Maryland: A moral reckoning on assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

Jonathon Alexandre

Several years ago I had the opportunity to do a speaking tour in the state of Maryland. Based on that experience I can really appreciate the article by Jonathan Alexandre that was published on June 20, 2026 in the Townhall on the assisted suicide debate in Maryland. Alexandre writes:

Assisted suicide in Maryland is stirring through this electoral season and will certainly be in the 2027 Maryland General Assembly. Regardless of how the issue is framed by proponents of physician-assisted suicide, the outcome is still death. They have given death a new wardrobe. They've dressed a lethal prescription in the language of compassion. But do not be deceived. Make no mistake: physician-assisted suicide is still suicide. The goal is still death. The poison is still poison. And the people who will be most exposed to it—the people who will feel its weight most brutally—are the same people who have always been asked to carry the heaviest burdens in this state: Black Marylanders and our brothers and sisters living with disabilities.

Alexandre comments on role of the Black legislative caucus who were the Firewall in defeating previous assisted suicide bills.

For years—the Black legislative caucus of Maryland stood as a firewall. At approximately 30 percent of the legislature, the African American delegation was more than a constituency. It was a conscience. They knew what their communities knew. They had heard the sermons. They understood, instinctively and historically, that when the government starts making death affordable and convenient, it is the poor and the brown and the disabled who get offered the off-ramp first. They voted no, no to Medical aid in dying (MAID) because they understood the stakes.

The members of the legislature representing the most Black-populated jurisdictions in this state consistently voted against the bill in 2019 with a simple, almost pastoral, reasoning: they feared medical centers, including nursing homes, would coerce vulnerable people into a decision they hadn't truly made for themselves. That is a lived reality for communities where medical trust has been seared in the furnace of Tuskegee and forced sterilizations.

Alexandre is concerned that the Firewall is crumbling.

Now, whispers inside the statehouse and on the campaign trail suggest the firewall is crumbling. Some who once stood firm are reconsidering. Some are being told this bill is different this time—that the safeguards are real, that the community's fears are overblown. Some, it appears, are being persuaded by lobbyists, by campaign coffers, and by the social currency of national progressive credentialing. But you are being sold a lie, and in accepting it, you are selling your people downriver.

Safeguards? Alexandre comments:

The proponents of physician-assisted suicide love their so-called "safeguards." But they are an imposter’s gesture of responsibility with no actual protection. The bill requires that a patient be evaluated for mental health impairment, but only if the attending physician thinks they might have impaired judgment. In any other context where a person expresses a desire to end their life, society mobilizes. Dial 988. Crisis counselors. Full intervention.

But under this bill, because the desire to die has been legally gambled away into "medical treatment," the system does not intervene. It complies. It prescribes. It sends them home—alone, often without witness, without medical supervision—with a lethal dose and a death certificate that lies and says "natural causes."

And what of coercion? The bill's answer to coercion is to ask the patient if they're being coerced. Think about that. Undue influence, by definition, operates by overcoming a person's free will without their immediate awareness. If they knew they were being coerced, it would not be coercion. “Safeguard,” therefore, is a legal fiction designed to check a compliance box while a vulnerable human being is ushered toward their death.

Alexandre comments on what Black Marylanders experience in the health care system.

Communities of color in Maryland face documented, persistent disparities in healthcare access. Black patients are more likely to receive inadequate pain management. They are more likely to be categorized as terminal without exhaustive exploration of alternatives. They face greater financial barriers to life-saving treatment. They navigate a healthcare system that has, in living memory, exploited their bodies for research, sterilized them without consent, and delivered inferior care as a matter of policy.

Now, into this same broken landscape, we are being asked to introduce legal suicide as a medical option. And when the penniless state and strained insurers are facing budget shortfalls, when the cost of keeping a terminally ill patient alive is weighed against the cost of a lethal prescription, do we honestly believe that the patient in the underserved community will receive the same calculus as the patient in an affluent area of the state? At this point, this is more than a slippery slope. This is digging the pit, and our most vulnerable neighbors are standing at the edge.

Alexandre also comments on the disability community.

The disability community has been sounding this alarm for decades. They have argued that assisted suicide laws endanger them. When society tells certain communities, directly or indirectly, that death is cheaper than treatment, then choice becomes expectation, and expectation becomes pressure. All this is packaged in a sinister opaque bill that in the past would almost guarantee a no vote from black legislators. Now we are not so certain we can count on them to do the right thing for our community.

Alexandre comments on the role of the Church.

I do not say this to shame anyone. I say this because the Black church—the institution that has been the backbone, the sanctuary, the war room of this community through slavery and Jim Crow and every assault that came after—has been nearly unanimous in its opposition. The Maryland Baptists have spoken. The faith leaders of Prince George's County have spoken. But when elected officials begin to drift away from the communities they represent and toward the interests of those who fund their campaigns, we have a word for that. It is called betrayal.

