Legislation was introduced this year before the Maryland General Assembly that would legalize physician-assisted suicide — allowing doctors to legally prescribe a lethal medication at the request of a patient who has received a  six-month or less terminal diagnosis. 

This proposal, which is almost identical to failed legislation from 2015, 2016, 2017, 2019 and 2020, was filed again by a national group from Colorado called Compassion & Choices. They have spent millions across the country advocating on this issue and have publicly stated that passing this bill in Maryland in 2023 is their top priority. 

There is a lot of misinformation surrounding this debate. We want you to clearly understand why this bill is so troubling and such a bad idea for Maryland. Here’s an in-depth set of reasons why we strongly oppose these bills. 

For a quick summary of the many troubling aspects of PAS legislation that you can easily share, please check out our infographic (PDF). 

No doctor, nurse, family member or independent witness is required to be present when the lethal dose is taken.

• This creates a huge opportunity for abuse of patients – coercion of the elderly by those with a financial stake; forcing of the lethal prescription on those who cannot self-administer (e.g. an ALS patient) or who do not have the mental capacity to understand (e.g. an Alzheimer’s’ patient)
• The large majority of assisted suicide does not take place in a healthcare setting. 89.5% of assisted suicides in Oregon in 2014 happened at home.[1] What if something goes wrong and the patient needs medical help immediately? There is no one there to help.

Patients will pick up their lethal prescriptions at their local pharmacies.

• That means you’ll be waiting in line at the pharmacy and the person in front of you may be waiting to pick up their 90-100 pills to kill themselves. 
• In California, patients are allowed to receive their lethal prescription via mail. This eliminates any controls to prevent the lethal drugs from falling into the wrong hands. 

There is no requirement that patients receive a psychological evaluation before doctors can authorize physician-assisted suicide. A screening from a doctor untrained in mental health is not sufficient.

• We know that patients with a terminal diagnosis have much higher rates of depression[2]. Why shouldn’t a depressed person receive treatment for that condition before they are even allowed to consider suicide?
• During a 2016 legislative hearing in Maryland, a top supporter of this bill claimed a required mental health check would “unnecessarily slow down” patients access to lethal drugs. 

Accurately predicting a six-month terminal diagnosis is next to impossible – even doctors admit that it is simply an educated guess.

• The Oregon “Death with Dignity” data makes this argument for us: 7 patients receiving a PAS prescription in years prior to 2015 took the lethal dose in 2015. That means they outlived a 6 month terminal diagnosis by more than a year, at least.
• We all know people who have outlived their terminal diagnosis by months to years.
• New treatments for once incurable diseases are being discovered every day. 

Suicide contagion is a real problem that proponents refuse to answer for.

• A new study in the Southern Medical Journal shows a direct link between legalizing physician assisted suicide and an increase in non-PAS suicides statewide[4].

PAS is seen as a cost savings measure for insurance companies, including state Medicaid programs.

• In states like Oregon, both private and public insurance cover the cost of assisted suicide drugs. This increases pressure on insurance companies and the state to offer PAS instead of life saving treatments that are likely much more expensive.
• In the fiscal note prepared for the 2016 Maryland legislation, they implicitly argue this bill may save the state money: “The Medicaid program may realize savings to the extent a qualified individual dies sooner than would otherwise occur”

Pain is not even in the top 5 reasons why patients wanted physician-assisted suicide (it’s 6th) 

• As noted in the an Oregon “Death with Dignity” report (2015), the three most frequently mentioned end-of-life concerns were: less able to engage in activities making life enjoyable (96.2%), losing autonomy (92.4%%), and loss of dignity (75.4%). Inadequate pain control ranked 6th with only 28.7% of patients reporting this as a reason why they wanted a lethal prescription.  

Maryland Residents Already Have Excellent End of Life Care Options 

• Palliative care is available to all patients dealing with a serious illness, whether terminal or not, and is a multidisciplinary approach to providing relief from pain, stress, etc. that comes with serious illness.  
• Hospice care is available to all with a terminal illness and provides pain relief and symptom management – all of which is paid for by Medicare/Medicaid and almost all private insurance plans.
• Why isn’t the Maryland Legislature doing everything it can to increase use of palliative and hospice care before it even considers legalizing suicide? The Workgroup Report on Hospice Care, Palliative Care and End of Life Counseling[5] summarized this issue well and helped implement a number of changes in Maryland to increase access. However, more can still be done on this issue.
• Medicare is now covering end of life counseling. This should increase the number of Medicare patients who are fully educated about existing end of life care options such as palliative care and hospice care. We know from Oregon that 60.2% of those receiving a PAS prescription in 2014 were on Medicare or Medicaid[6].

[1] Oregon Death with Dignity Act – 2014 Report – Oregon Public Health Division https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf

[2]Depression and end-of-life care for patients with cancer, Donald L. Rosenstein, March 2011 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181973/

[3] “A Fighter Trains His Ire on Assisted Suicide” New Boston Post, November 30, 2015 http://newbostonpost.com/2015/11/30/a-fighter-takes-aim-at-assisted-suicide/

[4] “How Does Legalization of Physician-Assisted Suicide Affect Rates of Suicide?” Southern Medical Journal, October 2015 http://stopassistedsuicidemd.org/wp-content/uploads/2015/11/Assisted-Suicide-Affect-Rates-of-Suicide.pdf

[5] http://www.oag.state.md.us/healthpol/hospice_and_palliative_care_workgroup_report.pdf

[6] Oregon Death with Dignity Act – 2014 Report – Oregon Public Health Division https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf

[7]CDC Minority Health Summary  http://www.cdc.gov/minorityhealth/populations/REMP/black.html

[8] National Hospice and Palliative Care Organization, Facts and Figures: Hospice Care in America, 2015 http://www.nhpco.org/sites/default/files/public/Statistics_Research/2015_Facts_Figures.pdf