How the most contested health questions on state ballots played out
Decisions made yesterday by voters will have profound implications for public health. Here are the results from the biggest issues that were considered:
1. Do terminally ill patients have a right to terminate their lives, and should physicians be complicit? NO
Massachusetts' move toward "Death with Dignity" was narrowly defeated by a margin of about 38,000 voters, with about 51 percent voting against physician-assisted suicide, reports the Boston Globe.
The measure would have allowed the state's doctors "to prescribe medication, at the request of a terminally-ill patient meeting certain conditions, to end that person's life." The "certain conditions" included the patient having six months or fewer to live and being judged mentally capable to make medical decisions. The patient would have had to submit the request twice orally and once in writing.
A similar law has been on the books in Oregon since 1994; more recently, Montana and Washington legalized physician-assisted suicide as well. The open intensely personal topic is ripe for controversy, but also morally ambiguous, and it doesn't adhere clearly to party politics.
The Massachusetts Medical Society officially came out against the measure, arguing, on a practical level, that "the proposed safeguards against abuse are insufficient," that it's difficult to determine exactly when someone's six months would begin, and that there are other ways of improving end of life care. More loftily, they reasserted the idea that "physician assisted suicide is fundamentally incompatible with the physician's role as healer."
2. Does the definition of marriage include gay and lesbian couples? YES
Maine and Maryland decided to uphold laws legalizing same-sex marriage, becoming the first states to do so by popular vote. Washington state approved gay marriage as well.
Minnesota voters rejected an amendment to its constitution that would have defined marriage as existing between one man and one woman.
3. Should the food industry be required to alert consumers to its use of GMOs? NO
California's Proposition 37 failed to pass, with 53 percent opposition to 47 percent support as of this morning.
Writing of the initiaive in the New York Times , food guru Michael Pollan said, "One of the more interesting things we will learn on Nov. 6 is whether or not there is a 'food movement' in America worthy of the name -- that is, an organized force in our politics capable of demanding change in the food system."
The ballot initiative, which the Atlantic covered in detail here, would have required that food including genetically modified ingredients be labeled. It's been called "scientifically baseless and politically stupid" by others.
4. What role should a) public funds, and b) the parents of minors play in abortion? BOTH SHOULD PLAY A ROLE
While no bans were on the table tomorrow, thanks to the Oklahoma State Supreme Court striking down a proposed "personhood" amendment, the "Florida Abortion Amendment," which would have prohibited the use of public funds for abortion except in cases where the mother's life is at stake, failed to pass.
Montana's proposal that parental notification be required for minors under the age of 16 who wish to undergo an abortion passed with nearly 70 percent of the vote. The wording doesn't indicate that parents have to consent, but they are required to have 48 hours' notice in non-emergency situations.
5. Is marijuana a legitimate pain medicine? Is recreational marijuana use okay? YES AND YES, MOSTLY
Massachusetts voted to permit the drug for medical purposes, but a similar measure failed in Arkansas, with slightly more than half voting against it. Voters in Montana decided to support a 2011 legislative bill that tightened restrictions on use of the drug, which was legalized there in 2004.
Meanwhile, Colorado and Washington voted in favor of initiatives to approve pot for recreational use. Colorado's success is on a second attempt; in 2006, the majority voted against legalization. Fifty-five percent of Oregon voters came out in opposition to the measure. It remains to be seen how and to what extent federal law will clash with the states' legalization.
In Washington, the most heated aspect of the debate is an included measure that makes it illegal for drivers to have more than 5 nanograms per milliliter of THC in their system -- as the Seattle Times explains, "there are no handy charts showing the number of tokes it takes to reach that level, because marijuana varies in strength and affects novice and seasoned users differently."
6. Is the Department of Health responsible for regulating safe sex in pornography? YES
Although it will only affect a small community -- namely, the Los Angeles County porn star community -- Measure B, which the LA Times calls "one of the most explicit ever seen on a ballot," will require actors to wear condoms when making adult films. The AIDS Healthcare Foundation backed the measure; the actors and actresses turned out in full force against it.
Both sides made strong arguments in the interest of public health -- those in favor argued that it would prevent the spread of STDs while promoting the message that "safety is sexy"; those against point out that the money would be better spent directly providing sex education and treating those with HIV.
7. Should home health care providers be publicly regulated? NO
Michigan voters ended up rejecting an amendment that would have limited the collective bargaining power of home health care workers and applied standards of quality to home care. Opponents had argued that its real purpose was to force the workers to unionize and allow the government to collect dues. The Detroit News has more details on what the stakes were for the industry and the people it serves.
8. Should smoking be banned from public places? YES
North Dakota passed a measure to prohibit smoking in public places, making the three-fifths of the U.S. smoke-free. As the director of the North Dakota Hospitality Association told the Jamestown Sun, in reference to the 11 cities that have already enacted bans, "It has been slowly creeping westward across North Dakota ... These things seem to be popular."
9. Should specific protections against abuse exist for dogs, cats, and horses? NO
The North Dakota Prevention of Animal Cruelty Initiative was rejected by 65 percent of voters. Itwould have taken a strong (and graphically specific) stand against animal abuse, making it a class C felony for anyone to "maliciously and intentionally burn, poison, crush, suffocate, impale, drown, blind, skin, beat to death, drag to death, exsanguinate, disembowel, or dismember any living dog, cat or horse."
The act would have upped the maximum prison sentence and fine for animal abusers from 1 year and $2,000 to 5 years and $5,000.
10. Should universal health care be blocked on a state level? MOSTLY, YES
Initiatives outlawing the individual mandate in Alabama and Montana passed, although like the 16 others that came before them, they are considered to be entirely symbolic. Wyoming took a potentially stronger (but still symbolic stand) by becoming the third state to amend its constitution in opposition to the mandate. Similarly, Missouri is attacking Obamacare from another angle by passing an amendment that will prohibit its governor from establishing a health care exchange.
But Florida, which would have required 60 percent approval to outlaw the mandate, did not even reach 50 percent support.