Alexandre challenges legislators who are wavering on opposing assisted suicide.

To any Black Maryland legislator who is wavering—who has been lobbied, who has been charmed, who has been offered some calculus of political benefit in exchange for this vote—I want to humbly appeal to you now.

The people who are pushing this bill have money. They have infrastructure. They attempted to wave poll numbers in your face. But they are not your misdiagnosed grandmother, your neighbor who cannot afford a life-saving specialist, your disabled cousin fighting to be seen as fully human. A vote to legalize physician-assisted suicide targets those who look into your eyes every day. It places a state-sanctioned death option before our people who, in many ways, have never had equal access to life-affirming care.

Alexandre completes his article by urging Maryland legislators to oppose assisted suicide.

Maryland's Black legislators were right the first time. They were right in 2019. They were right in 2024. And if they hold that line—if they choose their people over political expediency—they will be right again. History will vindicate them. Our communities will thank them. And in a generation where so many surrendered, they will be counted among the few who stood firm on solid ground for life when death was hoping to meet our people down river.

More articles on the Maryland assisted suicide debate.

• Maryland assisted suicide bill appears to be dead again (Read).
• Great news. Maryland assisted suicide bill is dead (Read).
• Assisted suicide, disability discrimination and racial disparities (Read). 
• Maryland assisted suicide bill may permit euthanasia (Read).

Assisted suicide was legalized in three US states in 2025. Are you concerned?

Alex Schadenberg

Alex Schadenberg
Executive Director, 

Euthanasia Prevention Coalition

In 2025, assisted suicide was legalized in Delaware, Illinois and New York. This means that there are now 13 US states plus Washington DC that permit assisted suicide. The 13 states include California, Illinois and New York, three of the six most populated states in America.

This is tragic and will result in many early deaths and will lead to the further medical abandonment of people in need.

Previous to this year, the last state that legalized assisted suicide was New Mexico in 2021.

Are you concerned? I am concerned.

I watched the recent online US assisted suicide lobby political meeting. During the meeting the assisted suicide lobby outlined that, in 2026, there will be at least 18 states with bills to legalize assisted suicide. 

We are very concerning with some of the listed states which included: Connecticut, Maryland, Massachusetts, Nevada and Virginia. There are other states that the assisted suicide lobby are focusing on that are less likely to legalize assisted suicide in 2026 including (but not limited to) Arizona and Florida.

Our allies have been very successful in the past few years but the issue seems to be changing How are we to respond?

Let's look at the most recent successful campaign. 

The Slovenian people voted on an assisted suicide referendum on Sunday, November 23, 2025 and voted to overturn the assisted suicide bill that was passed in the Slovenian legislature in July 2025. More than 53.5% of the voters rejected the assisted suicide law.

This was a great victory, that was accomplished by a small group of committed citizens who stuck to their talking points. They achieved the victory for people who are sick, people with disabilities and pensioners against all odds, as they were up against the government and a well funded death lobby.

Slovenia is not the United States, but the principles in the successful campaign will transport to North America.

They weren't afraid to call it what it is. They used the term poisoning. Assisted suicide is to provide a lethal concoction to poison a person to death. 

The never used the language of the other side. The other side continuously lied about what the assisted suicide law said or what assisted suicide is. The campaign focused on telling the truth and challenging the lies.

They called assisted suicide, health care reform. Most jurisdictions require health care reform to enable a more equitable provision of care. Assisted suicide poisons a person to death. Dead people don't need health care.

The called assisted suicide pension reform. Slovenia, like most jurisdictions, invest a significant portion of their budget into the pension system. Assisted suicide poisons a person to death. Dead people don't collect pensions.

Proper medical care. The other side focused on suffering. The campaign opposing assisted suicide talked about proper care, and explained that assisted suicide forces people, who cannot attain proper medical care, to be poisoned to death.

The Slovenian campaign was more aggressive than most campaigns, but they won even though they were massively out-spent.

The take-away from the Slovenian referendum is that people innately oppose killing people, but you must be willing to state what assisted suicide is. The Slovenians built their campaign on a few key talking points and stuck to them. Hiding behind nice language or presenting the issue in a way that seems more socially acceptable avoids the reality that assisted suicide is about killing people by poison.

I am not afraid to say that I oppose killing people.

Maryland assisted suicide bill appears to be dead again.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I was cleaning up emails when I came upon an important article by Jack Hogan that was published in the Maryland Daily Record on March 3, 2025.

The Maryland legislature has debated bills to legalize assisted suicide on a nearly annual basis since 2015. According to Hogan, this year's assisted suicide Bill (HB 1328/SB 926) appears to, once again, lack support in the Senate. Hogan wrote:

Hours before the Maryland House of Delegates on Monday revived a perennial debate over whether to legalize medical aid in dying, state senators canceled a hearing on the bill, appearing to forgo the debate in their chamber and all but guaranteeing that the measure won’t have a serious chance of becoming law until after the next election cycle.

