Decisions about Death

March 26, 1993

There was a time when deathbed scenes were occasions for families to gather around a loved one to assure as peaceful a passage from life as possible. Now medical technology has turned many such scenes into nightmarish vigils over people whose only sign of life is a beep on a machine.

Current Maryland law provides little guidance in these situations. In a recent decision involving custody of a man in a persistent vegetative state, the Court of Appeals noted that legislatures, not courts, are the proper place to debate the societal values that should influence life-and-death decisions.

Fortunately for Marylanders, there has been a lively public debate on these issues, spurred in large part by a conference on right-to-die legislation held last November at the University of Maryland School of Law. Today, legislation that emerged from groups represented at the conference faces key votes in both houses of the General Assembly.

Both bills would provide a framework for end-of-life decisions and update current law in several key areas. Maryland is one of only three states that does not provide for a durable power of attorney for health care matters -- the power to appoint a surrogate to make decisions in the event a person becomes incapacitated. Moreover, the state's living will statute, allowing for life-prolonging treatment to be withheld or withdrawn, does not cover many common situations, such as advanced Alzheimer's disease or a persistent vegetative state.

The measures before the legislature would update Maryland's provisions for living wills and power-of-attorney documents, but fTC they address larger questions as well. Some history: Competing bills were introduced in each house that contained important differences in several areas. Drafted by a group headed by Judge John Carroll Byrnes of the Baltimore City Circuit Court, those measures took great pains to address potential abuses, such as situations in which people have no close family or friends to be their advocates, or cases in which families are clearly dysfunctional.

Those concerns are valid, but critics successfully argued that the alternative bills now under consideration have adequate safeguards and that the Byrnes approach would put an undue burden on the majority of families. Moreover, current evidence suggests the larger problem is not undertreatment of dying patients but overtreatment.

The bills under consideration today are modeled on a Virginia law that has worked well there. They are concise and easily understood by families, physicians and health care institutions. These are important bills, and they reflect the kind of compromises that characterize a sound and thorough debate. We urge a swift passage, so that state law will at last provide clear guidance to all the families who will some day need it.

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