We will all die one day. But, talking about death is one of the most difficult conversations we can have. For many, the difficulty comes from a feeling of powerlessness. We generally don’t know how or when we will die.
The majority of Maine people want a higher level of control over their final days, including the ability to obtain medication to end their lives if they are diagnosed with a terminal illness. In a poll two years ago, nearly three-quarters of Mainer supported allowing terminally ill patients to obtain life-ending medication. There was majority support across religions, political affiliations and ages.
With this in mind, a small bipartisan group of lawmakers have introduced legislation to allow Maine people to end their lives under a limited and restricted set of circumstances. It is the third attempt to pass such a law in Maine in four years.
Six states allow patients to end their own lives with medication, so-called “death with dignity.”
“This honors the fact that we have control over our lives, which is the basis for the United States,” Rep. Patricia Hymanson, the bill’s lead sponsor, said in an interview with the Bangor Daily News.
“People want control over their death,” she said.
It is harsh to accept, but some Mainers are already ending their lives. Hymanson, a doctor, shares a story of one of her cancer patients who mixed together the drugs she was prescribed and took them to end her life. Her story is not uncommon, as several people told members of the Health and Human Services Committee on Wednesday.
Formalizing this process, with a doctor’s oversight and access to life-ending medication can be empowering for some. It can horrifying for others. So, while we support the concept of death with dignity, it is crucially important to get the details right.
The backers of LD 1313 have learned from the mistakes made in past attempts to legalize assisted dying in Maine and from the experiences of other states. For example, previous bills in Maine were too vague and did not include reporting requirements, which bring transparency to the process.
LD 1313 is very detailed in terms of who would be allowed to self-administer medication to end their life and sets up a specific process that must be followed. It includes several consultations and waiting periods. A qualified patient must have been diagnosed with a terminal disease that will result in death within six months. Two doctors must confirm that the patient meets the requirements of the law. The patient must make three requests for life-ending medication, one in writing that must be witnessed by two people, one of whom is not related to the patient. This witness can not have a financial interest in the patient’s affairs.
The attending physician must discuss other options including palliative care and comfort care, hospice care, pain control and disease-directed treatment options. Two physicians must also assess the patient for depression and other conditions that may impair their judgment. If such conditions are found, the patient must be referred for treatment of those conditions.
A patient can rescind a request for life-ending medication at any time. This bill also allows physicians, pharmacists and others who object to the program to decline to participate.
The bill also requires annual reporting about the number of prescriptions written and the number of deaths that occur under the act.
In Oregon, only 1,459 people have used that state’s 21-year-old death with dignity law to end their lives with prescribed medication. More than 75 percent of these patients had cancer, and 11 percent had a neurological disease, often Lou Gehrig’s Disease. More than 90 percent were enrolled in hospice, and more than 90 percent died at home.
In Maine, a death with dignity law would likewise be used by few people, but for those people and their families, it is very important. Some have expressed frustration that terminally ill patients with slowly progressing diseases may not qualify under the bill. That is a valid concern, but a very complicated one in an already complex issue. The sponsors of LD 1313 are wise to start with a narrowly and carefully tailored bill with restrictive safeguards in place.
It’s important for patients and their families in states that have death with dignity laws to begin end-of-life discussions earlier. That means these difficult, but critical conversations are happening at a time when patients have more options for their care and final days.
Debate over LD 1313 will be emotional and difficult for many. Lawmakers should not lose sight of the importance of allowing Maine citizens to gain more control over the end of their lives, if they want it.