The Health and Government Operations and Judiciary Committees of the Maryland House of Delegates held a joint hearing today about HB1021 – Richard E. Israel and Roger “Pip” Moyer Death with Dignity Act. Our executive director, Peg Sandeen, attended the hearing and for an hour and a half testified in support of the proposed bill and answered questions from the committee (the witness panel also included the current Delegate Shane Pendergrass, the primary sponsor of the bill, Stephen H. Sachs, a former Maryland Attorney General, and McShane Glover, a close friend of Dick Israel, who is one of the two people named in the title of the bill). This is the full text of the testimony.
Testimony in Support of Maryland’s Proposed Death with Dignity Bill
I am the executive director of the Death with Dignity National Center, an organization dedicated to improving and expanding the medical options available to terminally ill patients. In addition, I am a social worker, an instructor at the Portland State University School of Social Work, and the surviving widow of a terminally ill individual who wanted desperately to control the timing and manner of his death. As an advocate and a family member profoundly impacted by an avoidable and horrible dying experience, I strongly commend the sponsors of this legislation for your leadership in bringing this important issue forward.
Advances in medical technology have led to improvements in the care of dying patients that were unimaginable even 40 years ago. But these same breakthroughs have allowed some terminally ill patients to be kept “alive” far beyond any point of natural death, leading to extensive suffering and a diminished quality of life. To address this social problem, in 1994 Oregon enacted a carefully crafted Death with Dignity law that allows a terminally ill person to receive a prescription to hasten death safely and humanely, and requires that the medication be self-administered.
Oregon Death with Dignity Act
Now in its 18th year of successful implementation, the law sets forth precisely delineated conditions under which a patient may qualify for the medication. The bill under consideration in Maryland draws upon this model and the comprehensive peer-reviewed medical literature examining Oregon’s experience with it. These provisions act as safeguards to prevent abuse and medical mistakes, and they have worked exceedingly well. The requirements include a minimum age (18), maximum prognosis (6 months), waiting periods, repeated requests, second doctor’s opinion, and a finding of mental capability, as well as mandatory discussion of hospice and all other feasible alternatives.
The Oregon Experience
Annually, the State of Oregon issues a report on usage patterns related to Death with Dignity, and I would like to share some of findings from the most recent report. In the 17 years the law has been successfully implemented only 859 Oregonians have hastened their deaths under the auspices of the law. The Death with Dignity Act in Oregon is rarely used, in 2014, 3.1/1000 deaths were attributable to physician-prescribed aid in dying.
In those same 17 years, 1, 327 individuals have received prescriptions to hasten their deaths, meaning that over time about 30% of individuals who went through all the steps to qualify chose not to hasten their deaths, but rather died from their underlying terminal illness. For them, the Death with Dignity Act provided peace of mind and a modicum of control during their final days.
The data tell us that most participants had cancer (78%) or ALS (8.3%); died at home (94.6%) and were receiving comprehensive end-of-life care through participation and enrollment with hospice (90%). Sixty percent had private insurance, and 38% had a government-funded form of medical insurance like Medicaid or Medicare. Individuals who take advantage of Death with Dignity in Oregon are not individuals without other health care options. They are insured, cared for by hospice. They tend to die at home surrounded by their loved ones.
Death with Dignity Option a Comfort to Patients and Families
Oregon has proven that the existence of the legal option of physician Death with Dignity, though it is sparingly used, is of enormous comfort to terminally ill patients and their families; moreover, it has had a positive psychological effect upon countless others as they think about what kind of end-of-life care they would want if they were to experience terminal illness.
Despite the cataclysmic predictions of its opponents, the Oregon experience has also shown that such a legal alternative can be a catalyst for medical progress, prompting other improvements that enhance the overall medical care of terminally ill patients in the state. A robust process of public education and legislative debate can be expected to spawn new and creative proposals to advance end of life care in Maryland.
The process in which you are engaged is of the utmost importance to the people of Maryland, who want and deserve the highest quality, most humane end of life care possible. I applaud your efforts and offer my personal and professional assistance as you grapple with this profound subject.”
Image by Jimmy Emerson, DVM.