieved in an open, bipartisan fashion." The governors also called on the Senate to heed U.S. Sen. John McCain's, R-Arizona, impassioned plea to return to "regular order" and not continue the recent practice of hyper partisanship.
The governors are speaking; the question remains whether Congress is listening.
Juan Garay graduated from Boston University School of Law in 2017.
The Role of the Courtroom in Combating Domestic Violence
The rhetoric surrounding the courtroom can be idealistic. The courtroom is supposed to be a symbol of justice, where every party has a fair opportunity to be heard. Yet the reality for survivors of domestic violence is far from this ideal. Survivors who have the strength to seek their day in court have already shown an incredible amount of strength and courage. They should be met with hope, encouragement, and assistance. But this is a goal yet to be achieved.
Survivors often feel unsafe walking into the courtroom. Not only are survivors at more risk after leaving their abuser, “[a]busers also use court appearances as opportunities to stalk and maintain contact with their ex-partners.” Survivors face an uphill battle in the courtroom. As Sara Ainsworth of Legal Voice stated, “[t]here's an enormous bias against anyone making accusations [of abuse].”
Domestic violence survivors may end up in the courtroom for a variety of reasons, including seeking a protective order and child custody proceedings. Current law in Massachusetts governing domestic violence in custody proceedings falls far short of the protection society owes to survivors. First, the definition of abuse is narrow, only encompassing physical abuse. Specifically, Massachusetts General Laws Section 31A defines abuse as “(a) attempting to cause or causing bodily injury; or (b) placing another in reasonable fear of imminent bodily injury.” The statute further states that either a pattern of abuse or a ‘serious incident’ of abuse (defined as “(a) attempting to cause or causing serious bodily injury; (b) placing another in reasonable fear of imminent serious bodily injury; or (c) causing another to engage involuntarily in sexual relations by force, threat or duress”), triggers a rebuttable presumption that granting the abuser sole or shared custody is not in the best interest of the child. The presumption is triggered by a preponderance of the evidence, and can be rebutted by a preponderance of the evidence. A past or current protective order does not automatically trigger the presumption.
Further, while the facts that brought about a protective order can be admissible, protective orders themselves cannot be admitted as evidence of abuse. This means that even if a survivor has succeeded in protecting herself and her child(ren) by obtaining a protective order, she will not automatically get custody of her children. She will have to face her abuser again in the courtroom, and will have to prove once again that abuse has occurred. Further, even if there was extensive verbal, emotional, and psychological abuse, the presumption against custody will not be triggered.
In addition to dealing with statutes that do not adequately protect them, survivors must also deal with judges who may not understand their experiences. In fact, women who are seeking protection for themselves and their children from an abuser are often met by similar behavior from judges. Domestic abuse is often described with what is termed the ‘Power and Control Wheel.’ The wheel describes that variety of ways abusers use their power to manipulate and control their victims. The Texas Council on Family Violence created a power and control wheel that describes the ways judges also reinforce women’s entrapment.
The role of the court in protecting domestic survivors must extend beyond equitable orders. It is an unfortunate truth that sexism is still a very real reality in the courtroom. Moreover, many judges do not understand the dynamics of domestic violence, and do not handle custody disputes with the appropriate sensitivity to domestic abuse, even if they are statutorily required to do so. Judges have the opportunity to empower victims, or to make them feel even less in control.
The idea that judges can play a positive role in protecting domestic abuse survivors is not new. In 1999, The Northeastern University Press published an article titled “Battered Women in the Courtroom: The Power of Judicial Responses.” The article lists multiple ways judges can support survivors: supportive judicial demeanor; take the violence seriously; make the court hospitable; prioritize women’s safety; address the economic aspects of battering; focus on the needs of children; enforce orders and impose sanctions on violent men; and connect women with resources. Specific recommendations targeted sexism during proceedings, including “refusing to joke and bond with violent men”; “talking with battered women rather than around them”; “correcting institutional bias in favor of men”; and “eschewing bureaucratic/perfunctory or hostile attitudes toward victims and casual or collusive attitudes with batterers.”
The article identified five types of judicial demeanor in hearings for protective orders: 1) good-natured; 2) bureaucratic; 3) firm or formal; 4) condescending; and 5) harsh. Interestingly, “[t]here types . . . were demonstrated toward violent men[:] [f]irm or formal, bureaucratic and good-natured. Most judges were good-natured with women and firm with violent men. Condescending and harsh demeanor was not directed toward violent men.” (emphasis added). There is no excuse for the gender discrimination revealed by this study.
While this study is dated, women still face judges who are hostile toward domestic violence survivors. Judges can make a difference by understanding that survivors can be overwhelmed in the courtroom; ensuring a the record is comprehensive; not blaming the victim; and having zero tolerance for violence and gender discrimination during proceedings.
Judges can be powerful role models by choosing to treat women with respect and taking the humble approach of recognizing their need to learn the dynamics of domestic abuse in order to be effective judges.
Boston University School of Law, class of 2018