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The Maryland General Assembly is considering an End-of-Life Option Act for the fourth time in as many years. If passed, the legislation would allow terminally ill individuals, who have been given six months or less to live, the option to legally end their lives with a lethal dose of prescribed medicine.
Supporters of the bill say that individuals should have the right to end their lives with dignity and exercise control over the final stage of their life. A 2015 poll showed that 60 percent of Marylanders support a “death with dignity” option for terminally ill patients.
Opponents of the measure have argued that in addition to the moral and ethical considerations, public safety could be put at risk if the legislation passes. Concerns have been raised that the new law could be used to target people with disabilities, or that a patient could be deemed mentally fit, but actually be unable to make a sound decision on this issue.
We delve into the debate and hear what listeners have to say.
Produced by Monna Kashfi
KOJO NNAMDIYou're tuned to The Kojo Nnamdi Show on WAMU 88.5. Welcome. Later in the broadcast what does diversity in the classroom look like and why does it matter? We get a preview of our Kojo Roadshow. But first the Maryland General Assembly is considering legislation to address end of life options for the fourth time in as many years. The legislation would allow terminally ill individuals who have been given six months or less to live the option to legally end their lives with a lethal dose of prescribed medication.
KOJO NNAMDIThe District passed similar legislation in 2016. Supporters of the bill say that individuals should have the right to end their lives with dignity and exercise control over the final stage of their life. Opponents of the measure have argued that in addition to the moral and ethical considerations public safety could be put at risk if the legislation passes. Both houses of the Maryland legislature have heard testimony on the bill and the debate rages on. Joining me in studio is Senator Will Smith representing Silver Spring and Tacoma Park in Maryland's State Senate. Will Smith, thank you for joining us.
WILL SMITHThanks for having me. Pleasure to be here.
NNAMDIAlso with us is Kim Callinan, CEO of Compassion and Choices. A nonprofit organization that advocates for individual end of like choice. Kim Callinan, thank you for joining us.
KIM CALLINANThank you so much for having me here today.
NNAMDIAnd joining us by phone is Dr. Marie-Alberte Boursiquot, an internist based in Ellicott City and a member of the Maryland Against Physician Assisted Suicide coalition. Thank you for joining us.
MARIE-ALBERTE BOURSIQUOTThank you for having me.
NNAMDISenator Smith what does this legislation say and what's different this time around?
SMITHWell, I would say this time around -- it's been introduced for four years in the legislature and this time we have the advent of, you know, I think 17 states are considering legislation like this have already dropped in the legislature, 24 I think by the end of 2019. Six states have moved forward with this and the District of Columbia as you mentioned, but in Maryland it's polling. The latest poll that came out, the Goucher poll came out just out week showed that two thirds of Marylanders support this option.
SMITHEven MedChi, the Maryland State Medical Society came out and they've change their position from opposition to no position and that was after they had taken an internal with their physicians. And it shows that the majority of physicians in Maryland actually support this option. So it's definitely a new day. We've got new members in the legislature. We've got a national trend. And we've got 20 years of data to look back on from Oregon. So I feel confident this year. That's what's different this year than years past.
NNAMDIThe bill has several strict requires for someone who wants to exercise this end of life option. Tell us what the law would require of patients.
SMITHSo patients would have to consult a physician. They would have to make three requests, Two orally and one in writing. If the person has some sort of a capacity issue in terms of their mental capacity to make a decision, the bill requires that two attending physicians and a consulting physician refer that person to a mental health expert for another round of consultation. You've got to have two witnesses there that attest to your ability and your willingness to engage in this process. It's got to be within six months. So there are lots of protections that we've crafted into this bill over the course of the last for years.
NNAMDIThe legislation being considered would legalize medically assisted suicide. How is that different from physician assisted suicide?
SMITHSo this something that the bill prescribes that you have to be able to self-administer. And so folks that are, you know, they're obviously clear eyed going into the process, but then they also have to be able to self-administer. So that's the distinction that we've drawn into bill and that has worked in Oregon and in the five other states and in Washington D.C.
