Rewriting the Rules of Death for Terminally Ill Adults

Amy Krimm
CAP 9 Critical Thinking Paper
Green Group
March 21, 2016

Death with Dignity laws, such as the one recently passed in California and the one
considered by the Maryland General Assembly, give the option for terminally ill adults to request
a medical prescription that will hasten their death. Also known as assisted physician death or aidin dying, these laws are a compassionate choice because they give to option to end the pain and
suffering of an individual with a terminal illness. The decision of dying on ones own terms rests
in the hands of a patient; when he/she is prescribed the lethal drug, it simply gives him/her the
option to take it (Bharath). It is the choice of the patient to request medication, not of the doctor,
which gives patients a sense of dignity that they can decide when they are ready to end the
suffering. Death with dignity follows the ethical principle of autonomy, which is an agreement
to respect anothers right to self-determine a course of action (Beauchamp). Legalizing aid-indying will also allow authorities to regulate practices of assisted physician death and make them
safer and more humane. The Maryland General Assembly must pass the Death with Dignity
law because it follows the ethical principle of autonomy, is a compassionate option for terminally
ill adults, and will ensure safe and legal physician-assisted death.
In 1999, Maryland became the thirty-eighth state to make physician-assisted death illegal.
This was in response to Dr. Jack Kevorkian who assisted in the suicide of a man suffering from
amyotrophic lateral sclerosis (Richard). Since then, many advocacy groups and lawmakers have
been fighting to change this law. After being rejected in early 2015, Senator Ronald Young
proposed another Aid-in-Dying bill to the Maryland General Assembly in March of 2016.
However, Young withdrew the legislation before scheduled review because it did not have
enough support to pass (Wiggins). When proposed in 2015, many people did not understand
what the bill was requesting. Governor Larry Hogan said, I believe that a physicians role is to
save lives, not terminate them (DeBonis). The widespread mistrust and reluctance to support

laws such as this stem from a lack of understanding. In order to be eligible to receive a
prescription for the lethal medication, patients would have to be diagnosed with a terminal
condition and certified as having less than six months to live, which means that it would be
unlikely for a physician to save the patients life. In addition to being diagnosed with a terminal
illness, one would have to be mentally competent and be able to self-administer the drugs
(Goucher). While Sen. Ronald Young did his best to convey the purpose of Death with Dignity
laws, it was still a fairly radical bill in 2015.
In 2016, after a yearlong push to make Maryland one of just a few states in the nation to
legalize Aid-in-Dying, Sen. Ronald Young put his bill in front of the Maryland General
Assembly once again. This time, he had many studies and support from the public to back up his
proposal. A recent poll from Goucher University shows that over fifty percent of every
demographic group and sixty-five percent of the general public support Death with Dignity
(Goucher). However, the senate committee once again did not pass the Death with Dignity bill.
The bill needed six votes to pass, but only received two votes, both from senators who were cosponsors. Taking the overwhelming public support in to account, Young commented on why he
believes that the bill failed again in 2016: People on the committee let their own views come in
(Wiggins). By opposing aid-in-dying, lawmakers are going against the will of the people. While
Young does not know if he will sponsor a similar bill next year, Kim Callinan, chief program
officer for the advocacy group Compassion and Choices said that she will not rest until
Maryland lawmakers heed the will of the majority of their constituents and pass this bill
(Wiggins). A companion bill is pending in the House of Delegates, but is unlikely to succeed
because it will have to go through the senate again in order to become law. In the past two years,

advocates in Maryland have proposed two Aid-in-Dying laws, but neither of them were passed
due to personal biases and lack of understanding from committee members.
In the medical community, tough personal decisions are made in accordance with
bioethical principles, which regulate medical practices dealing with human life and well being.
Some issues, such as aid-in-dying, bring bioethics to life by questioning the physicians sense of
right and wrong and the duties he/she owes others (Beauchamp). One of the four core principles
of health care ethics is the bioethical principle of autonomy, which honors the patients right to
make his/her own decision about his/her body. Advocates for aid-in-dying believe that patients
should be able to make judgments about the quality of their life and decide their own personal
course of action (Ersek). It is standard practice in the medical community to follow bioethical
principles, so medical procedures that follow these principles should be legalized.
People who oppose death with dignity use the term assisted suicide, which, as laid out
in Senate Bill #418, is legally incorrect: The U.S. Supreme Court has drawn a legal distinction
between withdrawing life support and assisted suicide based on causation and intent (Richard).
Actions in accordance with this bill do not constitute suicide, homicide, or mercy killing. As
stated in the bill, the physicians participation in the process is voluntary, meaning that Death
with Dignity laws do not demand that a physician be involved if the process is against his/her
moral beliefs (Richard). The Aid-in-Dying bill presented to the Maryland General Assembly
informs opposition and establishes ethical guidelines for both physicians and patients to follow.
The Death with Dignity movement was set into motion by activists such as Brittany
Maynard, a California resident who moved to Oregon so she could legally determine the manner
and timing of her death following a diagnosis of terminal brain cancer. In 2014, aid-in-dying
medication was not legal in California, so 29-year-old Maynard moved, with her husband and

