Many of us have filled out an advanced health directive form that tells family members and medical providers what kind of end-of-life care we would want if we become unable to direct our care.
Through questions that are spelled out in state law, we are asked if we would want treatment to prolong our lives if doctors have concluded that we were terminally ill. We are asked if we would want to withdraw feeding tubes and intravenous hydration. And we are asked if we would want medication to alleviate pain “… even though it would hasten my death.”
Extending this notion of autonomy for patients is what’s behind L.D. 1313, the Maine Death with Dignity Act. Views on death and dying are complicated, and different people answer those questions differently. But it is widely accepted that it is an individual’s right to accept or refuse care, and whenever possible, people should be allowed to make their own choices.
The bill, sponsored by Rep. Patricia Hymanson, D-York, lays out the circumstances under which a patient diagnosed with an incurable, irreversible disease that is expected to cause death within six months can request medicine that would end their lives sooner. The bill will be the subject of a public hearing Wednesday before the Health and Human Services Committee.
The legislation lays out a number of safeguards to prevent abuse. The law would require the patient to be informed about all the options and to make multiple requests for the medication, both in writing and verbally. The patient needs to have received a terminal diagnosis, confirmed by a second opinion, and the doctors need to conduct a mental health screening. The medication cannot be prescribed if a mental health professional determines that the patient is depressed or suffering from some other disorder that makes that person unable to make an informed choice. The patient would have to be physically capable of taking the medication themselves, without the assistance of a caregiver.
Those provisions distinguish “aid in dying” from other concepts with which it is often confused. What is being proposed is not “euthanasia,” or so-called “mercy killing,” because all the decisions and actions are done by the patient and not on the patient’s behalf. And it’s not accurate to call it “assisted suicide,” because that implies that these patients would otherwise live if not for the intervention. It’s available only to people who are already dying and want to be able to limit their suffering.
Aid in dying is also not an alternative to hospice, or other end-of-life care. In the cases where it is appropriate, a death-hastening prescription is one in a range of options available to people who have reached the limits of medical intervention. In Oregon, the first state to pass such a law, about a third of the people who receive a prescription do not ever take the medicine, indicating that, at least in some cases, having the option is enough.
This is not a new issue for Maine. A referendum that would have legalized this kind of care was narrowly defeated by Maine voters in 1999, and it has come before the Legislature on two other occasions since then.
What’s changed since the first referendum is that 20 years of data have been collected in other states, especially Oregon, that belie some of the hypothetical scenarios presented by opponents.
There has been no stampede of assisted deaths in Oregon. In the entire history of the law, doctors have issued prescriptions 2,217 times, accounting for about four in 1,000 deaths, less than half of 1 percent. Studies have found no evidence to indicate the law has been used to save money for insurers, or to force poor people to end their lives, or for greedy heirs to collect their inheritance.
What they have seen, however, is that since the law was put in place, patients are better informed about their options and are requesting palliative and hospice care in greater numbers.
Maine should join the seven states that offer this option. Activists are gathering signatures to get this question on the 2020 ballot, but lawmakers should not put off a decision. Maine does not need another divisive referendum campaign in which complex issues are reduced to 30-second TV ads. People who are suffering should not be made to wait until 2021 for the relief they want.
Lawmakers should listen to the testimony Wednesday and ask any questions that bother them. And they should pass L.D. 1313, giving an option to competent, capable people who have suffered enough.
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