ANNAPOLIS — At the end of a terminal illness, choosing when to die should be left up to the individual, the Maryland House of Delegates narrowly decided on Thursday.

By a margin of eight votes, the House leaned in favor of allowing physicians to prescribe medication to terminally ill people, at the patient’s request, to aid in their death. The bill must still pass the state Senate and Gov. Larry Hogan (R), without a veto, before it can become law.

Maryland lawmakers have debated “death with dignity” or “assisted suicide” legislation since 2015, but a bill has never progressed out of committee until this year. The chamber’s 74-66 vote, however, showed a slight swing in favor of a concept already in practice in other states.

“It’s very close,” said Del. Karen Lewis Young (D-Frederick) after the vote. “It’s one of the tightest votes I’ve seen in my five sessions.”

Lewis Young voted in favor of the bill along with Frederick County’s two other Democratic delegates, Ken Kerr and Carol Krimm. The three Republican delegates — Barrie Ciliberti, Dan Cox and Jesse Pippy — voted in opposition.

The decision was far from falling along party lines, however, with 25 Democratic members voting against the bill.

Before the vote, the chamber listened in near silence as colleagues rose and shared memories of family members, friends and former colleagues whose deaths or illnesses left them in opposition or support of leaving the decision of when to die to those who are sick. Several of the delegates were moved to tears by the stories.

Del. Geraldine Valentino-Smith, a nurse at the National Institutes of Health and Democratic representative for Prince George’s County, however, rose from her seat to offer words of warning.

“I know full well why this is an intensely painful issue for all of us, but I truly believe we as government officials cannot, and should not, put the state behind the idea that there is a particular justified time when we qualify a life, as such, that it is OK to extinguish it,” Valentino-Smith said.

The state allows patients to refuse care, whether it’s declining a specific treatment, signing a “do not resuscitate” order or refusing to be placed on a ventilator or feeding tube.

But in the years the General Assembly has debated these bills, the argument has shifted from giving people the choice to end pain to giving people the control over being a burden to their families, Valentino-Smith said. From there it is a “slippery slope” to allowing the bill to be expanded to people without terminal illness who may perceive themselves as a burden, she said.

Republican members of the House also questioned if this bill would pressure low-income residents to not seek hospice or other more expensive end-of-life care. Cox defended his vote against the bill on Thursday with a case he oversaw in court, where potentially life-extending surgery was being delayed due to cost and the patient being uninsured.

“Money is the root of much evil. In that case, keeping my client’s son alive and providing the health care at the end of his life that he needed, was a financial consideration that the hospital didn’t want to bear,” Cox said.

In an interview after the debate, Lewis Young disagreed that the scope of the current bill was at risk of someday being expanded.

She said Maryland should watch decisions other states make on end-of-life options and monitor the data collected on Maryland’s participation rate, if the bill becomes law. However, she was doubtful the Legislature would later move to expand the law to cover people who are not terminally ill.

“I don’t see this as a slippery slope. In fact, I see some people who ask for the prescription and never take it,” Lewis Young said. “But it’s insurance — if the pain ever becomes that unbearable — that they have the capacity to chose.”

If the law passes, physicians and health care facilities across the state will have to grapple with how to implement it.

Frederick Memorial Hospital declined to comment on the bill or how it would affect logistics at the hospital.

The James M. Stockman Cancer Institute in Frederick County also did not return a request for comment on Thursday. Nor did Peggy Funk, executive director of the Hospice and Palliative Care Network of Maryland.

The fate of the bill is now in the hands of the Senate’s Judicial Proceedings Committee.

The committee will need to vote on the cross-filed version of the bill, which it heard testimony on in February, in order to advance the debate. Sen. Michael Hough (R-Frederick & Carroll) serves on the committee, but was unaware of any scheduled vote as of Thursday.

Hough took issue with some of the provisions of the bill. Patients must have six months or less to live in order to request medication to end their life, which is an imprecise time frame to determine, Hough said by email.

