Governor Janet Mills today signed LD 1313, known as the Death with Dignity Act, into law. The law establishes the procedures to allow those with a terminal illness and a short time to live to be prescribed medication to end their life. These procedures include, among others, two waiting periods, one written and two oral requests, a second opinion by a consulting physician and a psychological evaluation. Similar legislation is in place in Oregon, California, Colorado, Vermont, Washington, Hawaii and Washington, D.C.
To complement the law, Governor Mills also signed Executive Order Number 9 requiring the Department of Health and Human Services to report all actions taken by licensed physicians and others to track the use of lethal medications permitted by LD 1313 over the course of the upcoming months and years, including any medical, sociodemographic or geographic factors and trends to ensure that the personal liberty and autonomy of all Maine people is protected.
“It is not up to the government to decide who may die and who may live, when they shall die or how long they shall live,” said Governor Mills prior to signing the bill. “While I do not agree […] that the right of the individual is so absolute, I do believe it is a right that should be protected in law, along with protections for those who are unable to articulate their informed choices and those who do not have access to quality end of life care.
It is my hope that this law, while respecting the right to personal liberty, will be used sparingly; that we will respect the life of every citizen, with the utmost concern for their spiritual and physical well-being, and that as a society we will be as vigorous in providing full comfort, hospice and palliative care to all persons, no matter their status, location or financial ability as we are in respecting their right to make this ultimate decision over their own fate and of their own free will.”
The law will go into effect 90 days after the adjournment of the Legislature. Executive Order Number 9 takes effect immediately.
Governor Mills’ complete set of remarks, as prepared for delivery, are below:
“It is difficult to speak about death on days such as these, as late spring lifts up dormant life and summer invites us to happier times.
Some say that dusk is both the most beautiful and the most troublesome time of the day. That is why the subject of impending death, the dusk of our days, is difficult.
Today we deal with a bill -- commonly called “physician assisted suicide” or “death with dignity” -- that purports to address the decisions relating to end of life care, the dusk of our lives.
The basic principles for and against this bill are these:
Those in the shadows of life — as all of us shall be at some time — deserve the highest level of care, compassion and caution from those in charge of society’s resources; from those in charge of its rules, laws and mores.
For those unable to care for themselves -- of whatever age, ability or capacity -- society has a paramount responsibility. It is society’s role, both governmental and charitable, to lift people up, to give people the means to pursue the highest level of self-sufficiency, happiness and opportunity.
A law that permits the act of suicide by those nearing the end of life could be seen as an abdication of this responsibility.
On the other hand, there are those who say that what government must provide — and all that it should provide — is the protection of personal liberty to the extent that the exercise of that liberty does not infringe on the rights and security of others. The opportunity for someone of sound mind facing imminent death to avoid further suffering is viewed by some purely as an act of personal liberty, a decision with which government should not interfere.
In the context of L.D. 1313, the pursuit of individual liberty beseeches us to authorize in law an act of suicide with the assistance of the medical profession.
An individual would be free, without punishment of law, to ingest a lethal amount of a nonprescription drug, or to terminate one’s life in some other manner, were it not for the requirement of the prescribing of a lethal dosage of a drug.
So the assistance of the medical professional presents a moral dilemma for many in the health care profession and for spiritual leaders who caution against suicide in any form, who caution against government placing its stamp of approval on actions that may devalue life and against the participation and assistance of government and licensed professionals in life-taking measures.
On the other side of the moral dilemma is the fact that medicine has found ways to prolong life way beyond the expectancies of the past. What sometimes attends that extended life, and extended disease, is extended suffering, pain, great physical and mental discomfort.
What is the balancing of rights then, when an individual, in the throes of suffering and facing certain death, but while still competent, wishes to end life, denying death its ultimate pain?
Some argue that enactment of L.D. 1313 equates to the government authorizing taking life, or “playing god” with the lives of our citizens.
It is not up to the government to decide who may die and who may live, when they shall die or how long they shall live. It is our duty to provide the most comprehensive end of life care possible, a task we have only recently begun to recognize. But what is the responsibility of society when compassionate end of life care may not be adequate or accessible?
We also have a duty to prevent people from being victimized, to prevent discrimination against persons with disabilities, to make sure others do not take advantage of vulnerable citizens.
Despite the narrowest of votes in the House of Representatives, L.D. 1313 appears to be favored by a majority of Maine people surveyed, and it includes some, though not all, safeguards to protect the decision-making of competent terminally ill patients and to protect misuse and abuse of lethal medications and the diversion of dangerous drugs.
This right to decide the means of ending one’s life by lethal prescription may be seen as an extension of the right to decline life-sustaining care articulated by the 4-3 majority of the Maine Supreme Judicial Court more than thirty years ago in In Re Gardner, 534 A.2d 947 (Me. 1987). The Court found that the law recognizes a previously competent patient’s “right of self-determination in matters of health care to be essential to the integrity and dignity of his person.”
In arriving at this conclusion, Chief Justice McKusick pointed to the classic articulation of individual autonomy by John Stuart Mill:
“‘The only part of the conduct of any one, for which he is amenable to society, is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over his own body and mind, the individual is sovereign.’
While I do not agree with John Stuart Mill that the right of the individual is so absolute, I do believe it is a right that should be protected in law, along with protections for those who are unable to articulate their informed choices and those who do not have access to quality end of life care.
After weighing these concerns then, and perhaps for other reasons I am unable to articulate today, I have decided to sign LD 1313.
For all of these concerns, however, I am also issuing Executive Order Number Nine, which requires the Department of Health and Human Services to engage in Emergency Substantive Rulemaking within the next few months. The broad purposes of this Executive Order are to provide a high level of protection for those in care and of those who shall be in care; to track trends in the utilization of the law; to pursue our responsibility for end of life care; and to avoid the moral and social consequences of a law that in some way could facilitate the taking of life without the full authority of the individual.
It is my hope that this law, while respecting the right to personal liberty, will be used sparingly; that we will respect the life of every citizen, with the utmost concern for their spiritual and physical well-being, and that as a society we will be as vigorous in providing full comfort, hospice and palliative care to all persons, no matter their status, location or financial ability, as we are in respecting their right to make this ultimate decision over their own fate and of their own free will.