Aid-in-dying advocates and at least one top House member were initially under the impression that Judicial Proceedings Committee Chair Will Smith would reschedule the canceled hearing, which was planned for Wednesday.

But top senators didn’t have plans to reschedule, and House Majority Leader David Moon wrote in a text message that he heard the bill was dead in the Senate.

In 2019, the Maryland assisted suicide bill passed in the House by a vote of 74 to 66 but failed in the Senate by a tie vote of 23 to 23.

According to Hogan, since the Senate does not appear to support the assisted suicide bill that it will not be considered in Maryland again until 2026.

Great News: Maryland Assisted Suicide Bill is Dead

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Sapna Bansil reported on March 1, 2024 for the Capital News Service that Maryland's assisted suicide bill (HB403/SB443) is dead because it didn't have support in the Senate Judicial Proceedings Committee. Bansil reported:

Senate President Bill Ferguson, D-Baltimore City, said in a press conference Friday that the measure had not won enough support among the 11 members of the Senate Judicial Proceedings Committee to move forward this term. Ferguson indicated he was unwilling to bring the bill for a vote if it was likely to fail.

“For this year, it’s certainly over,” said Senate Judicial Proceedings Committee Chair Will Smith, D-Montgomery, noting the bill would have fallen one or two votes shy of passing his committee.

The bill’s failure elicited strong emotions from its supporters on Friday, many of whom have experienced years of setbacks on the issue.

Sen. Ariana Kelly, D-Montgomery, a member of the Judicial Proceedings Committee and a bill co-sponsor said that she has public support for the bill.

Sen. Mike McKay, R-Allegany, Garrett and Washington said that he was pleased with the decision.

Bansil reported that Senate President, Bill Ferguson, believes that another assisted suicide bill will likely be introduced next year.

A similar assisted suicide bill was defeated in Maryland last year and assisted suicide bills were introduced in Maryland every year between 2015 and 2020.

Congratulations to all of the people in Maryland who have worked for many years to continue defeating assisted suicide bills.

Assisted suicide, disability discrimination and racial disparities.

This message was sent out by Diane Coleman from Not Dead Yet on Febraury 12. 

On February 8, the Maryland Senate's Judicial Proceedings Committee held a public hearing on a proposed assisted suicide bill (SB0443). That morning prior to the hearing, the Patients Rights Action Fund organized a press conference of opponents. Anita Cameron represented Not Dead Yet and made the following compelling arguments against the bill.

Anita Cameron

Anita Cameron's Press Conference Remarks

I'm Anita Cameron, Director of Minority Outreach for Not Dead Yet, a national disability organization opposed to medical discrimination, healthcare rationing, euthanasia and assisted suicide. 

SB 0443 will put sick people, seniors and disabled people, especially, at risk due to the view of doctors that disabled people have a lower quality of life, therefore leading them to devalue our lives.

In 2021, Lisa Iezzoni, a professor of medicine at Harvard University, conducted a survey of 714 doctors around the country as part of a study. She found "82.4 percent reported that people with significant disability have worse quality of life than nondisabled people. Only 40.7 percent of physicians were very confident about their ability to provide the same quality of care to patients with disability, just 56.5 percent strongly agreed that they welcomed patients with disability into their practices, and 18.1 percent strongly agreed that the health care system often treats these patients unfairly."

Now add race and racial disparities in healthcare to this. Blacks, in particular, receive inferior health care compared to whites in the areas of cardiac care, diabetes, cancer and pain management. Doctors are more likely to write us off as terminal, making us eligible for assisted suicide.

COVID, in particular, has laid bare racial disparities and disability discrimination in healthcare that leads to medical rationing and futility decisions that can end a person's life. Michael Hickson's case is a clear case of discrimination against disabled people.

Michael Hickson was a 46-year-old Black man from Texas, the father of 5 children. Mr. Hickson was a quadriplegic, the result of a brain injury caused by a heart attack. He was placed in a nursing home, where he contracted COVID. He was sent to St. David Hospital, in Austin, Texas. However, due to his disability, the doctors decided not to treat him, stating that he had no quality of life, though family videos show him laughing and singing with his wife and children. He was placed in hospice and allowed to die.

I, too, have personal experience with racial discrimination and disparities in healthcare. The most blatant example of this was when I went to the emergency department last year in intractable pain. A white woman, also in pain, was next to me in the hallway because it was very busy that day. We had the same ER doctor caring for us. She, without asking, got Dilaudid, a potent pain medication, while I got a pat on the shoulder and sent home.

As long as disability discrimination and racial disparities in healthcare exist and as long our broken, profit-driven healthcare system limits people's access to treatment, services and supports, assisted suicide laws like SB 0443 have no place in Maryland.

