NCD letter to Maryland legislature regarding assisted suicide
February 26, 2020
Judicial Proceedings Committee
Maryland Senate
Miller Senate Office Building
2 East Wing
11 Bladen St.
Annapolis, MD 21401
RE: HB 643 / SB 701 (“End of Life Option Act”)
Dear Chair Smith, Vice-Chair Waldstreicher, and Members of the Judicial Proceedings Committee:
I write to you as the congressionally-appointed Chairman of the National Council on Disability – an independent, nonpartisan federal agency charged with giving advice to the President and the U.S. Congress on matters affecting the lives of people with disabilities – and as a long-time former Maryland resident to make you aware of our recently released federal study, The Danger of Assisted Suicide Law,[[1]](https://ncd.gov/publications/2020/ncd-letter-md-legislature-assisted-suicide#_edn1) and recommendations regarding existing and proposed assisted suicide laws pursued by states across the country. Based upon the findings of our recent federal study, we strongly advised state lawmakers not to legalize any form of assisted suicide or active euthanasia, whether called by those terms or others, but rather to pursue a strong healthcare system that includes long term services and supports for all people, including people with disabilities with and without a terminal prognosis.
I have enclosed a copy of our recent report for you and your staff to read in its entirety, but in the interest of your committee hearing this Friday, February 28, I will briefly summarize a few of our key findings as to why we strongly caution against efforts to legalize assisted suicide.
First, although bills like HB 643 / SB 701 are promoted as ways to assist in relieving suffering at the end of one’s life, our study of available data found that the top five reasons doctors note that their patients’ give for making assisted suicide requests do not include pain or fear of future pain. Although that alone is noteworthy given the sound bites associated with the “need” for such laws, even more striking are the top five reasons given – “loss of autonomy” (95.5 percent), “less able to engage in activities” (94.6 percent), “loss of dignity” (87.4 percent), “losing control of bodily functions” (56.5 percent), and “burden on others (51.6 percent).[[2]](https://ncd.gov/publications/2020/ncd-letter-md-legislature-assisted-suicide#_edn2) To those long familiar with disability policy, these all sound like cries for help warranting examination of existing policies and resources. That these options are even available as boxes to check in the Oregon state reports indicate that these are viewed as acceptable reasons for people to seek to end their lives with assistance, even though each one is a disability-related psychological expression that, from a policy perspective, can and should be addressed through health care and supports and services, just as if a person with a disability who is nonterminal had made the same expression. Legalizing assisted suicide removes the impetus to address underlying policy concerns that these reasons suggest may exist.
Second, assisted suicide laws contain provisions purporting to safeguard patients from problems and abuse, but research in our report showed that these provisions are wholly ineffective and often fail to protect patients in a variety of ways, including:
- Though promoted as creating choice for people at the end of life, in states where assisted suicide is legal, insurers have denied expensive, life-sustaining medical treatment for those who seek to fight their illness or simply lengthen their lives, but have offered to subsidize the lethal assisted suicide drugs, foreclosing choice and potentially leading to patients hastening their deaths.
- Misdiagnoses of terminal disease and/or of prognosis can also cause frightened patients to hasten their deaths. I am a living example of this, having vastly outlived the original prognosis I was given for my cancer.
- People who experience depression are at increased risk of harm where assisted suicide is legal.
- Assisted suicide laws apply the lowest legal culpability standard available to doctors, medical staff, and all other involved parties – that of a good faith belief that the law is being followed – which creates incredible potential for abuse.
