December 05, 2019
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Maine’s ‘death with dignity’ law is in effect. Here’s how the rollout is going.

Marina Villeneuve | AP
Marina Villeneuve | AP
Maine Gov. Janet Mills signs a bill in June that made Maine the ninth state to allow terminally ill people to end their lives with prescribed medication.

The rollout of Maine’s new law allowing doctors to prescribe life-ending medication has moved faster than in other states with similar laws, though major health care providers in the state won’t allow so-called “death with dignity” until at least January.

Maine is now one of nine states to allow people to adopt such a law after it was passed by the Democratic-led Legislature earlier this year and signed into law by Gov. Janet Mills in June.

Adults with a terminal illness who are deemed mentally competent can request life-ending medication from a doctor, who can choose to fill the prescription after two oral requests, two waiting periods and one written request with recordkeeping requirements.

It took effect on Sept. 19 after a people’s veto initiative from opponents of the law failed to get enough signatures to make the ballot. The Maine Department of Health and Human Services has issued emergency rules governing the law and the Legislature will consider rules next year.

Wide adoption will take time. Maine’s largest provider will allow physicians to participate, but not until January. Others have a moratorium in place. Religious hospitals won’t be participating. There are also questions about the drugs that will be used. Here’s how the program has begun.

Maine’s rollout has been relatively quick once the law was adopted. Maine voters narrowly rejected a similar law in 2000. This year’s law came after another referendum threat. Peg Sandeen, the executive director of the Death With Dignity National Center, an Oregon group that advocates for such laws, said Maine’s rollout is moving faster than other states.

In many other places, there have been lengthy periods between passage and implementation or a large share of unwilling providers. Sandeen pointed to Vermont, where she said the first prescription wasn’t written until two years after the law took effect in 2013.

Hawaii residents struggled to get prescriptions filled until around March this year after the law was signed in April 2018 and went into effect this January, according to KLTV. In Colorado, the law was passed in November 2016 and went into effect the next month, though patients struggled to access life-ending medication for weeks afterwards, The Denver Post reported.

The Maine Center for Disease Control and Prevention adopted emergency rules two weeks ago allowing DHHS to collect data from health care providers and requiring any physicians prescribing life-ending medication to submit several forms related to the end of life process.

Those data-gathering rules will be in effect until January, when the Legislature will take up any tweaks or changes, said state Rep. Patricia Hymanson, D-York, who sponsored the law. They do not affect the rules concerning participation in the Death With Dignity Act.

One major health care provider has said it will participate, while other hospitals are likely to develop policies by December if they’re going to join. MaineHealth, the provider that runs Maine Medical Center in Portland and covers an area with more than four-fifths of the state’s population, has been the only provider to say it will allow providers to participate.

In a statement, MaineHealth said the decision was “in the best interests of our patients, our organization and our care teams.” It is delaying participation until Jan. 1 to develop policies.

Jeff Austin, a lobbyist with the Maine Hospital Association, said several other members of the association are also interested in providing the service. But with no more guidance forthcoming from the state, he said members are now trying to figure out policies as a group.

“They want to operationalize across the state and that takes more time than if they were trying to answer the questions on their own,” he said.

Brewer-based Northern Light Health and MaineGeneral Health of Augusta are still working on policies and are prohibiting participation in the law for now. A spokesperson for Covenant Health, a Catholic health system with locations in Bangor, Biddeford and Lewiston, said its providers will not be participating. Austin said most systems are likely to decide on policies by Dec. 1 for implementation by the new year.

Valerie Lovelace, chair of Maine Death With Dignity, said she has already been contacted by one person who has started the process of obtaining the medication. The state’s health department said because people don’t have to contact it to get the required forms, it doesn’t yet have data on people who have begun the process of using the program.

Leaders of groups representing hospice patients and people with the neurodegenerative disease amyotrophic lateral sclerosis have also reached out looking for guidance on the law. Lovelace said she was “incredibly optimistic” about the buy-in she’s seen from providers.

Sandeen said her group’s goal is for assisted dying to be seen as just another part of medicine’s continuum of care. “It’s all about medicine in my mind,” she said.

The rules specify no standard life-ending medication prescription, so providers want state regulators to weigh in. Sandeen said Maine is the only state that has issued emergency rules around death with dignity implementation, allowing the law to go into effect without delay.

Austin said hospitals are looking to the Maine Board of Pharmacy to weigh in on a standard life-ending prescription since the law does not specify one. Barbiturates branded as Nembutal and Seconal were widely used in other states until recent years, according to MarketWatch.

However, both have had availability problems: Nembutal’s manufacturer sought to prevent its use in executions in 2011 and the company that owns Seconal hiked the drug’s price after acquiring the rights to the drug in 2015.

The board discussed the law at a Thursday meeting, but delayed action until at least next month. Members said they wanted more information on pharmacist liability and drug combinations.

“You may be filling a prescription and you don’t even know what it’s for,” said Joseph Bruno, the CEO of Augusta-based Community Pharmacies and a former legislator who sits on the board.

 



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