L.D. 347 and L.D. 1066






Joint Standing Committee on Health & Human Services

Room 209, Cross State Office Building

Wednesday, April 5, 2017, 9:30 a.m.

Good morning Senator Brakey, Representative Hymanson, and Members of the Joint Standing Committee on Health & Human Services.  My name is Gordon Smith and I serve as Executive Vice President of the Maine Medical Association.  I am here today to testify “neither for nor against” L.D. 347, An Act to Support Death with Dignity and L.D. 1066, An Act to Promote Life with Dignity.

The Maine Medical Association is a professional organization representing more than 4000 physicians, residents, and medical students in Maine whose mission is to support Maine physicians, advance the quality of medicine in Maine, and promote the health of all Maine citizens.

The question whether physicians should be permitted to assist a patient in ending his or her life at a time and place of his or her choosing poses ethical challenges for us as a society and for the physician community as a component of our society.  I am testifying “neither for nor against” these bills today because a forum on the topic at our office on Tuesday, March 28th and a SurveyMonkey poll of our membership conducted between Friday, March 31st and Tuesday, April 4th suggest that physician opinion on this topic is evenly divided – and this division undoubtedly reflects our broader society.  We have decided the MMA Board of Directors should review the Association’s current position in opposition to assisted death at its next regular meeting scheduled for Wednesday, April 26, 2017.

I want to thank the prime sponsors of the two bills, Senator Roger Katz (R-Kennebec) and Representative Jennifer Parker (D-South Berwick) for their passionate interest in this topic and patient self-determination.  In addition to Senator Katz and Representative Parker, Representative Hymanson and several other legislators participated in our recent forum and contributed to the discussion.

The ethical dilemma for physicians presented by “assisted death” has its roots in the Hippocratic Oath which includes the caution known by all of us as patients – “First, do no harm.”  The long-standing ethical principle on this topic is Opinion 5.7, Physician-Assisted Suicide of the AMA’s Code of Medical Ethics and I have attached this Opinion to my testimony.  No national or state physician organization in this country has issued a policy statement in favor of assisted death although some have dropped their opposition. The MMA’s standing policy statement in opposition to assisted death is a Resolution passed by the MMA House of Delegates at its Annual Session on September 9, 2000 prior to Question 1 on the November 7, 2000 ballot.  Maine voters narrowly defeated this assisted death ballot initiative.  I also have attached this Resolution to my testimony.

The rationale underlying physician organization’s traditional opposition to assisted death initiatives is a strong belief in the value of hospice and palliative care to dying patients and their families.  During the late 1990s, the AMA, recognizing the need for more education of physicians about compassionate end-of-life care, developed a curriculum called, “Educating Physicians on End-of-Life Care” or EPEC.  While the State of Maine has made progress in improving access to hospice and palliative care since that time, we still need to do more.  Physicians also accept that the concept of “double effect” is an acceptable component of compassionate end-of-life care.  This concept means that proper pain control at the end of life may also have the effect of hastening the patient’s death.  Against this rationale for our traditional position is a patient empowerment movement that has been growing for nearly two decades, with support from the medical community.  Within this movement is increasing advocacy for patient autonomy and self-determination in one’s time of death.  But, as powerful as this movement is, there are legitimate concerns within the disability advocacy community that also need to be taken into consideration.

The MMA Board of Directors will consider both perspectives on assisted death and will attempt to resolve the ethical dilemma.  We will participate in your work sessions on these bills and will keep you informed of the results of our discussions on the topic.  Thank you for considering my testimony and I would be happy to respond to any questions you may have.