Thesis advisor: Marc Landy / The “Death with Dignity Act,” if passed in November 2012 in Massachusetts by means of a ballot initiative, would have allowed doctors to prescribe lethal drugs to patients with fewer than six months to live. Introduced by two pro-assisted suicide organizations from the Pacific Northwest, the initiative was expected to take advantage of a political “perfect storm” brewing in the Bay State. A blue state in a presidential election year, with President Obama at the top of the Democratic ticket, Massachusetts was expected to produce an electoral outcome favorable to assisted suicide. Oregon and Washington State had legalized physician-assisted suicide in 1998 and 2008, respectively. Polling in 2011 showed a 2-1 majority among Massachusetts voters in favor of assisted suicide. Nonetheless, the Archbishop of Boston and the Bishops of Worcester, Fall River and Springfield, organized as the Massachusetts Catholic Conference, took up the challenge to oppose the initiative. Relying on the expertise of paid political consultants, they mounted a two-tiered campaign. An internal component, directed at Catholics, included the dissemination of over 2 million pieces of in-print and electronic materials urging a “no” vote on the measure. An external component, directed at the wider public, relied on a coalition of organizations representing the three major religions, health and hospice organizations, disabilities rights activists, and pharmacists. Using “flaws” in the bill identified through strategic polling, they appealed to voters even sympathetic to assisted suicide to reject the bill. When the votes were counted 2.7 million Massachusetts citizens voted on the physician-assisted suicide initiative and it was defeated by 67,891 votes, 51.1% to 48.9%. One key to the defeat was the split in the vote in the city of Boston, where Question 2 was defeated 50.9% to 49.1% . Twelve of Boston’s 22 wards voted against the measure. Leading the way among the twelve were Dorchester, Roxbury, and Hyde Park, traditionally black, liberal Democratic strongholds. This study shows that even the most effective, well-funded, Church-initiated campaign in Massachusetts in 2012 might well have foundered on the 2-1 majority in favor of assisted suicide at the polls, not for the strategic identification of “flaws in the bill,” the broad-based coalition campaign based on them, and the “split in the vote in the black community in Boston.” . / Thesis (PhD) — Boston College, 2021. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Political Science.