2019 | Politics

Polarizing ‘End-of-Life’ Bill Returns in Legislature

Montgomery senator finds more support for his proposal

Will Smith, left, and Shane Pendergrass

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For the fourth time since 2015, a bill that would make it legal for Maryland residents with terminal illnesses to end their life with medication is drawing fresh debate in the state legislature.

The “End-of-Life Option Act,” sponsored by Montgomery County Democratic Sen. Will Smith and Howard County Democratic Del. Shane Pendergrass, would allow patients with six months or less to live to request a physician’s aid in bringing about their own death through self-medication.

The bill is scheduled for a hearing in the House Health and Government Operations Committee Friday.

Pendergrass introduced end-of-life legislation during the 2015, 2016 and 2017 sessions, but each time the bill was withdrawn after no vote was taken. Other unsuccessful attempts were made in the late 1990s. Under a centuries-old law, suicide is illegal in Maryland.

According to a 2018 Gallup poll, 72 percent of Americans approve of euthanasia for terminally ill patients if the patient makes a request to a doctor. That number has nearly doubled from 1947, when 37 percent of Americans approved of the practice.

“In Maryland it polls at 65 percent,” Smith said.

Six states and the District of Columbia have laws that permit physician-assisted death.

Smith said he believes the bill has a better chance of passing this year because of a large coalition of supporters. Fifty delegates have signed on as co-sponsors in the House and 19 in the Senate.

“That’s a top priority of mine, and I think we have a really good chance of getting it passed,” said Smith, who represents the Silver Spring area.

The bill would require dying patients to ask for life-ending medication themselves, and two witnesses would need to verify in writing that the patient was “of a sound mind” and was acting voluntarily. Only one of the witnesses could be a relative, and a neither witness could be the patient’s physician.

The patient would also need to show proof of residency using a tax return, driver’s license, voter registration card or leasing document. A physician could also verify that a patient was a resident by attesting to their personal medical history.

Michael Strauss, a retired general internist who lives in Rockville, started the advocacy group Marylanders for End-Of-Life-Options in late 2017 to help push for the bill.

Strauss said he was inspired to become involved with end-of-life legislation after taking care of many patients who were in pain during the final stages of their lives. Strauss also was inspired by his mother, who died from lymphoma four years ago at age 90.

“I told her I’d work on this,” he said.

Strauss said hospice and palliative care are generally good options for patients in their final days, but there are exceptions.

“They can treat the pain and some of the other concerns. But in a small minority of cases, there are patients who have some pain that doesn’t respond, or they don’t like to take their pain medications and they no longer feel they are no longer in control of their lives,” he said.

Strauss said the most commonly prescribed life-ending drug is the sleep-inducting drug Seconal. The doctor administers the drug, he said, by having the patient ingest 100 capsules’ worth of the drug dissolved in liquid. Within 15 minutes, he said, the patient becomes unconscious, and they die within 45 minutes.

Strauss said there are two other groups his organization is working with in Annapolis to advocate for the bill.

The Maryland State Medical Society, or MedChi, adopted a neutral position on the end-of-life bill two years ago, said Strauss, who is a member.

MedChi, he said, had opposed the practice until then because of the American Medical Association’s stance against end-of-life laws during the 1990s.

The bill is likely to encounter strong opposition from the Maryland Catholic Conference’s Annapolis lobby, which represents the Archdiocese of Washington.

The church has opposed the end-of-life bill since it was first proposed in 2015, said Associate Director Therese Hessler.

The bill, she noted, puts several vulnerable populations at risk including veterans, people with disabilities and patients in recovery from drug addiction.

“You can only imagine what can go wrong when a patient is prescribed 100 barbiturates,” she said.

Hessler said the end-of-life issue is fairly new, having surfaced in 1997 when Oregon enacted its bill.

But she hopes Marylanders see the risk in prescribing life-ending medication in the wake of an opioid crisis that took more than 1,600 lives through the first three quarters of 2018, up from 1,502 in all of 2017,according to the Maryland Department of Health.

“More people are understanding some of the real dangers of the legislation,” she said.

Hessler said she didn’t believe the bill could be altered in any way that would change the church’s position, and that the church would always support hospice and palliative care over any life-ending medication prescribed by a doctor.

Strauss said one-third of the patients who are prescribed the drug end up not taking it due to the costs, which can range from $400 to more than $1,000.

Strauss said there has never been a case of abuse of the drug that he knows of, and in only a few instances a patient did not die. He added that physicians, based on their professional experience, are capable of determining whether a patient is acting voluntarily.

“If you talk to physicians who consult in the legal arena, they know that this means the patient understands his or her physical and mental condition,” he said.

Strauss, however, said he respects those who disagree with the bill.

“This is a tough issue, and I respect every member of the legislature who has to wrestle with this,” he said.

Dan Schere can be reached at Daniel.schere@bethesdamagazine.com