Sunday, February 03, 2019

End of Life Options Act is better this year

By Mathew Goldstein

This year’s End of Life Options Act bill is a significant improvement over the bill offered two years ago. The procedure for the patient and the doctors are mostly the same as before. The difference is that various omissions in the original bill have been corrected so that we now have a comprehensive law that covers most of the forseeable issues and complications, such as dispensing with unused medication, recording and reporting the implementation of the law, the insurance impact, and health care facility opt-out details. It is apparent when reading the bill that considerable effort was made to protect the interests of all involved. The End of Life Options Act provides a procedure for people who have been diagnosed to probably die within six months from a fatal illness to hasten their deaths by overdosing on barbiturates. If you agree then visit the Secular Coalition for Maryland lobby page to send an email to the committees considering this bill, and the Death with Dignity Maryland action page to send emails to your state lawmakers, requesting that they approve it.

There are a few weaknesses with the current bill. One flaw is that the provision for dispensing with unused medicine is somewhat vague, I think it can be strengthened. However, the problem of properly dispensing with unused medicine transcends this particular bill and may need a separate bill to address fully.

There is an imbalance in how this bill protects institutional level freedom of conscience. This imbalance is not unique to this bill, it is also found elsewhere in existing Maryland law. There is a right of conscience at the individual level that is overridden by the institutional right of conscience provision. Freedom of conscience is not a one way street that applies selectively only to institutions opposed to a legal medical procedure. Accordingly, when non-public institutions objecting to some medical procedures can mandate employee refusal to provide them on freedom of conscience grounds it follows that non-public institutions that support those same medical procedures should likewise be permitted to mandate employee agreement to provide them. The latter provision is missing from this bill. An institutional level right of non-refusal is also missing from HEALTH-GEN. § 20-214. That law grants health care providers in Maryland a conscience right of refusal to provide all of their customers with "artificial insemination, sterilization, or termination of pregnancy".

Although Maryland has few publicly controlled health care provider institutions, it would be better if refusal conscience law that apply to employment policies of entire institutions explicitly excludes publicly controlled institutions. There should be a legal requirement that all institutional wide right of refusal and right of non-refusal policies be publicized so that patients can easily identify which health providers have such policies. The public has a need to know what health care services will or will not be provided by particular health care providers whenever the law renders the provision of those services optional.