NNAMDIYou are the co-sponsor of this bill along with Delegate Shane Pendergrass in the House. Why did you decide to support this legislation?
SMITHYou know, I've worked on this in the working group when I was in the House four years ago. And my constituents -- I've on couches of folks that would have liked to have availed themselves to this option in Silver Spring and Tacoma Park. Also I've have personally family members that would have liked to have availed themselves with this option had it existed at the time. So it's a personal issue for me, but it's also something that I've heard an awful lot about from constituents. It's a very emotional issue. You know, I've spent a lot of time on people's couches talking about this.
NNAMDIKim Callinan, there has been pretty extensive public polling conducted on this issue on Maryland. What do the polls show as far as public support for medical aid in dying?
CALLINANThe polls show that people support the passage of medical aid in dying by two to one. So two thirds of Maryland residents would like to see this option and the support is strong across all demographic groups, republicans, independents, democrats, Catholics, Protestants. It doesn't matter what demographic group you do, the reality is that everybody has experienced somebody, who's had some type of a challenging death. And people are looking for the peace of mind that comes with this legislation.
NNAMDIWhy do you think people, given a terminal prognosis should have the legal right to end their lives?
CALLINANBecause right now people are unnecessarily suffering. The legislation does not result in any more people dying. It simply allows people to avoid the very worst, the very hardest part of the dying process.
NNAMDIWhat about the effect of the decision on loved ones, caregivers? What have you heard from the patients and the families that your organization works with?
CALLINANYeah, we've really seen that what medial aid in dying does is it brings families together. It's an opportunity for people to come together to have a special moment where you're able to share with a loved one what they mean to you and what you've meant to them. It's about completeness and it's about comfort and peace of mind.
NNAMDIMarie-Alberte Boursiquot you have an objection to the end of life choice option as a physician. Tell us about that.
BOURSIQUOTWell, yes. Thank you. So, you know, medicine is a noble profession. It's based on the patient-physician relationship, which is unique in that it's based on trust. Medicalizing death does not address the needs of dying patients and their families. Phycisian assisted suicide is not medical care. Physicians are committed to preserving life not in taking lives. This bill would contribute to the corrosion of the patient physician relationship, which again is based on trust.
NNAMDIHow do you think it would facilitate the corrosion of the patient physician relationship, which as you said is based on trust?
BOURSIQUOTSure. One of our ethical principles basically patients have to believe and trust that a physician is looking out for their best interests. There's compassionate care already available to our patients as they approach the end of life. The majority of physicians and medical organizations, such as the American Medical Association and the American College of Physicians, of which I am a member have prohibitions against this practice.
BOURSIQUOTAs the American Medical Association states, physician assisted suicide is fundamentally incompatible with the physician's role as healer. There are a number of flaws with this legislation. And primary amongst them is the fact that there is no requirement that the patient receive a psychological evaluation before this prescription is written.
NNAMDIWell, allow me interrupt for a second, because, Senator Will Smith seems to suggest that the patient is allowed to consult with a mental health practitioner how is that different from what our guest is saying?
BOURSIQUOTWell, they're allowed, but they're not required.
SMITHThat's right. But, you know, under the legislation you've got to consult with two physicians. One is your attending physician and a consulting physician. And those folks are in the best position to make that initial prognosis if further evaluation is necessary. If further evaluation is necessary and if either physician decides that that's the case, then they must be referred to a mental health professional. So there are significant projects put in place in this bill.
SMITHAnd frankly in Oregon, in over 20 years or just about 20 years, there just haven't been any instances of this type of coercive behavior. So I know that there are lots of hypotheticals that are, you know, put out there all the time. But in reality and in practice, it's simply just not the case.
NNAMDIWell, another hypothetical comes from Charlie and Adams Morgan who emails, "A vulnerable severely ill person is persuaded by greedy persons, who stand to gain from the ill person's death that assisted suicide is the thing to do. How does the legislation guard against this scenario?
