Yes on 1

Should a terminally ill adult who is of sound mind be allowed to ask for and receive a doctor’s help to die?

Those who have seen a friend or relative through the final stages of a terminal illness have witnessed the courage and grace with which the loved one accepts the inevitable. In many cases, too many cases, they also have witnessed the unrelenting pain and the degrading loss of control that can result when medical miracles run out.

The Maine Death With Dignity Act that would become law with voter approval of Question 1 effectively and compassionately addresses this tragic situation. It is about nothing less than allowing mentally competent adults whose lives are about to end the ability to decide for themselves how, when and where that end will occur.

It is about nothing more. It is not about euthanasia, it is not about society ridding itself of burdens, it is not about greedy heirs or rapacious HMOs. It most certainly is not about forcing patients or physicians into anything without their full and informed consent.

Any voter who has not yet read the entire 11-page Act should do so before Election Day. The provisions to ensure that a patient’s decision to end life is completely voluntary, unpressured and informed are comprehensive.

The diagnosis that the patient has an irreversible, incurable terminal illness and less than six months to live must by made by two physicians working independently. The patient must initiate the request for medication to end life in writing before two witnesses who cannot be relatives or anyone else who might conceivably benefit from the patient’s death. If the patient is unable to write, the request must be made in sign language or other means which the attending physician and witnesses deem to be utterly unambiguous. A licensed psychiatrist or psychologist with no professional connection to the attending physician must evaluate the patient and determine he or she is mentally competent. A palliative care specialist must determine that the patient is receiving high-quality end-of-life care and make any recommendations or referrals necessary. Then, and only if all the above conditions are fully met, the patient must make a second request. Further, a waiting period of at least 15 days must elapse between the patient’s initial request and the writing of a prescription for life-ending sedatives and a second waiting period of at least 48 hours must elapse before the prescription can be filled.

And, as one more protection against even a whiff of outside influence, this: Any person – doctor, nurse, nursing home operator or employee, relative or insurance company executive – who coerces or pressures the patient in any way during any step in this process can be charged with a Class A crime, the most serious felony under Maine law.

The Maine Death With Dignity Act is closely modeled after a similar law in effect in Oregon for two years. In 1999, its first full year, only 27 terminally ill patients made the choice to end their lives, far less than 1 percent of total deaths. More importantly, the quality of care for the dying in Oregon has experienced stunning improvement; that state now leads the nation in referrals to hospice and in the use of pain medication for the terminally ill. As a result of those and other steps to allow the terminally ill to die at home surrounded by friends and family, Oregon now has the lowest hospital mortality rate in the nation. Maine, by contrast, is 50th among the states in use of hospice, it is one of only six states without a hospice Medicaid benefit and it is near the top in hospital mortality.

Among the opponents of Question 1 are the American Medical Association and the Maine Medical Association. The primary argument offered by these organizations is that assisting suicide in any way violates the physician code of ethics. The proposed Maine law, however, makes it explicitly clear that no physician, other health-care provider or even the patient’s pharmacist can be compelled in any way to participate.

It is troubling that, although the AMA and MMA are officially opposed, many member physicians readily, though confidentially, concede that colleagues do in extreme situations make life-ending medications available to suffering patients surreptitiously. These surely are acts of compassion and there is simply no reason such compassion should not be available to all, without the caprice or stealth.

Far more troubling, though, is that No on 1 has chosen to degrade this terribly serious issue with a campaign of fear and misrepresentation. It is not true, as opposition ads assert, that a patient would have to ingest 60 to 100 pills – a few grams of barbiturate dissolved in a few ounces of water is the truth. This law will not make it legal for lethal drugs to be sent through the mail – potentially lethal drugs of the same category already can be delivered that way and there already are safeguards in place to ensure they do not fall into the wrong hands. And the hysteric claim that bungled doctor-assisted suicides in Oregon have led to complications and 911 calls by terrified family members is absolutely false, it is a rumor concocted by opponents of the law in that state and repeated often enough to be taken now as fact.

It is true that the family does not have to be notified that the patient is seeking assistance in dying but not, as opponents imply, to cover up the actions of health care providers. The patient is asked twice during the weeks-long process if he or she wants to notify family. In Oregon, most have, a few have not. It is their choice.

And choice is what Question 1 is about – the most difficult choice a person could ever make but one that, in the most difficult situation life could ever offer, a person should be entitled to make. The Maine Death With Dignity Act allows that choice and it virtually guarantees it is one that is informed and completely voluntary. It deserves voter support on Nov. 7.