Lawmakers say death with dignity law 'just a matter of time,' despite bill withdrawal

If you're faced with six months to live and the prognosis of a possibly painful death, should you be able to legally acquire and consume medications that will end your life at the moment of your choosing?

Oregon voters answered that question in the affirmative 20 years ago, but a similar bill in Maryland's legislature will once again fade away without a vote on the floor as lawmakers are withdrawing House Bill 370, formally titled the "Richard E. Israel and Roger 'Pip' Moyer End of Life Options Act."


Had it become law, the legislation would have allowed terminally ill, but mentally competent individuals to request medication from their doctor that the patients would then take on their own in order to end their life.

Del. Shane Pendergrass and Sen. Guy Guzzone, both Howard County Democrats, said they do not have enough support to pass the bill, marking the third year in a row Democrats have given up on passing aid-in-dying legislation.

Proponents argued the bill would have given people more control over the last months of their lives, minimized suffering and maximized the amount of time patients could spend with loved ones while still feeling well.

"I have seen two people, in particular, have really, what I would say were difficult deaths that were protracted and involved a lot of suffering," said Kaili Van Waveren, a volunteer with Compassion and Choices, an advocacy group that supported the bill. "I want to be able to enjoy the last days of my life with my family. I don't want to be in such intolerable pain that that is what overwhelms me and all that I have."

Opponents of the bill argued for alternatives to ease suffering, such as hospice, and that aid-in-dying legislation presents a moral hazard that could lead to people being coerced into ending their live before they are truly prepared to do so.

That was a prime concern for Carroll County representative Del. Susan Krebs, R-District 5, who sits on the House Health and Government Operations Committee. That committe heard testimony against the bill involving the reasons given by Oregon patients who had taken their lives under that state's law as to why they made that difficult decision.

"The number one reason was they didn't want to be a burden on their families," Krebs said. "When you're sick and you're ill and sick and older, you certainly don't want to feel guilted into taking your life."

Although the bill will not be voted on this legislative session, it is unlikely aid-in-dying legislation will die away. According to Dennis Twigg, a partner at Hoffman, Comfort, Offutt, Scott and Halstad in Westminster who focuses on elder law and medical assistance, it's an idea that increasingly comes up in his practice.

"With baby boomers grappling with their own parents' health care, I've noticed an increased sentiment expressing puzzlement and concern about how-end-of-life care works. Of their own accord, folks have asked me about the status of assisted suicide in Maryland and what their options are," he said. "I think that there's a quiet groundswell coming that will inevitably compel the legislature to explore this option."

This is hardly surprising to Isabella Firth, president of the LifeSpan network, a professional association for senior care providers in the mid-Atlantic region. Although LifeSpan does not take an official position on the bill or the issue of death with dignity generally, she said, "It's healthy to have these kinds of debates, especially in a legislative arena."

Firth sees the interest in death with dignity bills as part of a larger shift in attitudes toward aging, elder and end-of-life care, all driven by the fact that we are living longer.

"People think they go along in time and then they fall down one day and they are dead. Most people don't die that way," she said. "They experience a series of disabling diseases or conditions and they are living through those periods of disability for a longer period of time, too."

Baby boomers have either watched, are watching or soon will watch their parents go through this process, and many are unhappy with the prospect and seeking alternatives. Retirees are choosing to rent instead of own, Firth said, to age in place or signing on to grassroots programs such as the Village Movement that are completely different from the institutional choices, the nursing homes and assisted livings, available to their own parents.

"I think that's what is pushing and propelling these debates like HB 370 is that you can look at your parents or elderly relatives you know and say, 'I choose not to do that," she said. "The fundamental thread through all of these new ideas and concepts is control. Boomers, millennials, we want to control our experiences and our future and our deaths."


That element of control is something that has also stood out to Regina Bodnar, executive director of Carroll Hospice, who testified against HB 370 in Annapolis. While one of her chief concerns is a common one —that a legal category of acceptable suicide drifts over time to involve a pressure upon people to end their lives — her main objection is practical. Hospice exists to provide people with control over, and comfort, during the last six months of life, and it is underutilized.

"Hospice is a benefit that the government says you are entitled to for six months, and the national median length of stay is 17 days," she said. "Why would we add another option when in truth the options that we have, in robust hospice programs, are not being accessed early enough?"

Patients direct all aspects of their care in hospice, and through the use of advanced directives, can choose to be taken off a feeding tube or other device that would otherwise keep them alive, Bodnar said. Powerful medications are also available for pain, but Bodnar notes, as did Krebs, that in the data available from Oregon it was not fear of pain that topped the list of reasons for people who ended their lives.

"It has to do with loss of control and autonomy and no longer being able to do the things that you enjoy," she said. "A very small percentage of patients select this option, and an even smaller percentage of patients who elect the option actually take the drug."

In 2016, 204 people requested the medications in Orgegon, but only 133 ultimately used them to end their lives.

Bodnar believes what people really want is the feeling that they have options, are in control and that they may have an opportunity to enjoy the things they love with the people they love in their last months —the very things hospice is good at.


"I walk away with the message that hospice needs to do a better job of saying, 'You're in control, we're here to help,'" she said.

Not everyone agrees with Bodnar's assessment, of course.

"Hospice is a great option for everyone; however, to say that hospice care can fully provide both the control and comfort that all people want or require is simply not true. There are limits to pain management," said Van Waveren of Compassion and Choices. "I stand for the right of an individual to say when they have suffered enough."

While Bodnar's argument that hospice is underutilized appeals to the intellect, Van Waveren's appears to resonate with people on some deep level also. Since 1997, five states have followed Oregon in allowing some form of legal right to die: California, Colorado, Vermont, Washington and Montana.

This may, Firth suggests, represent an irreversible trend.

"Ultimately these bills are going to pass," she said. "It's just a matter of time, I believe."

The Baltimore Sun contributed to this story.

Editor's Note: A previous version of this story misspelled the name of a law firm in Westminster. The firm is Hoffman, Comfort, Offutt Scott and Halstad.