ANNAPOLIS — Legislation to permit terminally ill adults access to lethal doses of medication drew praise Tuesday from civil rights groups, who spoke of the fundamental right of people facing imminent to end their suffering, but scorn from advocates for the disabled, who said every life has quality even as bodily functions are failing.
“In the most challenging moments for a patient whose life’s course has been set by the dictates of a disease, the right to control one’s destiny is a deeply and fundamentally important one,” the American Civil Liberties Union of Maryland stated in written testimony to the Senate Judicial Proceedings Committee. “This bill ensures terminally ill patients that autonomy and ensures the right to be treated with compassion, the right to make one’s own informed choices free from government intrusion, the right to self-determination and, ultimately, the right to live and die with dignity.”
But Richard Davis, of The Arc Maryland, said individuals who live with disabilities akin to those facing terminal illness have historically faced bias and abuse from people questioning their “quality of life.”
“This [legislation] would make a vulnerable population even more vulnerable,” Davis told the committee. “A life with disabilities is still a dignified life.”
Adding his voice in opposition to the bill, former Baltimore Ravens linebacker O.J. Brigance, who has ALS and uses a wheelchair, urged the committee to reject the legislation, saying life is precious – even with a debilitating and terminal illness.
“Every day, every hour, every minute, every second of life is God given,” said Brigance, 45, who speaks with the aid of a computer. “I don’t know how many days I have left to live but every one has a purpose.”
Brigance’s testimony ended with applause in the crowded hearing room and praise from the committee chair.
“You are truly inspiring,” said Sen. Robert A. “Bobby” Zirkin, D-Baltimore County. “The things you have done in our community are remarkable.”
The proposed Death with Dignity Act would permit terminally ill but competent adult Marylanders with prognoses of death within six months to ask for and receive from their doctors a prescription for a lethal dose of medication to be self-administered.
Doctors would be absolved of any disciplinary, civil or criminal liability for acceding to the person’s wishes, 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 person’s records to another doctor.
The legislation contains procedural safeguards, such as requiring patients to make an oral request for a prescription followed by a written request, which they must sign with two witnesses. The attending physician cannot be a witness and only one of the witnesses may be a relative of the patient; a person who would benefit from the patient’s death (such as a life insurance beneficiary); or an owner, operator or employee of the health facility where the patient is being treated.
The attending 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.
Sen. Ronald N. Young, the bill’s chief sponsor, said terminally ill Marylanders “should have that personal choice” to end their lives.
The measure, Senate Bill 676, “lets them go out in a gentler way rather than go through the suffering,” said Young, D-Frederick. “They [should] have that option there if they find it unbearable at the end.”
But Sen. C. Anthony Muse, of the Senate committee, voiced opposition to the bill and said legislators should focus more on “life with dignity,” especially for the terminally ill.
“At what point do you determine what is suffering?” asked Muse, D-Prince George’s.
The legislation would 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 wring that the patient is competent.
The Maryland Disability Law Center said it has “a serious concern” about the bill in light of what it called a lack of physician sensitivity to people who live with disabilities.
Across the nation, disability advocates “encounter doctors that discriminate against people with disabilities in their prognoses, treatment decisions and advice to patients and their families, due to lack of information or erroneous assumptions about the prospects of people with disabilities to live quality lives,” MDLC stated in written testimony to the Senate committee. “The bill fails to address these widespread problems, equip doctors with complete information, or ensure that disability-appropriate supports are offered (or even understood) and options fully explored.”
But the ACLU of Maryland said the legislation is about giving “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.”
The group added “it is patients – our fathers, mothers, husbands, wives, siblings or dear friends who are suffering at the end of life – who have a deeply personal right to make that choice, not the government.”
Under the bill, the patient’s legal cause of death would be the underlying terminal illness that led to the aid in dying request, making no mention that the person took his or her own life.
The measure would make it a felony punishable by up to 10 years in prison and a 10,000 fine for a person to willfully alter or forge a request for aid in dying, conceal or destroy a patient’s rescission of the request or exert undue influence on a patient to request aid in dying.
The bill is cross-filed in the House. Del. Shane E. Pendergrass, D-Howard, is the chief sponsor of House Bill 1021.