Commentary: Why did medical-aid-in-dying bill stall?
By Michael J. Strauss
The writer, a retired internist, is president of the group Marylanders for End-of-Life Options.
The arrival of Sine Die in Annapolis demands that we look back at the session and ask a simple question: How can a bill supported by 70% of Marylanders fail to pass for the 10th year?
Once again, the Maryland General Assembly failed to pass the End-of-Life Option Act, which has been discussed in Annapolis since 2015. The bill would have allowed mentally competent, terminally ill Marylanders with less than six months to live access to medical aid in dying (MAID), allowing them to take medication to end their lives peacefully. The bill includes multiple cautionary steps to ensure there is no abuse of the process, which now is authorized in 10 states plus Washington, D.C.
With 70% statewide support in credible and consistent polling, and majority support in virtually every geographic and demographic subgroup, how could this bill have failed again, when early in the session the Senate president predicted it would come to the Senate floor?
In my opinion, there is a three-part answer.
The most immediate reason is that, as I understand it, one senator, who previously co-sponsored and voted for the bill, reversed their support in the days leading up to a committee vote. This meant the bill could not pass out of committee. I can only wonder if this reversal was a political effort to secure support for other bills at the expense of people who are dying. My message to the senator is that it is not right to play politics with peoples’ lives. I expect the senator’s constituents will remember this in the next election.
A second explanation is that opposing witnesses and legislators continue to generate, in my opinion, hypothetical reasons to oppose the bill despite data that refute the theoretical harms. The following is a small sample:
No increases in state suicide rates. The opposition claims suicide rates have increased in states with MAID despite, to my knowledge, no such data in psychiatry, medical or public health journals.
No issue with Hippocratic Oath. Opposition previously claimed MAID violated the oath physicians take in medical school, but a study shows that virtually all medical schools have oaths accommodating MAID. So now the opposition claims it violates the original Hippocratic oath. True, but so does removing kidney stones and performing surgery. We should NOT be seeking guidance from a position stated 2,400 years ago.
No abuse of drugs. Despite opposition claims, to my knowledge there has never been a credible case of unused MAID drugs being abused, because patients do not fill their costly prescriptions until ready to take them, and because the drug powders are now mixed together and realistically cannot be separated or abused.
No patient coercion. After 25 years of MAID in this country and more than 10,000 prescriptions for life-ending drugs (of which about a third were never used), to my knowledge there has never been a credible documented case of a patient being coerced into using MAID.
No need for evaluation by a psychiatrist in every patient. Multiple psychiatrists claimed, in my view without evidence, that only mental health professionals can evaluate patients for disorders that diminish mental capacity. However, two recent studies disprove this belief. Attending clinicians effectively serve this role.
No insurance company denials of care when MAID is available. Despite fears that insurance companies might deny claims to encourage people to use MAID, to my knowledge there has never been a credible case of an insurer denying treatment coverage because the patient qualifies for aid-in-dying.
The final and, at its core, the real reason for most MAID opposition is religion. As simple as that. These individuals believe their religious values should dictate public policy and override contrary views. Indeed, even when it comes to abortion the Maryland General Assembly transcended this religious dogmatism by approving a bill last year to place on the ballot a constitutional amendment allowing a woman’s right to choose. But when it comes to one’s own competent choice for a painless death, others’ religious views prevail.
Under the proposed law no one is required to participate in MAID. Anyone who opposes the law can decide not to participate, including patients, physicians, and pharmacists. But Marylanders should have the option to choose.
The late Congressman Elijah Cummings, for whom the bill is named, put it succinctly in a 2019 supporting letter: “. . . at the end of life, an individual’s right to self-determination about one of the most personal decisions that anyone could make supersedes the moral sensibilities of others.”
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