Six years ago, a respected minister asked Baltimore Circuit Judge John Carroll Byrnes to order the withdrawal of a life support system that was keeping his comatose wife alive.
The woman had been in a coma for 41 days, the minister said. When she was stricken, he told the judge, she told him that she "didn't want to live like this."
Her doctor testified that the woman might have only a 1 in a million chance of recovery.
Nonetheless, Judge Byrnes didn't issue the order to remove the life support system. He's glad he didn't. The woman regained consciousness six days after the hearing and soon recovered completely.
That episode launched Judge Byrnes on an intensive study of the so-called right-to-die issue. The effort has led to a bill that would allow people to give family members or friends the authority to decide whether to order or remove life-sustaining treatment when they become medically incompetent.
The bill, discussed yesterday at the University of Maryland Law School, is to be introduced in the 1993 General Assembly.
"I think it's an effort to respond in a comprehensive way and a balanced way to an evolving right that all citizens have in making their health-care decisions," Judge Byrnes said, adding that the legislation would protect vulnerable patients from abuse.
Maryland has a living-will law that enables people to dictate future health care. But it is one of only three states without a statute that allows people to delegate power of attorney for life-and-death medical decisions.
Any competent adult can refuse medical treatment, under Maryland law.
Decisions on whether an incapacitated person can be denied life-sustaining treatment has led to high-profile court cases. Most prominent is the U.S. Supreme Court's 1989 Cruzan decision, which ruled that states can pass laws setting right-to-die standards.
The 61-page Maryland bill is an attempt to strike a balance between a medically incompetent person's right to die and the state's interest in preserving life, drafters say. Judge Byrnes headed the drafting committee, which also included Assistant Attorney General Jack Schwartz.
Mr. Schwartz wrote the state attorney general's 1988 opinion that gives surrogates the authority to refuse medical treatment for medically incompetent friends or family members in some instances. The opinion urged the state to enact a law to that effect.
The bill would allow surrogates with power of attorney to order the withdrawal or the use of such devices as respirators and feeding tubes, even if the patient is not terminally ill or comatose.
Under the bill, it would be a crime to help someone commit suicide. That would prevent someone like Michigan's Dr. Jack Kevorkian from helping patients inject lethal drugs, Judge Byrnes said.
Under the bill, hospitals would not be required to follow a surrogate's orders to withhold or withdraw life-sustaining treatment if the patient is the sole supporter of a minor and there is a "reasonable" chance of recovery.
The measure also incorporates the language of Maryland's living-will law that forbids the withdrawal of life-support systems for pregnant women.
The bill received mixed reviews at yesterday's conference. Karen Rothenberg, a UM law professor, said that it unfairly limits the death wishes of pregnant women and sole supporters of minors.
"Women will be most affected by this," Ms. Rothenberg said.
Dr. Louis C. Breschi, a physician who is a member of Franklin Square Hospital's ethics committee, said that the bill addressed a need to end treatment that prolongs a patient's suffering without much benefit.
"There is medical futility in many, many areas," Dr. Breschi said. "People ought to maintain the right to say 'That's enough.' "