SMITHThe legislation -- so of those two witnesses that I talked about a little bit earlier, one witness cannot be a family member and the other witness cannot stand to gain financially or otherwise from the person taking this option. So there are two witnesses involved, one has to be a completely disinterested party. And so we think that's a level of protection that would, you know, prevent from that type of coercive behavior that the emailer is worried about.
NNAMDIMarie-Alberte Boursiquot, you were about to say?
BOURSIQUOTYes. So I was going to say, my understanding, though, is that the bill requires that two witnesses be present at the time that the patient requests suicide, but not at the time of suicide. And I think that's a difference here.
SMITHThat's technically not correct actually. One -- you know, the bill does prescribe that at least once that the patient make the request alone. So outside of, you know, the presence of those two other parties. And then the second piece is that there's an option. You can be alone when you take this medication or when you avail yourself with this option, but you don't have to be. And in Oregon, again, where we've had the longest amount of data running most folks choose to have this as a familial experience. Most folks that are taking this option are people that in -- I think 90 percent are people that are in home palliative care and are surrounded by family. And it's a peaceful family oriented process.
NNAMDIMarie-Alberte Boursiquot, the argument has been made during testimony on this bill that a death with dignity law could pose a public safety threat and be used to exploit patients with disabilities. Can you expand on the objections from the disability rights community?
BOURSIQUOTSure. And that's absolutely correct, because Maryland's leading disability rights groups recognize the many dangers the bill poses to those with intellectual and developmental disabilities such as falling prey to undo influence from doctors or family members resulting in a lack of true informed consent and that's the critical piece here, true informed consent.
NNAMDIHere now is Cheryl Grossman in Washington D.C. Cheryl Grossman, you're on the air. Please describe your condition and tell us how you feel about this issue.
CHERYLYes. Thank you so much for the opportunity. I was approached several years ago during my active chemotherapy treatment when I was considered terminal by the psychiatrist at a famous medical cancer center. Since I had been in treatment many times over many years that didn't I just want to end it, because it was okay. And that I could just have them turn up my meds and I would drift to sleep and that would be the end. And I was in a vulnerable position at that time.
CHERYLI was heavily medicated undergoing active chemotherapy. And I could have very easily said, you know, right now with all the nausea and all the pain and this active treatment and my hair falling everywhere in my 20s and I had gone through this many times that that was it. Thankfully I did not choose that, but I have to think that many others may not be so lucky. They may have other pressures. They may have families who are struggling to put food on the table and make their mortgage. They may have treatments like mine that were not fully covered or covered at all by insurance. Those financial and support burdens are real for disabled people and that's where the collusion can come in.
CHERYLAnd there's nothing in these bills that protects against that.
NNAMDIOkay. We have a slightly different point of view from Dr. David Myers in Tacoma Park, Maryland. Dr. Myers, go ahead please.
DAVID MYERS (CALLER_Thanks, Kojo. And thanks, Will, for leading this bill again in Maryland. I wanted to start, Kojo, by saying that the AMA actually this year took an amazing stand. They rejected their ethics committee's recommendation to continue their 25 year old report on physician's support of aid in dying. The AMA now does not have a position. The medical community has moved now to say that we as physicians have the responsibility not to betray our patients at the end of their lives with terminal illnesses in the last six months. When they have the capacity to talk with us about their needs, we cannot walk away from them and say, we cannot help. Right now we do allow patients in Maryland to refuse food and water at the end of life to kill themselves easily.
NNAMDIWhat does your own situation?
(CALLER_Well, so that was my professional point, but you're right this is also very personal to me. I'm a family physician, but I myself was diagnosed with glioblastoma, a fatal form of brain cancer six months ago and the life span for this is normally 10 to 15 months. So I've spent the last six months learning how to live while dying. And this is the kind of option that I've talked with my family about, with my loved ones, with my friends. And I really wish was available to me and people like me in Maryland.
