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.