The arrival of Sine Die in Annapolis demands that we look back at the session and ask a simple question: How can a bill supported by 70% of Marylanders fail to pass for the 10th year?
Once again, the Maryland General Assembly failed to pass the End-of-Life Option Act, which has been discussed in Annapolis since 2015. The bill would have allowed mentally competent, terminally ill Marylanders with less than six months to live access to medical aid in dying (MAID), allowing them to take medication to end their lives peacefully. The bill includes multiple cautionary steps to ensure there is no abuse of the process, which now is authorized in 10 states plus Washington, D.C.
With 70% statewide support in credible and consistent polling, and majority support in virtually every geographic and demographic subgroup, how could this bill have failed again, when early in the session the Senate president predicted it would come to the Senate floor?
In my opinion, there is a three-part answer.
The most immediate reason is that, as I understand it, one senator, who previously co-sponsored and voted for the bill, reversed their support in the days leading up to a committee vote. This meant the bill could not pass out of committee. I can only wonder if this reversal was a political effort to secure support for other bills at the expense of people who are dying. My message to the senator is that it is not right to play politics with peoples’ lives. I expect the senator’s constituents will remember this in the next election.
A second explanation is that opposing witnesses and legislators continue to generate, in my opinion, hypothetical reasons to oppose the bill despite data that refute the theoretical harms. The following is a small sample:
No increases in state suicide rates. The opposition claims suicide rates have increased in states with MAID despite, to my knowledge, no such data in psychiatry, medical or public health journals.
No issue with Hippocratic Oath. Opposition previously claimed MAID violated the oath physicians take in medical school, but a study shows that virtually all medical schools have oaths accommodating MAID. So now the opposition claims it violates the original Hippocratic oath. True, but so does removing kidney stones and performing surgery. We should NOT be seeking guidance from a position stated 2,400 years ago.
No abuse of drugs. Despite opposition claims, to my knowledge there has never been a credible case of unused MAID drugs being abused, because patients do not fill their costly prescriptions until ready to take them, and because the drug powders are now mixed together and realistically cannot be separated or abused.
No patient coercion. After 25 years of MAID in this country and more than 10,000 prescriptions for life-ending drugs (of which about a third were never used), to my knowledge there has never been a credible documented case of a patient being coerced into using MAID.
No need for evaluation by a psychiatrist in every patient. Multiple psychiatrists claimed, in my view without evidence, that only mental health professionals can evaluate patients for disorders that diminish mental capacity. However, two recent studies disprove this belief. Attending clinicians effectively serve this role.
No insurance company denials of care when MAID is available. Despite fears that insurance companies might deny claims to encourage people to use MAID, to my knowledge there has never been a credible case of an insurer denying treatment coverage because the patient qualifies for aid-in-dying.
The final and, at its core, the real reason for most MAID opposition is religion. As simple as that. These individuals believe their religious values should dictate public policy and override contrary views. Indeed, even when it comes to abortion the Maryland General Assembly transcended this religious dogmatism by approving a bill last year to place on the ballot a constitutional amendment allowing a woman’s right to choose. But when it comes to one’s own competent choice for a painless death, others’ religious views prevail.
Under the proposed law no one is required to participate in MAID. Anyone who opposes the law can decide not to participate, including patients, physicians, and pharmacists. But Marylanders should have the option to choose.
The late Congressman Elijah Cummings, for whom the bill is named, put it succinctly in a 2019 supporting letter: “. . . at the end of life, an individual’s right to self-determination about one of the most personal decisions that anyone could make supersedes the moral sensibilities of others.”
Michael J. Strauss is a writer, retired internist, and president of the group Marylanders for End-of-Life Options.
Brian H. Childs says
I would like to have the reference for the claim that virtually all medical school versions of the Hippocratic Oath allow for MAID. I am currently teaching in my third medical school and none of them even have such an oath including my days in the University of Maryland.
I do not think that the criticism of MAID laws is essentially religion, though some of it surely is. While I am sympathetic that there may be situations where hastening one’s death is understandable I also think we do not spend enough time and resources in mastering palliative care. I also do not think that physicians need be involved in hastening death if such an act is considered a ‘right’. Perhaps Lawyers would be suitable purveyors of the act and we use a different acronym.
Sharron Cassavant says
A very cogent summary of reasons to support this legislation. It’s very frustrating when a bill is stalled in committee and does not receive a public airing.
And you’re so right that no person or group should be allowed to dictate private moral decisions for another.
David Montgomery says
There can be no better response to this litany of falsehoods than an article in todays National Review “ThisWeek”
Since 2001, when the Netherlands became the first country to legalize euthanasia, about ten other countries have normalized, in some form, what is euphemistically called “assistance in dying.” Critics of the Dutch law, which limited eligibility to patients whose conditions are “hopeless and unbearable,” argued that its criteria were subjective and prone to gradual loosening. Now among those scheduled to die is a 28-year-old woman with autism, depression, and borderline personality disorder whose symptoms, her psychiatrist concluded, will never improve. In neighboring Belgium, the president of a health-insurance fund suggested that euthanasia should be made available to elderly persons who would like to relieve the state of the burden of their care. The clinical provision of death perverts the patient–physician relationship and the medical vocation, whose purposes are curative and palliative. Killing is neither.
Willard Engelskirchen says
My mother died at nearly 101. The last few years of her life she was essentially blind and deaf. She had nearly no meaningful contact with anyone including her sons. Some days she could not be awakened. She was in a very good nursing home in Chicago.
She was sometimes with it some times not. During one of her better times I had a discussion with her on her wishes. She said she did not want any treatment to prolong her life. She had already asked me to help end her life and I had told her that there was nothing I could do. I reviewed her wishes with her and then went over them with the nursing staff and the staff physician. Both the nurses and the doctor objected and said they disagreed. I insisted.
Not only did the medical professionals not want to help her end her life, they fought her wishes. The medical community, IMHO, needs to consider the patients wishes.