Dr. Anne Hanson's Testimony Opposing Assisted Suicide

Suicide Contagion; Safeguard Failures; and Implications for the Practice of Psychiatry 

This article was published by Choice is an Illusion.

Anne Hanson MD

The Maryland Psychiatric Society opposes HB 643, the End-of-Life Option Act. Since this bill was first introduced in 2015, the Maryland Psychiatric Society has extensively deliberated the legislation within the organization through several listserv discussions, a member survey, and a four hour pro-con debate sponsored jointly with the Maryland somatic physician's organization, Med Chi. In addition to reviewing the legislation each year, we considered information contained in the American Psychiatric Association's resource document on assisted suicide (APA 2017) and other literature as cited in the references below.

The Maryland Psychiatric Society recognizes that this is a divisive issue and that some of our members disagree with the organization's position. Those members have been encouraged to contact their elected officials to contribute their thoughts and we welcome consideration of both sides of this serious policy.

The Maryland Psychiatric Society maintains its opposition to HB 643. There are three general areas of concern.

1. Suicide Contagion

Promotion of this bill, and assisted suicide laws generally, transmit a dangerous message to vulnerable Maryland citizens. According to the Centers for Disease Control,  at any given point in time 4% of people are experiencing suicidal thoughts. One-sixth of those individuals will attempt suicide (1.4 million Americans), and 3% will die (Shreiber and Culpepper 2020). Translated into Maryland numbers, this means that 242,000 people are presently thinking of killing themselves, 40,333 will attempt suicide, and 1210 will die.

Suicide clusters and contagion are well established phenomena with documented connections to media coverage and publicity (Blasco-Fontecilla 2013). The Centers for Disease Control and the World Health Organization both promulgate guidelines for the media coverage of high profiles suicides (Carmichael 2019). These guidelines advise against the portrayal of self-destruction as a “brave,” or “romantic,” and discourage reports which idealize suicidal behavior. They also caution against explicit discussion of suicide methods. These recommendations were developed in part due to a study which demonstrated that deaths by helium asphyxiation increased by more than 400% in New York following publication of the book Final Exit in 1991 (Marzuk 1993).

Proponents of assisted suicide laws violate these public health recommendations when they describe self-destruction as a “graceful” or “beautiful” expression of personal autonomy (Death With Dignity 2020). To date there have been no well designed studies to clarify the relationship, if any, between adoption of assisted suicide laws and states rates of un-assisted suicide. However, following the highly publicized death of Brittany Maynard in 2014 the number of assisted deaths by lethal medication in Oregon nearly doubled, from 71 in 2013 to 132 in 2015 (Oregon 2015). In a letter to the Colorado Springs Gazette, Dr. Will Johnston documented the case of a young man who was inspired to research suicide methods online after being impressed by, and admiring, Brittany Maynard's suicide video (Johnston 2016).

Here in Maryland, two people with serious mental illness have sought psychiatric help to die on the basis of their mental illness. One was a resident of the Maryland state hospital system and made a request for lethal medication on the day the 2019 bill failed in the Senate (Hanson, personal communication). Another was a resident of the Eastern Shore with schizophrenia who contacted several forensic psychiatrists for a capacity assessment in order to apply for euthanasia in Switzerland (Neghi and Crowley, personal communications).

Adoption of this law carries serious implications for people with mental disorders who would demand equality under the law. People with serious and treatment-resistant eating disorders could qualify, since qualification is based upon prognosis rather than diagnosis.

2. Safeguard Failures

The Maryland Psychiatric Society considers the statutory safeguards to be inadequate. Furthermore, they historically have been ignored without consequences to the negligent physicians.

Between 1998 and 2012 a total of 22 Oregon physicians were referred to the Board of Medical Examiners for non-compliance with the provisions of the Death With Dignity Act. None could be sanctioned due to the “good faith” protections of the law, even when required witness attestations were missing. No attempt has been made by Oregon, or any independent researchers, to document unreported cases in Oregon since the entry into force of the DWDA. The true reporting rate in Oregon is therefore unknown (Lewis 2013).

Similarly, in the first year of the Colorado law all prescribing physicians attested that they followed the law even when 42 cases were missing the consultant's evaluation, 22 had no written request, and nine of 69 cases were not reported at all by the physician (Colorado 2017).

In 2016 the Des Moines Register investigated ten years of data in Washington and Oregon, and found that in 40% of cases the reports were missing key data.

Failure to submit required reports, or to hold physicians accountable for reporting failure, is a substantial weakness of this legislation. Even if all required documents were accounted for, there has been no study to date to confirm the accuracy and specificity of these statutory safeguards.

In Maryland, one physician was even willing to violate our state's criminal prohibition. The late Dr. Lawrence Egbert admitted participation in the assisted suicide deaths, by helium asphyxiation, of six non-terminally ill Maryland residents. Three of those patients had co-existing clinical depression. His actions were discovered purely by accident. He was never charged or prosecuted in Maryland. He admitted in an interview with the Baltimore Sun that he had been involved in 15 suicides in Maryland and 300 nationwide (Dance 2014).