CALLINANYeah. Sure. I just wanted to follow up on what the caller earlier said. Her story is exactly why we need this legislation. In her scenario it was a third party, the doctor, who was offering this option to her, but with medical aid in dying the person is in charge of the process from start to finish. They're the ones that are requesting the medication. They're the ones that are certifying that it's what they want. They are in control of the process. They also have to be able to self-ingest the medication themselves. So what we're actually doing is ensuring that it's the patient's wishes and desires that are being honored and not a third party, who's putting their priorities on top of somebody.
NNAMDIDr. Marie-Alberte Boursiquot, is there any circumstances you feel where it would be appropriate for a patient to seek medical assistance in ending his or her life?
BOURSIQUOTWell, suicide is the voluntary and intentional taking of one's own life.
NNAMDIIn most cases -- in most states that's also illegal.
BOURSIQUOTRight. And this is not what physicians do. We are committed to preserving life not taking life. This bill is very impersonal, because often times many physicians are still against this type of practice, because it's not medical care. And so in many instances when a patient is seeking this type of assistance it involves a disruption of the patient physician relationship, with the physician that they've known for the (unintelligible). And they must now seek care from another physician if you will.
BOURSIQUOTAnd the physician barely knows the patient, okay. There is no requirement that I understand that a physician or a nurse be present at the time of the suicide. And so what happens if the suicide is not successful? We also have the potential here for the unleashing of very addictive drugs, barbiturates in particular, that are highly addictive and they can cause life threatening withdrawal.
NNAMDIAllow me to have Will Smith respond. How does the legislation address these issues?
SMITHSure. In fact, I think the legislation's outlines a very personal process. The legislation says that you have to -- that the attending physician has to provide the patient with all the alternatives including palliative care, other options for treatments. Things like advance directives have to be discussed. They also have to advise that you have and you should consult with your family. So it's a very personal experience. I don't know if you want to talk -- jump in.
CALLINANYeah, if I could just jump in, that I want to be really clear that the legislation also indicates that this is not suicide. The person is already dying and that they're simply doing is looking to avoid the very worst part of the dying process. The legislation is designed so that a person is able to make the choice on how they want that end of life experience to look. And so, therefore, they may choose to be with family, which is what 95 percent of people do, but they may also choose to be alone. And that's deeply personal time and one that only the individual person should make.
NNAMDIDiane Coleman in New York has a question about the administration of all of this. Diane, you're on the air. Go ahead, please.
DIANE COLEMANHi. Thank you for taking my call. I want to correct something that got said a little bit earlier. But suicide is not illegal in any state. These laws are about assisted suicide and specifically about immunizing from any form of liability or professional responsibility issues, people who assist in the suicide of another. One of the things that has been talked about here is the idea that the person has to be able to self-administer.
DIANE COLEMANBut these statutes typically do not require self-administration, and in fact, perhaps more importantly, they don't do anything to make sure that happens. Once the doctor gives the prescription, the drugs can be in the home and anybody can administer them with or without consent. And we live in a society where 1 in 10 elders are abused according to the New England Journal of Medicine. And I'm a disabled person myself. We know that the rate is--
NNAMDII know, but we're running out of time very quickly, Diane. So how are patients protected?
SMITHI'll just say one thing that I'm not aware of a single statute that says -- are you aware of a single state that has a statute that they -- I'm sorry. What did the caller say? That they have to --
NNAMDIThe patient has to administer it himself or herself.
CALLINANSo the statute absolutely does say that the person has to be able to self-ingest the medication.
CALLINANThat's in the statute. In addition, we have to keep in mind that at the end of life people have medication, all kinds of medication. I mean, hospice basically delivers buckets of morphine to somebody's house. There's no possible way medical care could be delivered if we as a government was trying to regulate each and everything. The person goes through a very very extensive process to actually qualify for the medication. A far much more rigorous process than they do any other type of end of life medication, which also could result in death.
