Opinion: The time is now for the End-of-Life Option Act in Maryland

This opinion piece was offered in response to this week’s column by Michael Collins, Legislating death with dignity needs debate with dignity

By Kim Callinan

Thursday afternoon, the House Health and Government Operations Committee will hear testimony on the “Richard E. Israel and Roger ‘Pip’ Moyer End-of-Life Option Act,”  HB370.

This legislation offers mentally capable, terminally ill adults with no hope of a cure the option to voluntarily request a prescription for medication from their doctor that they can decide to use to die peacefully if their suffering becomes unbearable.

The facts

Debates about medical aid-in-dying legislation, like the one taking place in Annapolis, are understandably passionate. But it is important that these debates remain based on facts, not on speculation and myth.

The fact is medical aid in dying has been safely practiced for a combined 30-plus years across six states in America: Oregon, Washington, Montana, Vermont, California and Colorado. The law has been carefully studied by doctors and reported on by state agencies and in academic journals.

The conclusions are clear. The laws work as intended. Medical aid in dying is a safe and effective medical practice. In fact, throughout this decades-long history, there has not been a single incidence of abuse or coercion.

The Maryland legislation is based on time-tested safeguards for medical aid-in-dying laws in other states that are necessary to ensure that the terminally ill adult patient is protected, while also recognizing that too many regulatory burdens will make it unnecessarily difficult for dying people to access the law.

Two doctors, three requests

The legislation requires that two independent doctors certify that the dying person is capable of making their own decisions and is likely to die within six months. Both doctors must also certify that the person has not been coerced.

The law has been carefully crafted to ensure that the dying person is in charge of the process from start to finish:

1) The person must make the request three times — once in writing and twice orally — and they must be alone with the doctor once when they make one request;

2) there is a 15-day waiting period;

3) the person must consult with two different doctors;

4) the person must self-ingest the medication; and

5) at any time during the process, the dying individual can change their mind and decide not to take the medication.

Participating in medical aid in dying is completely voluntary for both the patient and healthcare providers. The safeguards in the legislation protect vulnerable people, and they protect the doctors who treat them.

The legislation as drafted protects people with disabilities as is evidenced by this letter from Disability Rights Oregon: “DRO has not received a complaint of exploitation or coercion of an individual with disabilities in the use of Oregon’s Death with Dignity Act.” Evidence-based research also concludes that the legislation has the potential to improve hospice and palliative care, by spurring earlier conversations between doctors and patients about end-of-life care options, and leading to higher utilization of hospice and palliative care.

In addition, more than one-third of terminally ill adults in Oregon who get aid-in-dying medication do not take it. But studies show they enjoy peace of mind knowing they can take it if they need it. It enables them to enjoy their remaining time, free of worrying about suffering through an agonizing, prolonged death.

Growing support

Since terminally ill Californian Brittany Maynard first shared her story nationwide and advocated for medical aid in dying in October 2014, people across the country have been raising their voices in support of medical aid in dying with laws recently being enacted in California and Colorado, and awaiting passage in Washington, D.C. A groundswell of support has also been building here in Maryland.

Quite simply, constituents want this option. A bipartisan survey shows that 65% of Maryland voters support the bill with majority support across key communities including Catholics, African-Americans and Republicans.

This past year, the Maryland State Medical Society dropped its opposition and has now taken a neutral position on the legislation. The bill has also been endorsed by organizations like the United Seniors of Maryland, the ACLU, the Unitarian Universalist Church, the Central Atlantic Conference of the United Church of Christ and the Libertarian Party of Maryland.

Palliative care

While palliative care and hospice programs provide extraordinary comfort to patients and work wonders for many dying people and their loved ones, there are times when even the best palliative options cannot alleviate pain and suffering. Patients may suffer from physical and emotional agony, a loss of autonomy, and an inability to engage in enjoyable activities. Only the dying person can decide whether their pain and suffering is too great to withstand the pain. This legislation puts the decision-making power where it belongs: with the dying person.

The voices of Maryland residents deserve to be heard. The time has come for state lawmakers to act on behalf of the majority of their constituents and pass the “Richard E. Israel and Roger ‘Pip’ Moyer End-of-Life Option Act” so that as we each face the inevitable end of our lives, we are offered autonomy over how we die — and the peace of mind that goes along with it.

Kim Callinan is a 20-year Maryland resident and the chief program officer at Compassion & Choices, the nation’s oldest, largest and most active national organization working to improve end-of-life care.