Doctor-aided suicide called personal right, mercy killing at House hearing

ANNAPOLIS – Legislation to permit terminally ill adults access to lethal doses of medication drew praise Tuesday from a leading civil rights group, which spoke of the fundamental right of people facing imminent death to end their suffering, but scorn from advocates for the disabled, who said every life has quality even as bodily functions are failing.

The proposed Richard E. Israel and Roger “Pip” Moyer End-of-Life Option Act would permit terminally ill but competent adult Marylanders with prognoses of death within six months to obtain a prescription for a lethal dose of medication to be self-administered.

The American Civil Liberties Union of Maryland cast the issue Thursday as one of personal autonomy.

“If a patient is suffering from a terminal illness and meets the stringent eligibility requirements found in this legislation, it should not be the role of the government to tell the patient that they may not make the choice to alleviate their suffering,” the ACLU chapter stated in written testimony to two House committees. “We must give our loved ones the dignity and respect to be able to make this extraordinarily difficult choice in a way that is thoughtful and medically appropriate.”

But The Arc Maryland said physician-assisted suicide laws have unintended consequences for people with disabilities who are susceptible to external influences and are often viewed by the more able-bodied as having little quality of life.

“People with intellectual and developmental disabilities are vulnerable to coercion and trying to please authority figures,” The Arc stated in written testimony to the two committees. “One of the top reasons people say they want physician-assisted suicide is to avoid being a burden to loved ones. Sadly many people with I/DD feel they are a burden, even when their family feels otherwise.”

The Arc and ACLU submitted their comments at a joint hearing before the House Judiciary and Health & Government Operations committees as they considered House Bill 370.

The legislation is before the General Assembly for the third consecutive year, having never made it out of either a Senate or House committee. The profound divisions that have accompanied the physician-assisted suicide bill continued at the hearing.

Del. Samuel I. “Sandy” Rosenberg, D-Baltimore, an HGO committee member and a co-sponsor of the bill, wondered aloud, “Why is it appropriate for the government to regulate the doctor-patient relationship?”

But Del. Neil C. Parrott, R-Washington and a member of the Judiciary Committee, criticized the bill, calling physician-assisted suicide mercy killing.

And Del. Kathy Szeliga, R-Baltimore and Harford counties, voiced concern that mentally ill patients could be steered toward suicide rather than helped under the bill.

“Who would keep a patient from doctor shopping” until he or she finds someone to prescribe a lethal dose? asked Szeliga, a member of the HGO committee.

Doctors absolved

Under the legislation, doctors would be absolved of any disciplinary, civil or criminal liability for acceding to the patient’s request for lethal medication, as would the pharmacist who dispenses the prescription. However, civil liability could apply for negligent conduct or intentional misconduct.

Doctors who do not want to prescribe the medication would be required to transfer the patient’s records to another doctor.

The bill has drawn opposition from the American College of Physicians’ Maryland chapter.

“The physician must always act in the best interests of the patient as healer, comforter and trusted adviser,” the group wrote in testimony to the committees.

Maryland law should focus on ensuring “that all patients have access to palliative care and hospice services at the end of life rather than promote suicide,” the group wrote.

The legislation would require patients opting for suicide to make an oral request to their doctor for a lethal prescription followed by a written request, which they must sign with two witnesses. The doctor cannot be a witness to the written request and only one of the witnesses may be a relative of the patient or a person who would benefit from the patient’s death (such as a life insurance beneficiary).

The patients would be required to make a second oral request at least 15 days after the initial oral request and at least 48 hours after the written request.

The doctor would have to determine the patient had made an informed and voluntary request and is competent and expected to die within six months.

To ensure the decision is informed, the doctor would have to tell the patient the diagnosis and prognosis and the risks associated with self-administering the drugs and feasible alternatives, including palliative and hospice care.

To avoid any undue coercion or influence, the conversation between the patient and doctor must be conducted without anyone else present. In addition, the bill would make it a felony punishable by up to 10 years in prison and a $10,000 fine for anyone who “coerces or exerts undue influence on an individual” to sign a written request for a lethal dose.

Unintentional push?

The legislation would also require attending physicians to refer the terminally ill patients to a consulting doctor to review the medical records, confirm the diagnosis and prognosis, refer the patient for a competency exam and verify the patient has made an informed and voluntary decision. Consulting physicians who suspect the patient is not competent would have to him or her to a mental health professional for evaluation.

An aid-in-dying request could not be granted until the mental health professional states in writing that the patient is competent.

But Disability Rights Maryland expressed concern that terminally ill disabled people might be unintentionally pushed toward physician-assisted suicide.

“People without disabilities generally view living with a disability as having lesser value, a widely shared perspective that has been internalized and strongly reinforced by our ableist culture,” the organization stated in written testimony. “People frequently encounter disability discrimination by the medical community in prognoses, treatment decisions, and advice to patients and their families, due to insufficient training or experience, and erroneous presumptions about the prospects for people with disabilities to live quality lives.”

Current law makes it a felony punishable by up to a year in prison and a $10,000 for a person, including a doctor, to knowingly assist in someone else’s suicide attempt.

Del. Shane E. Pendergrass, D-Howard, is chief sponsor of House Bill 370. Sen. Guy J. Guzzone, D-Howard, is chief sponsor of the cross-filed Senate Bill 354.

Israel and Moyer, the men for whom the bill is named, succumbed to Parkinson’s disease after battling the debilitating condition for years.

Israel, a former Annapolis alderman, was 72. Moyer, a former Annapolis mayor, was 80.