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Discussion over 'death with dignity' emerging in Maryland

If you ask supporters of legalized “death with dignity,” suicide is a dirty word.

Dr. Lawrence Egbert wishes the dictionary had a better word to describe what happened to more than a dozen Marylanders as he held their hands and watched their lives end. It wasn't suicide, says the doctor who lost his state medical license last month for his role in some of those deaths.

For Egbert and other supporters of the right to die "with dignity," the acts merely hastened the inevitable, while skipping past suffering. Many who are sympathetic to the idea are elderly and feel death creeping up on them, or have seen parents battle debilitating diseases for years, with death their only option for relief.

"As you get older and you have aches and pains, you start to think about the possibility of suffering," said a Baltimore-area woman in her 60s who, like Egbert, has acted as an "guide" for the group Final Exit Network, counseling those who want to end their lives. She would not allow her name to be published because state law prohibits assisted suicide. "We consider it the civil right of the 21st century."

The highly publicized death of Brittany Maynard, a 29-year-old with terminal brain cancer who ended her life under Oregon's death-with-dignity law last year, is renewing a national debate over assisted suicide — including whether to legalize it in Maryland.

Some lawmakers are proposing to enact a death-with-dignity law like those in place in Washington state and Oregon. And an ailing former Annapolis alderman, who has Parkinson's disease and says he is "ready to go," could provide a very personal side to the General Assembly debate.

Opponents are also coalescing, saying such a law could unfairly pressure vulnerable elderly and disabled people. Key officials such as the state Board of Physicians and Gov.-elect Larry Hogan say a physician's role is strictly to save lives.

While a $750 million state budget deficit is expected to consume much of this year's legislative session, lawmakers and advocates said they are preparing to give the issue attention it hasn't received in Annapolis in years.

Maryland outlawed assisted suicide in 1999, swept up in a national repudiation of Dr. Jack Kevorkian, the Michigan pathologist who became the face of the euthanasia debate in the United States. Maryland lawmakers approved the bill two weeks after a Michigan jury found Kevorkian guilty of second-degree murder for his role in the death of a man with Lou Gehrig's disease, which Kevorkian videotaped and sent to "60 Minutes."

Then-Gov. Parris Glendening, a Democrat, signed it into law despite calls for a veto, at the time making Maryland the 38th state to outlaw physician-assisted suicide.

The law forbids coercing or deceiving a person into committing suicide, providing the physical means to commit suicide or participating in the act of suicide. It does offer protections for health workers or family caregivers providing drugs or performing procedures to relieve pain.

But that hasn't stopped those like Egbert, a former anesthesiologist and Hampden resident who says he was with at least 15 Marylanders and 100 people nationwide as they died. He was medical director of Final Exit Network, a group that counsels people to die by placing hoods over their heads and filling them with helium.

The Maryland Board of Physicians stripped Egbert of his medical license for his role in six of those Maryland deaths, saying he acted unprofessionally and broke the law. He has appealed the decision, saying he was acting outside his role as a doctor.

Egbert, 87, has never been charged with a crime in Maryland; prosecutors said it would have been difficult to convict him. Charges against him were dropped in Georgia, and he was acquitted on charges in Arizona. He is awaiting a May trial in Minnesota.

Egbert won't be doing any lobbying in the General Assembly, unless he is asked, he said. After being linked to Kevorkian and dubbed "The New Doctor Death" by Newsweek magazine in 2012, he said he is considered a political liability.

"My guess is having publicity associating me with this would be a good way to lose," Egbert said.

But there are others who are stepping forward. For years, Baltimore-area supporters of Egbert and his views met in one another's homes or at the Waverly library to talk and learn more about end-of-life choices. Most were in their 50s or 60s, or older, and many had seen loved ones struggle through their final years.

"People shouldn't have to depend on luck or the grace of God or something like that," said Ruth Goldstein, a 62-year-old Pikesville resident who led the support group alongside Egbert. "They should be able to have options and make choices."

Maynard's public plea for states to liberalize assisted suicide laws reignited searing childhood memories for Del. Shane Pendergrass, a Howard County Democrat whose grandfather died of Parkinson's in the 1960s.