The bill also does not require that all patients undergo a mental health evaluation, Hough said. However, the bill stipulates a physician may refer a patient suspected of “suffering from a condition that is causing impaired judgement or otherwise does not have the capacity to make medical decisions” to undergo a mental health assessment before being prescribed medication in aid of dying.

Hough also repeated a problem that freshman delegates Pippy and Cox aired during their committee’s vote on the bill in the House, which is that the medication administered to aid the death is not listed as the cause of death on a death certificate. Instead, the certificate may say the person died of natural causes from the underlying disease.

“The bill sponsors are ashamed to call the bill what it is ... assisted suicide. The bill literally says this is not suicide and forces the state to lie on death certificates,” Hough said by email

Hough said he was opposed to the bill, which will need at least six favorable votes in committee to advance.

Follow Samantha Hogan on Twitter: @SAHogan.

Samantha Hogan is the state house, environment, agriculture and energy reporter for The Frederick News-Post.

Heather Mongilio is the health and Fort Detrick reporter for the Frederick News-Post. She can be reached at hmongilio@newspost.com.

(36) comments

sue1955

mrnatural, thank you for your last comment at 6:21.

sue1955

My earlier (more recent) comment was directed to Blueskyz. Sorry that was not apparent. I'm a little distracted. My daughter has been in the hospital since last Saturday and still there.

sue1955

Re your 3:31 comments; you and I could talk for hours. There are a lot of same experiences as to your mother and mine. My mother was in WV, four hours away. (She moved back to her hometown after she retired). I am sorry for what she and you had to go through. Unfortunately, this is par for the course. That goes for both young and old. I know enough people who have had or currently having this problem with being treated like a bug on a shoe (I'm not saying what I would like to say). My own doctor is appalled at the treatment of people and medical mistakes that go on that I have personally experienced, as well as other family and friends. (My own doctor is affliated with another hospital system). I appreciate you telling your story.

shiftless88

We humanely put our dogs and cats to sleep when they are suffering, so why shouldn't people be allowed to choose the same thing? I loved my dogs and cats so I wanted to keep them from undue suffering. It never had anything to do with my inconvenience or costs.

jagman

Finally something the MD lawmakers have done right. Everyone should have the power to make such a decision when that time comes. And for those opposed, nothing here would make it possible to end someones life against their wishes.

cyntiast

Death with dignity is very humane. I want this option if faced with an imminent terminal situation.

sue1955

Blueskyz: there is no "add reply" to your post, but I ran into the same thing with my mother. The only thing is that she couldn't actually talk. The pain was unspeakable. Morphine did not relieve her pain. As I've previously posted (to articles in the past), hospice was no help. Oh yes, they spoke to me in endearments and sent literature to me about grieving. None of which did anything for her. The nurse at the nursing home did nothing but sit at the nurse's station when I went to her to give my mother morphine (which nobody came the whole time my nephew and I were there). It's was horrible. I learned a lot from seeing what really happens.

Be aware, folks, that hospice is only as good as the doctor who is doing the prescribing. And, because there is so much paranoia over drugs due to the opioid "hysteria," people in intractable pain are suffering more than they have to.

And, forget the pain and palliative care departments in hospitals. Think again. They are
not helping (to say the least). They don't even come into the patients' rooms.

I've seen enough!

DickD

Sue, did your Mother have a directive on file that called for no special help, such as life saving - I don't mean help to relieve pain. But was there any medicine that would have relieved the pain?

sue1955

Dick, my mother did not have a DNR. She didn't believe in it, as she was in denial and always thought that she was going to live for a few more years. She took to heart her doctor (as a much younger women) saying to her that she was a "stoic."

Hospice had me sign paperwork once they got involved. It gave them permission to take whatever means to alleviate the pain. She died in the nursing home. The hospital would not keep her beyond so many days. Her doctor told me that he fought for even more days (in the hospital), but it was not approved. BTW, she had Medicare, Medicaid (thanks to the expanded benefits and she was "low income" in retirement - the nursing home worked that out), as well as Federal Government insurance since she retired as a Federal employee).