If Maryland is unwilling to enforce criminal prohibitions, the enforcement of statutory safeguards is even less likely. Connecticut's Division of Criminal Justice acknowledged that the statutory construction of their legislation would have prohibited prosecution for murder (Connecticut 2015).

3. Implications for the Practice of Psychiatry

This legislation has the potential to significantly complicate the practice of psychiatry in Maryland, for both the treating clinician and when functioning as an evaluator of decision-making capacity.

This law would carve out a class of people who theoretically could be categorically exempt from emergency evaluation procedures or civil commitment. Given that some individuals live for more than one year after receiving a lethal prescription, and that capacity may deteriorate over that time, it is unclear whether a qualified patient who has lost capacity could be assessed and treated for mental illness under this law.

There is no provision to correct an error if lethal medication is given to a patient who has concealed his or her psychiatric history from a prescribing physician. A treating psychiatrist who discovers an error would have no legal means to take custody of or dispose of the medication given to a patient. There is no procedural mechanism to challenge a faulty or erroneous capacity assessment.

A psychiatrist charged with assessing capacity must also rule out the possibility of coercion. In order to do this, the evaluator must be at liberty to interview any individual with relevant information. Under this law, a coerced individual could refuse permission for the evaluator to speak with anyone who has knowledge of the coercion.

The law allows the patient to ingest the medication at the time and place of his or her choosing. Thus, a participating facility could require an inpatient psychiatric unit to allow ingestion on the ward in violation of ward suicide prevention policies. This would be particularly detrimental on units designed for the treatment of eating disorders or in geriatric units, where it would be most likely to occur. People with mental illness also develop co-occurring serious medical conditions such as diabetes; since the law does not require the patient to accept any treatment, this condition would qualify as “terminal” if the individual refuses insulin (Oregon Health Authority 2018). California's health department regulations mandate that state psychiatric facilities must carry out assisted suicides within their units under certain conditions (9 CCR §4601).

Conclusion

Several additional deficiencies have been identified by other opponent groups, and the Maryland Psychiatric Society endorses these concerns. These include:

1.  No requirement for decisional capacity at the time of ingestion.
2.  No requirement for an independent or law enforcement observer at the time of ingestion.
3.  No mechanism to detect a negligent, incompetent, or malicious prescriber.
4.  The risk to third parties in the home (depressed or mentally ill family members).
5.  Detrimental psychological effects on the involved medical professional.
6.  No requirement for a doctor to notify a power of attorney or guardian that a prescription has been requested.
7.  Potential federal civil rights violations if the eligible person is institutionalized in a correctional facility or state hospital where prevention of suicide is an affirmative obligation.
8.  The lack of mental health screening instruments validated in this population for this purpose.
9.  No mandatory reporting or whistleblower protection for healthcare providers aware of negligent or malicious prescribers

References:

Anfang S et al. APA Resource Document on Physician Assisted Death. American Psychiatric Association 2017.

Blasco-Fontecilla, Hilario. “On Suicide Clusters: More than Contagion.” The Australian and New Zealand Journal of Psychiatry 47, no. 5 (May 2013): 490–91. https://doi.org/10.1177/0004867412465023.

California. Petitions to the Superior Court and Access to the End of Life Option Act. 9 CCR §4601 (2016).

Carmichael, Victoria, and Rob Whitley. “Media Coverage of Robin Williams’ Suicide in the United States: A Contributor to Contagion?” PLOS ONE 14, no. 5 (May 9, 2019): e0216543. https://doi.org/10.1371/journal.pone.0216543.

Colorado End-of-Life Options Act, Year One 2017 Data Summary. Available at: https://drive.google.com/open?id=1kBXgAFzHl6kcfsvtLHfOQ94Unk9mDa-  Accessed February 2, 2020

Connecticut Division of Criminal Justice. Written Testimony Regarding HB7015. 2015. Available at https://www.cga.ct.gov/2015/JUDdata/Tmy/2015HB-07015-R000318-Division%20of%20Criminal%20Justice%20-%20State%20of%20Connecticut-TMY.PDF. Accessed February 4, 2020

Dance, Scott. 2014. “Maryland Strips Doctor of License for Assisting in Six Suicides - Baltimore Sun.” Baltimore Sun, December 30, 2014. https://www.baltimoresun.com/health/bs-hs-suicide-doctor-20141230-story.html.

Death with Dignity National Center. Stories. Available at: https://www.deathwithdignity.org/stories/  Accessed February 2, 2020.

Johnson, Will. 2016 “Brittany Maynard’s Story Sends the Wrong Message to Young People.” Accessed February 2, 2020. https://www.choiceillusioncolorado.org/2016/10/brittany-maynards-story-sends-wrong.html.

