Patient protections are major concern at emotional hearing on medical aid-in-dying bill

Lynn Cave waited hours to provide public testimony in front of the Senate Judiciary Proceedings Committee Thursday afternoon.

“I have eye cancer that has spread to my liver. It will likely claim my life in just two years. I don’t want my disease to choose when I die. I want to make that decision myself,” she told the lawmakers on the panel.

Cave, of Silver Spring, said she supports SB 443, which would allow a qualifying terminally ill patient to prompt their own death through the help of a physician, often referred to as “medical aid-in-dying.”

“I’m on an experimental treatment. I want to live. Eventually the cancer will mutate and destroy my liver. After that happens, I will have about two weeks,” she said. “Having the promise of a dignified death on my own terms is my greatest comfort from what’s ahead.”

Cave is one of several patients with aggressive cancers and other severe illnesses who shared their challenging medical situations with the committee.

Husbands, wives, and long-time friends of those who passed away from fatal illnesses shared difficult stories of supporting their loved-ones in their final moments of life. Some supported and some opposed the controversial legislation. Medical professionals and religious leaders on both sides of the issue also weighed in.

Sen. Jeff Waldstreicher (D-Montgomery) is the lead sponsor of SB 443 and Del. Terri L. Hill (D-Howard) is the lead sponsor for the House version, HB 403. Both bills are titled the “End-of-Life Option Act (The Honorable Elijah E. Cummings and the Honorable Shane E. Pendergrass Act).”

There have been prior attempts to pass aid-in-dying bills in Maryland, while 10 other states and Washington, D.C. have passed similar legislation.

As Md. considers medical aid in dying, here’s how it’s playing out in D.C.

In 2019, the aid-in-dying legislation stalled on the Senate floor when one senator chose not to vote at all, leading to a 23-23 tie vote and the bill’s demise.

Some opponents believe such measures can create pressure on people with serious illnesses to end their lives, to avoid being a burden on loved ones. Others object on religious or other grounds.

Sen. Mike McKay (R-Allegany), was largely concerned that nursing homes might misuse or encourage the option of aid-in-dying if they see a financial incentive there.

Supporters of the bill believe that terminally ill patients should have the autonomy to determine how they experience their life’s end. But even supporters of the bill say that the topic is a challenging and sensitive issue.

Some lawmakers and those who testified said they were concerned the bills do not include sufficient safety parameters to ensure that vulnerable patients, such as the elderly and those with disabilities, are not coerced into seeking medical aid-in-dying.

Dr. Janet Conway, an orthopedic surgeon with a practice in Baltimore, said that she “can’t believe the End-of-Life Option Act is being introduced, again, in Maryland.”

“There are so many patient safety issues at stake,” she said. “There are no protections against the coercion by others. No protections against for the patient against neglect in treating and diagnosing depression. And no protection against inaccurate diagnoses of terminal illnesses.”

She also shared her experience of a loved one dying, as an example of the value of hospice and palliative care for a terminally ill patient as opposed to medical aid-in-dying.

“My mom died when I was 21 with ovarian cancer. Every day we had with her was precious, and at the end of her life, her exact words were ‘I feel like I am leaving the party early.’ We did our best to make her every second count. As a physician, it is my job to protect patients. No doctor is a death expert,” Conway said.

‘Appropriate protections’

Advocates for medical aid-in-dying believe the legislation will be successful in 2024.

At the Thursday committee meeting, Maryland’s Health Secretary Laura Herrera Scott testified in favor of the legislation, but said she would like to have the bill amended to tighten requirements for reporting aid-in-dying procedures to the Maryland Department of Health. Those amendments were not discussed during the Thursday meeting.

At the start of this General Assembly session, Gov. Wes Moore (D) signaled his intention to sign aid-in-dying legislation with “dignity at its core” if it came to his desk, but said he needs to “see what it looks like.”

Medical aid-in-dying legislation is sometimes referred to as “death with dignity” by supporters.

Senate President Bill Ferguson (D-Baltimore City) believes that “as a concept, there are enough votes in the Senate” to pass the legislation this year, but that much of the debate will be around the “appropriate protections in place.”

“I leave that one to the committee to really think through,” Ferguson said earlier this week. “They’ll be the ones that get expert testimony to really try to make the best decision on behalf of what comes to the floor. But it will be in the details.”

Under the bill, obtaining medical aid-in-dying would be determined and would proceed as follows:

To qualify a patient would have to be diagnosed with a terminal illness where the prognosis indicates the disease would likely result in the patient’s death within six months. The patient also would have to be mentally capable of making their own medical decisions.

A patient would make an oral request to receive medical aid in dying. The patient then needs to make a written request for the procedure.

The patient would need to make a second oral request at least 15 days after making the first oral request and within 48 hours after making the written request, according to the bill.

The written request for aid-in-dying would have to be witnessed by two individuals to testify that the patient is of sound mind and is requesting the procedure voluntarily. Only one of the witnesses can be a recipient of any benefit following the patient’s death or be a relative by blood, marriage or adoption. The attending physician may not be one of the witnesses.

The attending physician would verify that the patient meets the six-month terminal illness qualification, is properly informed of their options and is voluntarily requesting the procedure, rather than being coerced to do so. The physician also would have to verify a proof of residency to ensure that the patient is a Maryland resident.

If there are questions about the mental health of the patient who is requesting medical aid-in-dying, the patient is to be referred to a mental health assessment.

Participation of a physician would be voluntary. If a physician does not want to participate in the medical aid-in-dying process, the physician would be required to refer the patient to another physician.

The bill shields a physician from criminal liability and professional disciplinary action if they provide medical aid-in-dying in accordance with the bill.

The House hearing is scheduled for Feb. 16.

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