family, to one of four states where assisted physician death was legal (LaPook). When asked how
she made her decision, Maynard replied: At this point, I am not afraid of death. But I am afraid
of being tortured to death (Bharath). Maynard, like many other terminally ill adults, came to
terms with her inevitable death and realized that she wanted to die peacefully, on her own terms
and at a time of her choosing (LaPook). By denying mentally stable, terminally ill adults the
right to control how they die, lawmakers are denying these patients the compassionate option and
limiting their autonomy.
Compassion and Choices, the leading advocacy group for aid-in-dying, has been working
for the past 30 years to protect and expand end of life options. This organization works
nationwide in state legislatures, courts, congress, medical settings and communities to educate
both lawmakers and patients about aid-in-dying. Compassion and Choices (C&C) offers a free
consultation program for patients who need assistance making fully informed decisions about
their healthcare that are consistent with their values and priorities. Nancy Hoyt, the Chair of
C&C believes the path to change starts with individual supporters, which is why this group
focuses on gaining support within communities (Jacobus).
If Death with Dignity is not passed, there will continue to be no way to regulate end of
life decisions and practices. If the process is legalized, there will be more room for scrutiny and
applications of safeguards. Dr. Helene Starks, a professor in the Department of Medical History
and Ethics at the University of Washington, says, The practice [of physician assisted death] is
happening regardless of the legal status; keeping it illegal has the potential to cause more harm
than good (Pearlman). An alternative for aid-in-dying is palliative care, which provides comfort,
pain management and treats physical symptoms. However, in some cases, doctors, patients, and
family members feel as if palliative care provides insufficient remedy to the patient, and that the

only way to end a patients suffering is to give him/her the option of dying on his/her own terms
at the time of his/her choosing (Raffa). However, doctors, even palliative care specialists, are not
legally allowed to do what may be morally right for fear of prosecution. When medical practices,
such as aid-in-dying, are illegal, individual access to knowledgeable health care providers who
can help patients explore all end of life options is restricted. If all alternatives for dying in
comfort are not available to a terminally ill patient, prolonged suffering and illegal physician
assisted suicide could become the only options (Pearlman).
In order to get a Death with Dignity bill passed in the State of Maryland, Compassion and
Choices is expanding their staff and partnering with influential volunteers, including doctors and
family members of terminally ill patients. To make a lasting impression on lawmakers, everyone
who is a strong supporter of aid-in-dying must meet with local organizers to see what individuals
can do to help (DeBonis). The official Death with Dignity website provides a letter for people to
send to the Maryland legislature to convince lawmakers to change their minds about legalizing
physician assisted death. By increasing publicity of Compassion and Choices mission,
politicians will become educated on this topic and more likely to make an informed decision that
benefits their constituents (Jacobus).
Aid-in-dying, a medical procedure to end suffering of terminally ill patients, must be
legalized in the state of Maryland. Mentally competent adults with less than six months to live
should be legally allowed to make their own end of life decisions. The procedure is ethical, and
once legalized, authorities can enforce stiffer regulations to ensure safety and understanding for
everyone involved. Physicians will be able to carefully screen patients to ensure that they are
eligible, made the decision without outside pressure, and fully understand the choice. The
general public, from all demographics, supports aid-in-dying as a compassionate option to

relieve the suffering of terminally ill patients. The Maryland General Assembly must speak for
its constituents and pass a death with dignity bill because it will ensure safe and ethical practices
of assisted physician death, is a compassionate option, and is in accordance with the bioethical
principle of autonomy.