Lewis, Penney, and Isra Black. “Reporting and Scrutiny of Reported Cases in Four Jurisdictions Where Assisted Dying Is Lawful: A Review of the Evidence in the Netherlands, Belgium, Oregon and Switzerland.” Med Law Int 13, no. 4 (2013): 221–39.

Marzuk PM, Tardiff K, Hirsch CS, Leon AC, Stajic M, Hartwell N, Portera L (1993) Increase in suicide by asphyxiation in New York city after the publication of Final Exit. N Engl J Med 329:1508–1510.  https://doi.org/10.1056/NEJM199311113292022

Munson, Kyle, and Jason Clayworth. 2016. “Suicide with a Helping Hand Worries Iowans on Both Sides of ‘Right to Die.’” Des Moines Register, November 25, 2016. https://www.desmoinesregister.com/story/news/investigations/2016/11/25/too-weak-kill-herself-assistance-legal/92407392/.

Oregon. Death With Dignity Annual Reports. Available at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/ar-index.aspx Accessed February 2, 2020
Oregon Health Authority. 2018. Responses to Fabian Stahle. Available at: https://drive.google.com/file/d/1XopTDjBA2SAVBGBxpDazNN899eTHixSe/view. Accessed February 4, 2020

Shreiber, J, and L Culpepper. 2020. “Suicidal Ideation and Behavior in Adults.” Up-to-Date, January. https://www.uptodate.com/contents/suicidal-ideation-and-behavior-in-adults.

Assisted suicide by Zoom

This article was published by First Things on June 5, 2020

*Sign the petition: Healthcare regulations must not permit assisted suicide approvals by telehealth (Link).

By Wesley J Smith

Those who advocate the legalization of physician-assisted suicide always claim that doctor-prescribed death will involve a meticulous process of intimate conversations and hands-on examinations by qualified physicians. They promise that patients who request assisted suicide as a solution to illness or disability will receive a physical to determine the extent of the disease. If declared terminally ill, the patient must next be referred for a second opinion. Only then can the doctor dispense the lethal prescriptions.

But once it’s legal for doctors to prescribe poison, opinions about death and suicide quickly change. Assisted suicide boosters come to see “protections” as unjust “barriers” to attaining a “peaceful death.” This leads to cutting legal corners and breaking public policy promises.

The COVID-19 crisis has provided a pretext for further eroding supposedly ironclad guidelines. When the crisis first hit, assisted suicide advocates wrung their hands because people would be unable to access the medical examinations necessary to obtain doctor-prescribed death. Technology to the rescue! The American Clinicians Academy on Medical Aid in Dying—a newly formed association of doctors who assist suicides—recently published formal guidelines that permit doctors to assist suicides via the Internet. These guidelines state that examination should include a review of medical records and a video meeting via Zoom or Skype. The second opinion can simply be done by phone. This means that assisted suicides will be facilitated by doctors who never actually treated patients for their underlying illness, who may be ignorant of their family situations and personal histories, and who have never met their patients in the flesh.

Tele-assisted suicides have already been done. An article published in The Conversation quoted a doctor who quietly began doing streamed suicide consultations years before the COVID pandemic began.

“My patients love telemedicine,” Dr. Carol Parrot, a physician who lives on an island in Washington, told me during a Skype interview in 2018. “They love that they don’t have to get dressed. They don’t have to get into a car and drive 25 miles and meet a new doctor and sit in a waiting room.”

Parrot says she sees 90% of her patients online, visually examining a patient’s symptoms, mobility, affect and breathing. “I can get a great deal of information for how close a patient is to death from a Skype visit,” Parrot explained. “I don’t feel badly at all that I don’t have a stethoscope on their chest.”

Parrot told the interviewer that she “sometimes” consults the suicidal patient’s primary care physician. This means that she sometimes does not even bother to discuss the patient with the medical professional most familiar with the patient’s case.

*Sign the petition: Healthcare regulations must not permit assisted suicide approvals by telehealth (Link).

The dichotomy between advocates’ easy promises and actual practice was apparent long before the COVID crisis. In Oregon, where assisted suicide has been legal since 1994, one of the so-called “protective guidelines” requires doctors to refer patients for psychological “counseling” if the prescribing physician suspects that the patient has a mental condition “causing impaired judgment.” Alas, this supposed protection has proved specious. Few physicians ever make these referrals, and when they do, the resulting consultation is often superficial.

Here’s an example. In 2008, an article in the Michigan Law Review—written by the late suicide expert Herbert Hendin and Kathleen Foley, perhaps the nation’s foremost palliative care doctor—described the assisted suicide of Joan Lucas. Lucas tried to kill herself after being diagnosed with Lou Gehrig’s disease, but failed. She next sought assisted suicide. The death doctor referred her to a psychologist only “to protect my ass.”