Third, with strict privacy and confidentiality provisions, assisted suicide laws heavily restrict the collection and analysis of data, which prevents meaningful oversight. Where assisted suicide is legal, states have no means of investigating mistakes or even reports of abuse. Another significant problem with the data collection is the secrecy created by a common provision in assisted suicide laws for the last decade that requires that death certificates be falsified by physicians so that they do not show assisted suicide as the actual cause of death but rather the underlying disease or disability. In fact, in 2015 and 2019, that common provision in the Connecticut bill prompted that State’s Division of Criminal Justice to enter the debate. Although they did not take a position on the overall bill, the Division asked the legislature to delete that provision because they noted that it “effectively mandates the falsification of death certificates under certain circumstances… The practical problem for the criminal justice system and the courts will be confronting a potential murder prosecution where the cause of death is not accurately reported on the death certificate.”[[3]](https://ncd.gov/publications/2020/ncd-letter-md-legislature-assisted-suicide#_edn3)
Fourth, despite the restricted data available, there is already ample evidence of problems in states that have legalized the practice. In addition to anecdotal evidence detailed in NCD’s report, in the limited state data available from Oregon, where assisted suicide has been available the longest time, except for the first year, people whose illnesses did not result in death within six months have received lethal prescriptions in all 20 years the law has been in effect.[[4]](https://ncd.gov/publications/2020/ncd-letter-md-legislature-assisted-suicide#_edn4) And far from only being for those with supposed terminal illnesses, data from Oregon shows that scores of people with a host of conditions that when treated are not at all terminal nonetheless accessed the lethal drugs. These conditions included people with diabetes, arthritis, kidney failure, and gastrointestinal diseases, amongst many others.[[5]](https://ncd.gov/publications/2020/ncd-letter-md-legislature-assisted-suicide#_edn5)
Fifth, couple these grave shortcomings with the fact there is no required evidence of consent or self-administration of the lethal drugs, though required as a purported safeguard, and there is really no way for authorities to know whether the lethal dose was self-administered and consensual at the time of its ingestion. In Oregon, the state with the longest record, in about half the cases, no healthcare provider was present at the time of ingestion of the lethal drugs or at the time of death.[[6]](https://ncd.gov/publications/2020/ncd-letter-md-legislature-assisted-suicide#_edn6)
NCD’s The Danger of Assisted Suicide Laws report details many individual examples of the dangers outlined in this letter and many others. I strongly urge your careful reading of our report in its entirety and your consideration of the its findings and recommendations as you deliberate HB 643 / S 701 on Friday and reiterate that NCD, as a longstanding federal advisory body, and on the basis of its most recent research, recommended state legislatures not pass such laws.
Thank you for your time and consideration. Please do not hesitate to have your staff follow up with Lisa Grubb, Executive Director at lgrubb@ncd.gov and Joan Durocher, Director of Policy and General Counsel at jdurocher@ncd.gov with any questions or concerns you may have regarding this report or any other disability policy matter.
Respectfully,
Neil Romano
Chairman
[[1]](https://ncd.gov/publications/2020/ncd-letter-md-legislature-assisted-suicide#_ednref1) National Council on Disability, The Danger of Assisted Suicide Laws (2018), </assets/uploads/docs/ncd-assisted-suicide-report-508.pdf>, accessed February 25, 2020.
[[2]](https://ncd.gov/publications/2020/ncd-letter-md-legislature-assisted-suicide#_ednref2) Oregon Death with Dignity Act, 2018 Data Summary.
[[3]](https://ncd.gov/publications/2020/ncd-letter-md-legislature-assisted-suicide#_ednref3) State of Connecticut, Division of Criminal Justice, “Testimony of the Division of Criminal Justice,” Hearing on H.B. No. 7015, Joint Committee on Judiciary, March 18, 2015. Also State of Connecticut, Division of Criminal Justice, “Testimony of the Division of Criminal Justice,” Hearing on H.B. No. 5898, Joint Committee on Public Health, March 18, 2019, https://www.cga.ct.gov/2019/PHdata/Tmy/2019HB-05898-R000318-CT Division of Criminal Justice-TMY.PDF. The Division of Criminal Justice used the same language regarding the same section number in both instances.
[[4]](https://ncd.gov/publications/2020/ncd-letter-md-legislature-assisted-suicide#_ednref4) Not Dead Yet, “Oregon State Assisted Suicide Reports Substantiate Critics’ Concerns”, May 16, 2018, http:// notdeadyet.org/oregon-state-assisted-suicide-reports-substantiate-critics-concerns. “The Oregon Health Division assisted suicide reports show that non-terminal people receive lethal prescriptions every year except the first. . . . The prescribing physicians’ reports to the state include the time between the request for assisted suicide and death for each person. However, the online state reports do not reveal how many people outlived the 180-day prediction. Instead, the reports give that year’s median and range of the number of days between the request for a lethal prescription and death. . . . In 2017, at least one person lived 603 days; across all years, the longest reported duration between the request for assisted suicide and death was 1009 days. In every year except the first year, the reported upper range is significantly longer than 180 days (six months). [Yet] the definition of ‘terminal’ in the statute . . . requires that the doctor predict that the person will die within six months.” It cannot be known whether those who took the lethal drugs within the 180 days would have lived longer had they waited longer. 78 Death with Dignity Data, Washington State
[[5]](https://ncd.gov/publications/2020/ncd-letter-md-legislature-assisted-suicide#_ednref5) Oregon Health Authority, Public Health Division, Oregon Death with Dignity Act, 2017 Data Summary, 9 including n. 2, https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/ DEATHWITHDIGNITYACT/Documents/year20.pdf.
[[6]](https://ncd.gov/publications/2020/ncd-letter-md-legislature-assisted-suicide#_ednref6) Ibid.