NNAMDIA couple of more calls I got to take.
BOURSIQUOTI should add that there's the possibility here for insurance fraud, because the physician would be expected to falsify the death certificate and not list suicide as the cause of death when indeed it is the cause of death.
SMITHAs it was mentioned earlier, right now under Maryland law in most states across country, you can refuse medical care. You can stop taking food. You can stop taking water and that will ultimately end to your death. The underlying cause on your death certificate will always be the terminal illness that actually caused your death. So it's in line with what is already on statute across the nation.
NNAMDIQuickly now. Marcy Ruben in Gardena, California. You're on the air. Go ahead, please.
MARCY RUBENHi. Yes. I'm from Chevy Chase, Maryland and I have battled stage four metastatic breast cancer for six years. And I've been on 10 lines of chemo. I've had endless CAT scans. And I am fully in support of this bill, fully in support of this bill. My feeling is that, because I have lost some control as far as my body is concerned, I'm not equipped to not lose anything in terms of how I have my death. I want my death to be with dignity. It is not assisted suicide. It is a completely different thing. And those people who feel that it is assisted suicide or those people that are talking about theoretics, don't know what it's like to be a cancer patient.
NNAMDIOkay. Thank you very much for your call. We have a question from Dan in Ashburn, Virginia. Dan, you're on the air. Go ahead, please.
DANHi, thanks, Kojo. I just wanted to make sure your audience is aware. I used to be an industry rep for medical device company (unintelligible). I'm not sure if people know, but these representatives are asked all the time to turn off defibrillators and pace makers for patients in hospice. In those instances, thankfully it never happened to me, but I've had colleagues that patients expired in minutes before they even walked out of the room. And in some ways I'd like to know what the panel thinks about how is that really any different, because that happens all the time right now.
BOURSIQUOTWell, again, I have to just reiterate. We're talking about suicide, okay, which is not medical care. Obviously if --
NNAMDIHow's it different from what Dan talks about?
BOURSIQUOTWell, patients already have the option under autonomy to discontinue any care that they deem to be futile. And so with that discussion with their physician if it's deemed that your position is futile, you can refuse care. And if that involves turning off a defibrillator, if you will, that's a (word?). That is already an option for patients.
NNAMDIAlmost out of time. Will Smith or Kim Callinan.
CALLINANSure. So it's true that somebody can turn a defibrillator or medication at any time, but what some people would like is the option to end their suffering. There are some illnesses where there's not the option of turning something off. And so if you go through some very painful cancer treatments and you use medical interventions, sometimes those medical interventions result in excruciating pain. And people would like the option of knowing that they can end their pain and suffering if it's become too great.
NNAMDIThat was the case of John Rehm, Diane Rehm's late husband, who simply had to stop eating. Has a vote been scheduled on this bill for this session?
SMITHWe just had our hearing last week and we'll schedule a vote within the next couple of weeks before session ends. But I'll just say that, you know, this has been an emotional issue. I've heard very compelling stories on both sides of this issue. And lawmakers are considering all the options and taking this very seriously. I am optimistic and confident that, you know, we'll be able to move forward in the Senate this year.
SMITHWe've reviewed this for four years and produced I think a very tight piece of legislation that addresses and assuages all the concerns. And I just want to say thanks for all the folks that have taken time to, you know, to make their opinions heard on this, because this is a very personal and sensitive issue. But I think Maryland will be on the right side when we pass this.
NNAMDIDr. Marie-Alberte Boursiquot, thank you for joining us.
NNAMDIKim Callinan, thank you for joining us. Senator Will Smith it's my understanding that you're in the military and about to be deployed.
SMITHYes, sir. At the end of March, I'll be going off to Afghanistan.
NNAMDIWell, good luck.
SMITHThank you very much.
NNAMDIGot to take a short break. When we come back, we'll be discussing on the issue of diversity in schools. We're preparing for our Kojo Roadshow tomorrow. I'm Kojo Nnamdi.
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