The consultation was hardly a professional interaction. From the article:

The doctor and the family found a cooperative psychologist who asked Joan to take the Minnesota Multiphasic Inventory, a standard psychological test. Because it was difficult for Joan to travel to the psychologist’s office, her children read the true-false questions to her at home. The family found the questions funny, and Joan’s daughter described the family as “cracking up” over them. Based on these test results, the psychologist concluded that whatever depression Joan had was directly related to her terminal illness, which he considered a completely normal response.

In other words, the psychologist never personally saw the patient and never considered suicide prevention. As Foley and Hendin wrote, “The psychologist’s report in Joan’s case is particularly disturbing because ‘on the basis of a single questionnaire administered by her family, he was willing to give an opinion that would facilitate ending Joan’s life.’”

Promises were broken in Oregon's very first doctor-prescribed death in 1997. Assisted suicide boosters always depict such deaths as taking place in the context of long-term, caring relationships between doctor and patient. But according to Issues in Law and Medicine, when “Mrs. A” was diagnosed with cancer and asked for assisted suicide, her treating physician refused. So she simply went doctor shopping. A second doctor also declined and diagnosed her as depressed. She then contacted an assisted suicide advocacy organization that referred her to a new doctor—one known to be a proponent of physician-assisted suicide. This doctor gave Mrs. A the deadly injection a mere two and a half weeks after first meeting her.

Even when patients do not qualify legally for doctor-assisted death based on the nature or extent of their illness, advocates for euthanasia and assisted suicide manage to find ways around the diagnostic impediment. Canada permits lethal injection euthanasia only if death is “reasonably foreseeable.” But what about people whose deaths are not foreseeable? No worries—they can receive a lethal jab too. An ethics opinion from the College of Physicians and Surgeons of British Columbia decided that patients who are not eligible under current law for euthanasia can become eligible by starving themselves until they are sufficiently weakened and death becomes “reasonably foreseeable.”

What can we learn from all of this? “Protective guidelines” serve mainly to give a wary society a false sense of security about assisted suicide. But once we accept suicide as an acceptable answer to suffering caused by illness or disability, our attitudes toward death become so warped that obtaining suicide for requesting patients quickly becomes the overriding priority. Over time, practices become progressively unregulated—and nobody much cares.

Because many state legislatures are not in session due to the COVID crisis, attempts to legalize assisted suicide in states like New York, Massachusetts, and Maryland are temporarily paused. But these proposals have not gone away. When the political battle resumes, we will again hear many blithe assurances of strong protections. But history demonstrates that “protections” matter little once it is legal for doctors to help patients kill themselves.
More articles on this topic:

• Stop assisted suicide by telehealth (Link).
• Assisted suicide by telehealth and medical misdiagnosis (Link).

Maryland assisted suicide bill will be decided by three undecided Senators.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Maryland Senate

In 2019, the Maryland assisted suicide bill failed in the Senate by a tie vote of 23 to 23.

David Collins with WBALTV reported that the fate of this years assisted suicide House Bill HB 0643 and Senate Bill SB 701 will be in the hands of three undecided Senators. According to Collins:

Three senators who are on the fence may control the bill's fate: Sen. Jim Rosapepe, a Democrat who represents District 21, which encompasses portions of Prince George's and Anne Arundel counties; Sen. Obie Patterson, a Democrat who represents Prince George's County's 26th District; and Sen. Charles Sydnor, a Democrat who represents Baltimore County's 44th District.

Contact these three Senators and encourage them to oppose assisted suicide.

Jim Rosapepe: Jim.Rosapepe@senate.state.md.us

Obie Patterson: obie.patterson@senate.state.md.us

Charles Sydnor:  charles.sydnor@senate.state.md.us

Collins reported on the supporters and members of the group Maryland Against Assisted Suicide.
According to the report:

"You'll hear proponents of this law say, 'It's all about freedom of choice, it's my right, my life.' Well, I can tell you firsthand that these laws reduce your rights to care," said Dr. T. Brian Callister, a professor at the University of Nevada, Reno School of Medicine, and director of Medical Student Rural Education. 

"The lethal drugs used in assisted suicide have never been scientifically tested, and the U.S. (Food and Drug Administration) has never approved any drugs for this purpose," Dr. Joseph Marine, vice director of the division of cardiology at Johns Hopkins University. 

"No one who claims to be a healer should offer death as if it is an option on a menu to choose from depending on how one feels in the moment," said Sherman Gillums Jr., chairman of the federal Veterans' Families, Caregiver and Survivors Advisory Committee.

House Bill HB 0643 and Senate Bill SB 701 may permit euthanasia. Most of the new assisted suicide bills have language that allows a wider interpretation.

The Maryland bill is designed as an application process for obtaining a lethal dose. Most assisted suicide bills state that the person self-administer the lethal dose, making it an assisted suicide.

The Maryland assisted suicide bill does not require the person to "self-administer" the lethal drugs but rather the bill says "may self-administer."

