My wife Mary Klein underwent radical surgery and aggressive chemotherapy that almost killed her at the same time that she was lobbying nonstop for the Washington, D.C., law that allows medical aid in dying. A contradiction? No. Medical aid in dying, also known as MAID, is not suicide: It is choosing a peaceful end when all other means of living are exhausted.
Rapid technological advances in medicine have fueled the demand for more individual control in death. Doctors can sustain and prolong life far longer today, even for people with terminal prognoses. These magnificent achievements give many, many people and their families precious time together. Yet all too often, as death approaches, doctors fail. They are insufficiently trained in pain management and palliative care, let alone in the psycho-social and spiritual dimensions of dying. Needless suffering results. No one wants that. Polls consistently show that a significant majority of Americans would prefer a peaceful death at home to a drawn-out, perhaps agonizing, death in a hospital and that MAID should be an option for those who choose.
But MAID faces fierce opposition from disability advocates and the conservative right, who already have made strong headway in rolling back individual choice in reproductive rights. Opponents argue that medically assisted death for the terminally ill devalues life and that no guardrails can adequately prevent it from being used against society’s most vulnerable, the poor, elderly and disabled. They fear it opens the door to eugenics.
These are reasonable fears, ones that have been carefully considered in writing laws in the United States, including in legislation introduced in Maryland over the past decade. The laws allow only the terminally ill to request medications, not caretakers nor family members; two doctors must certify patients have six months or less to live, are requesting MAID of their own free will, are under no duress, are not psychologically distressed and can administer the drugs themselves; patients must make several verbal and written requests with waiting periods in between. These are not hasty decisions made under pressure.
Multiple lawsuits have sought to overturn state laws that permit MAID under tightly controlled circumstances. None have succeeded, but efforts continue. For example, disability rights advocates and an anorexic girl filed suit in June alleging that Colorado’s End of Life Options Act puts them at risk of being pressured into premature death.
I hear similar arguments when I lobby to protect D.C.’s Death with Dignity Act, which in the eight years since its enactment has faced continual attack. House Republicans in the latest budget showdown are trying to attach a provision to permanently ban the city from allowing the terminally ill to determine their final days. The data, however, simply do not support opponents’ fears of widespread abuse or targeting of the elderly and disabled. A National Institutes of Health study found that only 5,329 people died by MAID between 2000 and 2023 — an infinitesimally small percentage of the roughly 2.4-2.8 million people who die every year — and most suffered from cancer. The median age was 74, a slim majority were men, most had at least some college education. The profile does not match society’s most vulnerable or a sliding toward eugenics.
Thankfully, over the last 25 years, the rights of terminally ill patients to determine how they die have expanded considerably. Today, 13 nations and 12 jurisdictions in the United States allow MAID. Two decades ago, only Oregon, Switzerland and the Netherlands permitted the practice.
This remarkable change reflects several developments. Our understanding of individual liberty has grown to encompass reproductive rights and bodily autonomy, which laid the foundation for legislatures to recognize that dying falls well within the sphere of privacy and how the terminally ill face their last days should be an individual choice.
We all want dignity in how we face death. When people say to me, “But surely this is suicide?” I recall the words of my wife Mary who would reply, “I love my life. I am doing everything in my power to live. It is the cancer that is killing me and when the pain grows too great, I want to die in peace.”
She did, thanks to MAID, and I wish the same option would be available for Marylanders.
Stella Dawson is a board member of the nonprofit organization End of Life Options D.C. and a member of an advisory council for Compassion and Choices.
