It’s generally held that the first tenet of the practice of medicine is that one should “Do no harm.” That phrase, however, isn’t actually part of its common attribution to the Hippocratic Oath which rather pledges physicians to abstain from all intentional wrong-doing and harm. The distinction’s important because so much of medical treatment frequently causes patient injury, whether as a statistical given or an inevitable side effect. Every pill I’ve ever taken has had an accompanying warning of all the dangers such a prescription might entail. One television commercial after another similarly advertises the benefits of miraculous drugs while simultaneously listing myriad possible collateral complications, including death. To actually abstain from doing any possible harm would require healthcare professionals to limit themselves to a very narrow realm of medical intervention. 

Medicine routinely involves calculated risk. Surgery’s invariably invasive. Real-world medicine, best practiced, is to do as little harm as possible in achieving the best overall health of those being treated. If doctors really did no harm, we wouldn’t have an opioid crisis. Unfortunately, pain’s part and parcel of even modern medicine and its management is all too often a double-edged sword in combating illness. Without such management, many would simply forgo treatment regardless that their mortality be in jeopardy. 

If that’s the case when death’s merely a considered possibility and recovery a very real probability, why is it that some argue that unmanageable pain and suffering should be an accepted life experience when impending death is absolutely certain to be the outcome? Why is a physician’s administration of harmful medicine OK when the patient often doesn’t even realize the possible adverse effects and it has no guarantee of a remedy, but not OK when its dosage is assured to end the torture of an incurable impending death and is the expressed wish of the afflicted who, still mentally competent, assumes complete responsibility for its self-administration? 

The answer is that Maine hasn’t yet joined California, Colorado, the District of Columbia, Hawaii, Montana, New Jersey, Oregon, Vermont and Washington state in allowing a more humane choice in how one exits this existence. Not an exit stripped of compassion and dignity, filled with humiliation, pain, and merciless fear, but a departure granted the freedom of making one’s own determination has to the best practice of living one’s own demise. A death still capable of love. 

Once by citizen initiative and twice by legislative bills, Mainers have come close to approving medically assisted self-determined right-to-die legislation. 2000’s Ballot Question 1 was narrowly defeated, 51 to 49%. 2015’s LD 1270 was approved 76 to 70 by the Maine House, then defeated 18-17 in the Senate. 2017’s LD 347 passed the Senate 16 to 15, then lost 61-85 in the House despite having 73% of Mainers in favor of passage. 

Now, LD 1313 is the currently crafted Maine Death with Dignity proposed legislation to allow medically and legally qualified terminally ill Mainers the option to end their suffering peacefully, with grace and personal sovereignty where and when they choose. It specifically safeguards against its fatal palliative purpose being misused as a means of euthanasia or suicide. 

Testimony recently given before the legislature’s Health and Human Services Committee regarding LD 1313 exhibited the ongoing confusion many have as to both the actual law itself and the outcome of its implementation elsewhere. Most of the arguments presented against passage reflected personal biases based on fears, assumptions and conjecture unsupported by the law’s 21-year history. Imagined scenarios of “slippery slopes” leading to patient abuse and societal detriment simply haven’t occurred. Hospice care still thrives. Religious faith endures. No one’s died that wouldn’t have died if such a law hadn’t been put in place. No life ended that would have been enriched by being forced to suffer interminably because of someone else’s moral discomfort. No reasonable connection’s been made between the statistically small number of patients ultimately utilizing the law and the rise of actual suicides population-wide. The value of life has in no way been diminished by those choosing to hasten a no return journey they never chose to embark on so that the ride need not be so cruelly demeaning. 

All who testified displayed utmost civility and respect for opposing views. Most had difficulty controlling their emotional investment in the debate over what one person graciously described as “the irreducible differences in moral perspectives.” The two most memorable takeaways for me were a singularly stoic request to “Please allow me to die in Maine.,” and the sanguine invitation that “It’s time for the people of Maine to show compassion for each other.” 

Prolonging end-of-life suffering has no medical or moral justification. Whether one’s a doctor, family member or legislator, preventing those terminally ill from exercising their remaining free will to legally end their needless misery is to do harm. 

Death with Dignity isn’t about suicide’s choice of death over life. It’s about accepting that an unwanted ending to life needn’t be torturous and beyond our control. It’s about affirming and respecting the unique preciousness of each individual life facing the inalterable apolitical reality of imminent death. 

Gary Anderson lives in Bath.