As to what else they could have done for the pain, morphine by mouth is not effective. She should have received a major opioid by I.V. or an epidural that is continuously inserted in the body. A great-aunt had morphine in an I.V. (died of a massive heart attack in which the heart muscle was torn). She just slipped away painlessly later four days later.

As far as I know, epidural pain relief has to be administered at a hospital. My now-78 year old stepmother had that epidural after liver surgery five years ago. It was cancer and was discovered very early. It really got her through the open surgery over the first few days (after surgery). Then, pain pills were given over the remaining several days of her hospital stay and recovery at home. (This was done at a university hospital in Iowa. She lives in Waterloo, IA).

Blueskyz

Sue, My mother was in Maryland. There is no DNR any longer. Instead there are a laundry list of options that the patient needs to decide from. IVs vs no IVs, antibiotics vs no antibiotics, and on and on. FMH gave it to my mother around 2am after she finally had been admitted. The doctor rattled it all off to her not explaining anything. She refused to sign it because she didn’t understand what he was talking about along with the fact she had been sitting in the ER for hours and had been told in a flippant manner that ‘oh, I guess you know you have terminal cancer’ by a doctor there. My mother was 80 but was very active, worked a part time job and walked her dog 3+ times a day. She was mentally sharp until the day she passed. Everything is so complicated in healthcare. Luckily I was able to figure things out and advocate for her but it was a nightmare which we didn’t need. She also was booted out of the hospital even though the doctor requested she stay. Morphine can only do so much. I believe her pain was considerably more than she let us know. She too was stoic so it took a great deal for her to beg for it to be over.

mrnatural1

Just a side note -- we have family in both Waterloo and Iowa City (I assume that's the university hospital you referred to).

mrnatural1

sue,

WRT pain management, Fentanyl is usually very effective.

Unfortunately, it has a bad reputation because when it is abused it is often deadly.

When used as directed it works well. There are many ways to administer it. Often, only patches are needed.

mrnatural1

Great comment sue, thank you.

sue1955

Thank you for your kind comment, mrnatural. Also, my stepmother had been at the University of Iowa Hospital. You are correct. Her doctors were superb. It was very extensive surgery beyond what I stated earlier. She's fine today.

public-redux

"Cox defended his vote against the bill on Thursday with a case he oversaw in court, where potentially life-extending surgery was being delayed due to cost and the patient being uninsured."

The solution to the situation Cox describes should involve punishing the insurance companies (if they are involved) and/or hospital/care provider rather than to restrict the choices of the patient.

mrnatural1

[thumbup][thumbup] public-redux

shiftless88

This is already being carried out in several states without these imagined problems. Lord knows I want to be able to choose my time in a clean and painless way if I am suffering. I do not know why Republicans, who are the party of small government and personal responsibility, want to allow the government to interfere with this personal decision.

mrnatural1

Good point shiftless.

As the saying goes: Democrats want gov't out of the bedroom, republicans want gov't out of the boardroom.

Generally speaking -- the republican party seems overly concerned (some would say obsessed) with what other people do with their bodies -- sexual behavior; recreational drug use; reproductive rights, etc,

I've always found that very strange. I can appreciate the desire for less government, but in order to be consistent the republican party should MYOB when it comes to the actions of consenting adults.

gabrielshorn2013

[thumbup][thumbup][thumbup] mrnatural!

benedictus

They’re a little farther down this road in Europe. In Belgium, it started out as only for consenting adults. It’s been expanded to include adults unable to give consent. They’re in the process of expanding it to include children. Since they first allowed it 16 years ago, the number of cases has increased 50x.

DickD

OMG, I agree with Hough one more time.

BunnyLou

The party of death strikes again. I first babies now the elderly.

User1

“If the law passes THEN we’ll figure out how to implement it”...really? Shouldn’t that have been part of the death bill? Sounds like another Dimocrats Pelosi’s saying of “you have to sign it to see what’s in it”. Time to get out of this state!