"My parents wouldn't even take me to the nursing home during the last year and a half of his life," Pendergrass said. "He was a lucid man trapped in a deteriorating body. He didn't want to live like that."

Pendergrass considered putting in a bill over the next four years to address right-to-die legislation in Maryland, but was swayed to act this session by another personal story: the deterioration of former Annapolis Alderman Dick Israel.

Israel has dedicated the final months of his life to advocating for a legal way to end it. Last April, he resigned from the city council because the nursing home he needed to care for his Parkinson's disease was outside his district. His mind remains sharp, but as he wrote in a statement, it has essentially become "the prisoner of a failing body."

"As the body continues to fail to respond to the mind, life loses its meaning, purpose and hope," Israel wrote in a statement he hopes will be circulated around the legislature. "I have had 70 good years. I am ready to go."

Under the proposal, based on a law Washington state passed in 2008, a prescription for life-ending drugs could only be written for people with a terminal disease. It would require both a written and oral request, permission from two doctors, and two witnesses to the patient's intent — one of whom can have no financial gain from the patient's death. It would also require a 15-day waiting period.

The doctors would not need to attend the death; the life-ending prescription could be taken at home at a time of the patient's choosing.

Pendergrass could be a powerful voice for advancing the bill because she is vice chair of the House Health and Government Operations Committee, which would need to give the proposal its initial approval.

In the Senate, Frederick County Democrat Ron Young plans to file a companion bill. Though he's hopeful a bill could pass this year, he wouldn't be surprised if it took longer.

"A bad bill passes in one year; a good one takes two or three," Young said.

Opponents of the legislation are beginning to form a coalition of their own, including those who oppose physician-assisted suicide for religious reasons and those who seek to protect vulnerable elderly and disabled people.

"We are very concerned that people are going to be choosing physician-assisted suicide based on fears of disability, fears of being a burden, and lack of an adequate affordable health care and support system," said Samantha Crane, director of public policy for the Autistic Self Advocacy Network and a board member with Not Dead Yet, a national group that advocates for people with disabilities. "As a result, people with disabilities are really going to be losing out."

The lobbying arm of the Catholic Conference distributed pamphlets around the Annapolis state government complex, as well as in churches, hospitals and nursing homes late last year, reminding the public about religious considerations when making end-of-life decisions. It also called for love and compassion for the dying.

Mary Ellen Russell, executive director of the organization, said the pamphlets were released in anticipation of increased public interest in the church's teaching on such issues, but were not designed to rebuff efforts to legalize physician-assisted suicide.

"It's meant to offer clarity," Russell said. "The issue is in the air in all kinds of ways."

With the General Assembly expected to focus on the state's budget woes, she said, "we're hoping leaders in both parties aren't going to allow this issue to distract them."

End-of-life options have expanded in recent years in Maryland, with a new form replacing traditional "do not resuscitate orders." Known as a Maryland Order for Life Sustaining Treatment, the form carries the weight of a medical order and requires health workers and first responders to abide by patients' wishes for use of CPR as well as ventilators, feeding tubes, blood transfusions, dialysis and other treatments.

But while such orders broaden options for end-of-life choices, they are still a step away from an active decision to end life, said Paul Ballard, an assistant attorney general focusing on health decisions policy.

Asked whether those orders and the exceptions within Maryland's assisted-suicide law allow for some gray areas, Ballard said, "Philosophically, you get those arguments. If you could intervene and you don't, you're essentially saying you're giving up on life. But it's very different than taking a medication that will make you die."

Supporters of the assisted-suicide movement are lining up to explain that distinction, with stories from people like Alexa Fraser, a Rockville woman whose 90-year-old father tried overdosing on painkillers before fatally shooting himself last year. He had spent the last few years of his life struggling with falls and eventually Parkinson's disease, and repeatedly told his daughter he would rather die than go to a nursing home.

Fraser said she plans to testify in Annapolis and meet with lawmakers as needed.

Fraser said of her father's suicide, "I wish it hadn't had to be that way. I wish like all get-out that he just died painlessly in his sleep, but it was better than the alternatives for him. He made his choice."

Baltimore Sun reporter Michael Dresser contributed to this article.

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