Choices at the End of Life

February 24, 1994

A year ago, the General Assembly waded into the complex issues surrounding end-of-life medical decisions and produced the Health Care Decisions Act, a thoroughly debated, well-reasoned bill that took effect Oct. 1. But issues surrounding the right to die are back again this year -- needlessly.

A main thrust of the new law is to make it easier for people to express their wishes about life-prolonging medical care to avoid the painful scenes in which family members, physicians and courts are left to substitute their judgment for a patient no longer competent to make decisions.

Yet a bill sponsored by Senate Minority Leader John A. Cade of Anne Arundel County seeks to impose restrictions on the ability of people to write living wills or designate a health care agent to make decisions in case the patient is incapacitated. The proposal's restrictions would fall especially heavily on older people in nursing homes. Other provisions would tighten procedures for advance directives made orally and, curiously enough, on procedures for revoking a document if a patient changes his or her mind.

There has been no abuse of the current law that warrants these restrictions. Unless such evidence surfaces, there is no justification for reversing the policy reflected in the Health Care Decisions Act of making advance directives easier for Marylanders, not more difficult.

The Senate is also facing a measure that would outlaw physician-assisted suicide. Currently, public policy opposes the involvement of a physician in enabling death to come sooner than natural causes would dictate. However, nothing in state law specifically prohibits the kind of assistance Dr. Jack Kevorkian has given to a number of people in Michigan. Meanwhile, a House of Delegates measure would take the opposite approach by legalizing physician-assisted suicide.

A recent poll found that Marylanders, by a 3-1 margin, believe physician-assisted suicide should be legal. Even so, few physicians and health care workers want that burden -- especially in the absence of health care reform that could remove financial distress or fear of financial ruin as reasons to end one's life.

The right-to-die debate in Maryland is thoughtful and productive -- in part because policy-makers have not jumped prematurely to either end of the spectrum. Let's keep it that way.

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