CheetoBenito

Buh- bye!!!! Don’t let the door hit your fat arse on the way out!

DickD

Yes, what bothers me is when others make the decision for you and you cannot count on making the decision yourself.

threecents

This bill gives people the decision, but only if their doctor writes the prescription - for example for stage four cancer that will (or is) cause tremendous pain and death. For those who don't know it, this is what happens frequently at hospices.

Blueskyz

Unfortunately it doesn’t happen at all hospice facilities. My poor mother with stage 4 cancer was in so much agony, even with morphine, that she was begging to have it all ended. There was nothing we could do but watch and try to comfort her. BTW she was a staunch Republican who was against this bill before she became sick. Until you experience this situation with a family member or friend you really don’t know how important the choice to pass with dignity truly is to a patient.

Dwasserba

"...the argument has shifted from giving people the choice to end pain to giving people the control over being a burden to their families..." we already had a younger family member deciding someone was a burden when we knew she adored him and he volunteered to take her into his home. She had friends and a lifestyle but agreed. A handful of significant lies later, including hiding a dementia diagnosis from her and us, all the acquired money was spent, the CDs and accounts in other names, and she turned up here with her hat on. We did not know any of this yet. The couple went on vacation, was all. She cried just at the idea of being here, which was really upsetting for us, and we quickly recognized the mental issues. We had no answers for our questions and could not reach the caregivers for six weeks. When she got a bladder infection, we had no power of attorney, she could not name any antibiotics she was not allergic to, and she needed to see her own doctor in PA. So that happened. When we still could not reach the caregivers and she wanted to be near other family/friends, we set a process in motion to go to assisted living near them and another son volunteered to carry it through. She was a vet in her own right. It might have been done decades before - she was 94. "Follow the money" became "what money?" And so we found out in how many ways we had let her down by trusting who she trusted. All illegal. She had a happy life in her preferred place among friends and family and we could have pressed charges, but it would only distress her, why. The VA was helping us out. So we did not tell her. If that one had offered her pills at any point, she'd have taken them. He could have told her it was because she was a burden, she would have agreed. As the truth unfolded after seeking VA support, we were astounded. We knew she was alone a lot, but she said she wanted to be there with a busy young family. We did not know how many restaurant meals she paid for she wasn't present for, how much of the renovations she paid for etc. We feel terribly guilty for taking him at his word about everything. If at any point she were offered pills, I hate to think. Years later, relationships are fractured into the next generation (don't know what is said of us, but the children believe it, and the adults are protected by doing so).Yep. Family. It's always other people's, not your own.

BunnyLou

We are asking doctors who took an oath to protect life not destroy it. I don’t know how they feel anout it.

shiftless88

Bunny; I am sure different doctors feel differently. Luckily nothing in this law will force a doctor to prescribe such a pill.

benedictus

“Luckily nothing in this law will force a doctor to prescribe such a pill.” That’s coming. Give it 20 years. Our society doesn’t have much tolerance for conscience these days.

DickD

In regards to Bunny's comment below. I feel she has a valid point that once a doctor takes an oath to save lives, you are asking them to violate that oath to assist in a suicide. And that's what it is, even if you want to call it. "Death with Dignity". Is nothing sacrosanct in today's world?

CheetoBenito

Clueless, heartless and inhumane Deplorable. We’ll see how you feel when it’s your turn or one of your loved one’s with a catastrophic and terminal illness. Seriously, how do you live with yourself? Jackal.

is95a

Bunny, seriously?! A lot of people could accuse republicans with their staunch support of the NRA and refusing to pass common sense gun legislation as the "party of death". Banning bumpstocks is a start that is a day late and 1000's of live short. Such generalities are easy to throw out there if you are in grade school or if you call yourself "Bunny" it seems. Obviously its far more complex than just labeling democrats as the "party of death". I know plenty of republicans who are pro-choice. Ridiculous and incredibly narrow minded, but I shouldn't be surprised

threecents

There is an excellent new movie that touches on this topic. "Padddleton", available on Netflix.

public-redux

thanks

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