When examining the bill further the potential for euthanasia becomes more clear. The assisted suicide bill § 3–103 states:

A licensed health care professional does not violate § 3–102 of this subtitle by TAKING ANY ACTION in accordance with Title 5, Subtitle 6A of the health – general article.

This paragraph can be interpreted to provides full legal protection for Health Care Professionals who administer the lethal drugs.

Another addition to the recent assisted suicide bill is the acknowledgement that it may take at least 3 hours to die.

Current lethal drug cocktails may cause painful assisted suicide deaths that may take many hours to die.

Assisted suicide lobby researchers are working on their third generation of lethal drug cocktails. The results of the first two experimental lethal drug cocktails were:

The (first) turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain. The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients — and up to 31 hours in one case.The first two lethal drug cocktail experiments failed to provide a painless, fast death.

People who participate in these lethal drug experiments have consented to ingesting the lethal drugs, but are they consenting to participate in human experimentation?

Vote no to assisted suicide.

Marylanders need health care, not assisted suicide

This article was published by the Frederick News Post on February 17, 2020.

By Katie Collins-Ihrke is the executive director of Accessible Resources for Independence, the Center for Independent Living in Anne Arundel and Howard counties.

The Maryland Legislature is expected to again consider an “end-of-life option” bill in its new session. Once again, disability activists will be a prominent part of the coalition to oppose the bill as a discriminatory overlay to a beleaguered and inequitable health care system.
The bill, an assisted-suicide bill, authorizes health care providers to write lethal prescriptions for people who are considered terminally ill, and grants broad legal immunity to everyone involved in their deaths. It does not provide medical and palliative alternatives. The only course of action it facilitates is death.

People have every right to say no to treatment they don’t want. However, there is a sharp distinction between a patient deciding when not to have life-prolonging treatment and a doctor actively prescribing lethal drugs for the purpose of directly causing the patient’s death. As Dr. Joseph Marine, professor at Johns Hopkins University School of Medicine, has stated, assisted suicide:

“is not medical care. It has no basis in medical science or medical tradition ... the drug concoctions used to end patients’ lives … come from the euthanasia movement and not from the medical profession or medical research.”

Physician-assisted suicide is depicted by its supporters as a choice for patients who have tried everything; however, many Marylanders do not have access to “everything.” The medical system is focused on reducing costs as it remains profit-driven. Many people struggle to obtain basic care. Yet there still are “quality of life” prejudices against elders and people with disabilities, and people of color still cope with deadly health disparities. Survival rates for cystic fibrosis, for example, vary depending on the type of insurance a person has available. With the system so broken and no consensus about solutions either on the state or federal level, it is inherently dangerous to legalize assisted suicide for any class of patients.

Data from Oregon indicates that the leading reasons people request lethal prescriptions are unrelated to pain or unbearable suffering, but rather to factors such as perceived lessening of autonomy or dignity. These issues are difficult but they can be addressed by programs promoting greater access to consumer-directed home aide support and respite care, and a change in attitudes about human interdependence. The disability community has shown that severe physical limitations can be managed to maintain one’s enjoyment of life.

It is telling that supporters of last year’s assisted-suicide bill were critical to the point of abandoning the bill when quite minimal patient protections were added to it. Their concern seemed to be not in avoiding needless premature deaths, but in preventing delays and expenditure of resources. For example, a desire to die may be fueled by depression or other psychosocial factors causing suicidal ideation. But some proponents objected to a requirement that a person get a psychiatric evaluation before being given a lethal prescription because “There is a severe shortage of mental health professionals in Maryland,…[especially] in rural areas.” This seems like a tacit admission that Maryland residents may be underserved in their mental health needs at a time when they need services the most.

“End-of-life option” bills are consistently marketed to the public as applying only to people who are expected to die within six months, not to people with chronic illnesses or disabilities. But buyer, beware! Apart from the fact there is no way to prevent mistakes in diagnosis, even when more than one doctor is involved, the term “terminal illness” can be surprisingly elastic. An Oregon health official has written that conditions can be deemed terminal even if there is lifesaving treatment, but the person is uninsured or cannot afford it. This includes diabetes and other serious conditions which can be medically managed.

Curiously, last year’s proponents of the Maryland bill opposed an amendment to add terms like “irreversible” and “progressive” to the definition of terminal illness. Moreover, a recent medical commenter in the Baltimore Sun has urged that Maryland follow not Oregon, but Canada, which allows both assisted suicide and active euthanasia and which is dropping any requirement that death be “reasonably foreseeable,” thus offering assisted death to anyone with a significant health problem or permanent disability.

Disability advocacy organizations are against giving doctors the authority to write lethal prescriptions, regardless of how an assisted suicide bill is written. Catchphrases can’t change the fact that mistakes, coercion and abuses will occur. We aim for a more equitable and supportive health system which gives people true options so they can live as well as they can for as much time as they naturally have.