For the second year in a row, Maryland lawmakers have begun deliberating a measure that would allow doctors in the state to prescribe lethal medications to terminally ill patients who wish to end their lives.

“A terminally ill patient requesting a prescription to commit suicide deserves to be surrounded by compassion, not handed a prescription to take his or her life,” Mary Ellen Russell, executive director of the Maryland Catholic Conference, told a joint Maryland House panel Feb. 20.  The panel was hearing testimony on House Bill 404: the Richard E. Israel and Roger “Pip” Moyer End-of-Life Option Act.

The Maryland House of Delegates and the State Senate are considering companion “end of life options” measures that would allow a terminally ill patient to seek aid in hastening his or her death and would protect from prosecution those physicians who provide the medication to carry out that request.

The Maryland House of Delegates’ Heath and Government Operations Committee and Judiciary Committee heard from proponents and opponents of the proposed legislation.

A state Senate panel is expected to hold similar hearings Feb. 25.

“The (proposed) bill essentially allows a doctor to provide a patient a lethal prescription to take his or her life without any requirement that the patient first be offered appropriate therapeutic interventions to ensure his or her request is not influenced by a discrete and treatable mental, emotional or mood disorder that is commonly known to accompany a terminal diagnosis,” Russell said.

“The End-of-Life Option Act” is sponsored by Delegates Shane Pendergrass (D-Howard County) and Chris West, (R- Baltimore County). It would allow patients who have been told they have six months or less to live to request a combination of medications to end their lives.

Pendergrass said she co-sponsored the measure because “it is morally right to let people be in control of the ends of their lives when they have six months or less to live.”

Opponents of the measure have pointed out that it is almost impossible for doctors to accurately predict a terminally ill person’s life span. They have also warned that the measure doesn’t require patients to have a screening for depression.

Dr. William Toffler, an Oregon-based physician and the national director of Physicians for Compassionate Care, warned lawmakers in written testimony not to pass the proposal, which is similar to Oregon’s physician-assisted suicide law.

“Many individuals who have been labeled ‘terminal’ and given overdoses by their doctors were actually found to be depressed, yet the doctor who gave them the overdose had not recognized the depression,” Dr. Toffler wrote. “Since doctor-assisted suicide has become an option (in Oregon), I have had more than two-dozen patients discuss this option with me in my practice.  Most of the patients who have broached this issue didn’t have a terminal diagnosis.”

Kim Callinan, the chief program officer at Compassion & Choices – a national lobbying group advocating for “choice at the end of life” laws – urged lawmakers to pass the measure.

“Dying adults request medical aid in dying, not out of despair or depression, but to maintain some dignity and control in their final days, to ease their pain and suffering, and to help them pass peacefully,” she said.

Responding to a question by Delegate Deborah Rey (R-St. Mary’s County), Callinan described the “medical aid in dying” procedure. She said that six hours prior to killing himself or herself, a patient should stop eating and drinking. Two hours before the suicide, a pill is ingested to promote absorption of the life-ending drug. One-hour before the suicide, an additional pill is taken to prevent nausea, thus stopping the patient from throwing up the life-ending drug. Finally, a lethal powder is mixed with liquid and ingested. Callinan said many patients mix the powder with juice or another sweetened beverage to mask the bitter taste.

After the lethal powder is ingested, the patient will fall asleep. Death occurs sometime after that. Callinan said the time between falling asleep and dying varies from patient to patient.

Pharmacist Christine Sybert testified that the lethal medication causes death by respiratory arrest and that in Oregon, “the range of onset of death after taking the overdose is one minute to 4.3 days.”

“Physician-assisted suicide is not a ‘natural cause’ of death, and it is dishonest to consider naming it anything otherwise,” she said. “While it is natural to die, it is unnatural to want to die. Anyone who wants to die, and seeks sanctioning from the state to permit them to do so, is suffering from a mental disorder of depression or hopelessness.”

The proposal requires a patient to request life-ending medication several times with the doctor, twice verbally and once in writing. The doctor would be required to determine if the patient is indeed terminal and is mentally capable of making the request.

Russell stressed that under the proposal, patients seeking to kill themselves do not have to undergo a mental examination by a psychologist or psychiatrist.

The decision to refer to a mental health professional a patient seeking life-ending drugs, Russell said, “is entirely up to the discretion of the patient’s attending physician or consulting physician. “Neither the attending or consulting physician are required to have any expertise in evaluating a patient’s mental health,” she said.

The Maryland Catholic Conference was not the only religious-based group testifying against the measure. The MCC has joined with a broad-based coalition of other religious groups, advocates for the disabled, doctors and other health professionals to oppose physician-assisted suicide in the state.

Among those who have voiced reservations about the physician-assisted suicide proposal are: the Maryland chapter of the American College of Physicians, the Maryland Psychiatric Society, the Maryland Board of Physicians, the Maryland Disability Law Center, the Muslim Community Cultural Center of Baltimore, the Jesse Klump Memorial Fund suicide awareness and prevention program, the Not Dead Yet disability advocacy group, the Maryland Chapter of Agudath Israel of America Orthodox Jewish public policy group, the Baltimore Jewish Council, Maryland Right to Life, Maryland Legislative Lobby for Life, and a host of individuals.

 “The (Maryland Catholic) Conference joins many in the faith community who oppose this legislation not only because it violates the most basic tenet of our belief in the sacredness of life, but also because of the many dangers this legislation poses to vulnerable populations,” Russell said.

Pastor Nathaniel Thomas of New Redeemer Baptist Church in Forestville, told lawmakers that “moral argument against this proposal extends beyond religion.”

“It is our fear that, should the ‘End of Life Options Act’ pass, then this could become another way in which the disadvantaged and uneducated in our society are abused,” he said. “We have to consider the potential for unimaginable harm to people and families who are already challenged for the value of their lives in so many ways and could be subject to another form of discrimination in healthcare.”

Dr. Kevin Donovan from the Georgetown University School of Medicine doctor also criticized the proposal as “discriminatory and not progressive.”

“It creates, by law, a class of people whose lives should no longer be preserved,” he said.

Samantha Crane, director of public policy for the Autistic Self Advocacy Network, said, “This legislation would lead to many unintended consequences for individuals with disabilities who are often targets of coercion and abuse… It would endanger many more lives for people with disabilities who already feel like a burden to family and loved ones.”

Currently five states permit physician-assisted suicide. Vermont, California, Oregon and Washington State approved the action either by ballot initiative or through passage of a law by state legislators. In Montana, a judge ruled that physicians prescribing life-ending drugs do not face criminal penalties. The issue is currently before the courts in New Mexico.

A year ago, lawmakers in Colorado voted down a proposal to make assisted suicide legal in that state.

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