List of Works Cited

Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics (6th ed., pp. 38-39).
New York, NY: Oxford University Press.
Bharath, Deepa. "Most Influential 2015: Dr. Robert Olvera." The Orange County Register. N.p.,
18 Dec. 2015. Web. 13 Feb. 2016.
DeBonis, Mike. "'Death With Dignity' Laws Are Proposed, Bringing National Debate to D.C.
and Md." Washington Post. The Washington Post, 16 Jan. 2015. Web. 15 Feb. 2016.
Ersek, Mary. "Medscape Log In." Medscape. Journal of Hospice and Palliative Nursing, 2004.
Web. 17 Mar. 2016.
"Goucher Poll Releases." pag. Goucher.edu. Goucher Poll, 2015. Web. 13 Mar. 2016.
Jacobus, Claire. "Who We Are, Our Mission Our Accomplishments." Compassion & Choices.
Compassion & Choices, Web. 15 Mar. 2016.
LaPook, Jon. "Should the Terminally Ill Control How They Die?" CBS News. CBS
Interactive, 13 Mar. 2016. Web. 14 Mar. 2016.
Pearlman, Robert A., Clarissa Hsu, Helene Starks, Anthony L. Back, Judith R. Gordon.
"Motivations for Physician-assisted Suicide." Journal of General Internal Medicine.
Blackwell Science Inc, Web. 15 Feb. 2016.
Raffa, Connie. "Palliative Care: The Legal and Regulatory Requirements." European Journal of
Clinical Microbiology & Infectious Diseases 22.12 (2003): 778. NHPCO. Arent Fox, 22
Dec. 2003. Web. 19 Mar. 2016.
Richard E. Israel and Roger "Pip" Moyer End-of-Life Option Act, S. 418, 114 Cong. (2016).
Print.
Wiggins, Ovetta. "Effort to Legalize Assisted Suicide Fails." Washington Post. The Washington
Post, 3 Mar. 2016. Web. 14 Mar. 2016.

Annotated Bibliography
Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics (6th ed., pp. 38-39).
New York, NY: Oxford University Press. This source defined the ethical principle of
autonomy, and allowed me to understand that Death with Dignity will follow this
principle.
Bharath, Deepa. "Most Influential 2015: Dr. Robert Olvera." The Orange County Register. N.p.,
18 Dec. 2015. Web. 13 Feb. 2016. This article gave a personal perspective of a parent
whose daughter died without given the option of death with dignity.
DeBonis, Mike. "'Death With Dignity' Laws Are Proposed, Bringing National Debate to D.C.
and Md." Washington Post. The Washington Post, 16 Jan. 2015. Web. 15 Feb. 2016. This
article localizes the issue of Death with Dignity to the State of Maryland; it explains both
the reasons to pass the law and who the main opponents are.
Ersek, Mary. "Medscape Log In." Medscape. Journal of Hospice and Palliative Nursing, 2004.
Web. 17 Mar. 2016. This article defined the four bioethical principles that are used in the
medical community. Using these four principles strengthened my argument by providing
factual and relevant information.
Garriss, Kristen. "Md. Lawmakers Consider 'Death With Dignity' Act." YOUR4STATE. N.p., 24
Mar. 2015. Web. 19 Mar. 2016. This article gave legal background as to why the
Maryland General Assembly did not pass a Death with Dignity bill.
"Goucher Poll Releases." pag. Goucher.edu. Goucher Poll, 2015. Web. 13 Mar. 2016. This
academic poll gave credible facts and statistics to support by argument using the ethos
approach.
Jacobus, Claire. "Who We Are, Our Mission Our Accomplishments." Compassion & Choices.
Compassion & Choices, Web. 15 Mar. 2016. This informational welcome page on the
organization Compassion and Choices helped me understand this group's goal in
propelling the aid-in-dying movement forward.
LaPook, Jon. "Should the Terminally Ill Control How They Die?" CBS News. CBS
Interactive, 13 Mar. 2016. Web. 14 Mar. 2016. This article gives specific examples of
Aid-in-Dying activists and what they stand for, which allows the reader to understand the
extent of the problem

Pearlman, Robert A., Clarissa Hsu, Helene Starks, Anthony L. Back, Judith R. Gordon, Ashok J.
Bharucha, Barbara A. Koenig, and Margaret P. Battin. "Motivations for Physicianassisted Suicide." Journal of General Internal Medicine. Blackwell Science Inc, Web. 15
Feb. 2016. This scientific article defines the methods of physician assisted death, and
explains why in order to regulate these procedures one must legalize Death with Dignity.
Raffa, Connie. "Palliative Care: The Legal and Regulatory Requirements." European Journal of
Clinical Microbiology & Infectious Diseases 22.12 (2003): 778. NHPCO. Arent Fox, 22
Dec. 2003. Web. 19 Mar. 2016. This medical article defined other options for aid-indying, which was helpful to balance my research.
Richard E. Israel and Roger "Pip" Moyer End-of-Life Option Act, S. 418, 114 Cong. (2016).
Print. This bill gave me unbiased facts that help prove my argument and disproves its
opponents.
Wiggins, Ovetta. "Effort to Legalize Assisted Suicide Fails." Washington Post. The Washington
Post, 3 Mar. 2016. Web. 14 Mar. 2016. This article gives legal information about the
Death with Dignity bill that was recently put in front of the General Assembly.

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