Cyndie Rogers, 69, at her apartment in Gray. Rogers, who had non-Hodgkin lymphoma in 2015 and breast cancer last year, favors Maine’s new Death with Dignity Act. “Trust me, I’m not at the end of my life yet, but when the time comes, I want to be able to choose,” Rogers said. Brianna Soukup/Staff Photographer Buy this Photo

AUGUSTA — A two-time cancer survivor, Cyndie Rogers says she doesn’t want to go through a long, painful death, or put her family through the emotional agony of watching her endure that experience.

If the non-Hodgkin lymphoma or breast cancer she has battled return and become terminal, she wants the option under Maine’s new Death with Dignity Act to ask her doctor to provide her with a lethal medication.

“I’m not hoping to,” she said. “But whenever you have cancer, and especially when you have it twice, you have got to think of your end. You’ve got to.”

But Rogers, 69, of Gray has yet to find a doctor who will agree to support her wishes. One has refused, and another is “on the fence,” she says. Other terminally ill Mainers who want to use the new law may face the same challenge.

With the law due to go on the books on Sept. 18, Maine’s largest health care networks say they are still wrestling with implementing policy for their doctors. The law allows both doctors or the organizations they work for to opt out on moral or religious grounds if they choose, which means access to the law for patients like Rogers could be very limited.

“We are still considering and will fully evaluate the new law with our member organizations and providers to develop policies that will define the standard of care,” Karen Cashman, a spokeswoman for Northern Light Health, which runs the network that includes Portland’s Mercy Hospital, said in an email to the Portland Press Herald/Maine Sunday Telegram.

John Porter, a spokesman for MaineHealth, which operates Maine Medical Center and several smaller regional hospitals and networks, said MaineHealth was still developing a policy and planned meetings in early September with physicians all across its statewide network.

Joy McKenna, the communications director for MaineGeneral Health, which manages Maine General Hospital in Augusta and other facilities around the Augusta-Waterville region, said it was awaiting the final rule-making process on the law from the Maine Department of Health and Human Services before moving forward with a policy decision.

Health care professionals in other states also have been slow to accept assisted-dying laws, according to national advocates.

In Oregon, for example, a state where aid in dying was legalized 20 years ago, physicians were cautious. Only 22 doctors statewide participated in the provision of lethal medication in 2000 – a number that had grown to 103 as of 2018.

“There is definitely a deep ethical well that people have to look into on their own and see what image comes back to them, to see what their reflection in the mirror is, and they are going to have to decide if they are going to write the prescription,” said state Rep. Patricia Hymanson, D-York.

The primary sponsor of Maine’s new law, Hymanson, a licensed neurologist, is one of four doctors in the Legislature who backed the legislation, which passed the House of Representatives by a single vote.

Opponents have launched a petition drive to stay the law until a statewide “people’s veto” vote could be held. But opponents face the difficult task of collecting more than 63,000 signatures to delay the law before it goes into effect on Sept. 18.

Depending on the outcome of the challenge, Maine will become only the second state in New England, after Vermont, and the ninth in the country with an assisted-death law.

New Jersey enacted a similar law, which went into effect in August but has been stayed pending a legal challenge in state court.

California, Colorado, Hawaii, Washington state and the District of Columbia also have death-with-dignity laws on the books, while Montana patients also have access to life-ending medications by way of a state court decision.

Oregon, the first state to pass a death-with-dignity law, also took time to get its law up and working, said Peg Sandeen, executive director of the National Death with Dignity Center, based in Portland, Oregon.

With a population of 4.1 million, about four times that of Maine, Oregon reported 168 deaths in 2018 from medications prescribed under that state’s assisted-dying law, up from 16 when the law first went into effect in 1998, according to the state’s Public Health Authority, which is required to track the use of the law. Maine’s law includes similar reporting requirements.

A number of Maine doctors testified against the law at a legislative public hearing this year. Gov. Janet Mills said she wrestled with the issue, and that signing it into law was the most difficult decision she’s yet made as governor.

Sandeen, who has watched similar laws implemented in other states, said Maine is following a national pattern, and the number of doctors willing to participate in the law will steadily increase as they become more familiar with it.

“This law is all about physician behavior,” she said.

Sandeen said independent physicians will often step forward and niche practices will be developed, meaning that a number of doctors eventually specialize in working with patients who want to utilize assisted dying.

Maine’s law allows terminally ill adults, 18 or older, with less than six months of life expectancy to request a prescription for a lethal dose of medication. The individual would have to request the medication three times – twice verbally and once in writing – as well as have the physical capability to take the medication on his or her own.

The law also requires at least a 15-day waiting period between the first oral request and the written request, and then another 48-hour waiting period between the written request and when the prescription can be filled.

The physician writing the prescription will be required to affirm that the patient is not suffering from depression or any other psychological impairment and is not being coerced by family members or others. Doctors will not be obligated to write prescriptions for lethal doses of drugs, but the law will legally insulate doctors who do by creating an “affirmative defense” against charges of murder or assisting in suicide.

More than 100 people testified at the legislative public hearing on the bill in April, including several doctors and retired doctors who spoke in opposition. No doctors, other than the handful who serve as lawmakers, testified in favor of the bill.

The Maine Medical Association, which includes about 3,000 doctors, opposed previous attempts to pass an assisted-death law. This time it took a neutral position but advocated that doctors be given the option not to participate.

Andrew MacLean, an attorney who lobbies for the MMA before the Legislature, said doctors are sharply divided on the law, with some supporting it and others staunchly opposed on the premise of the Hippocratic oath of “first, do no harm.”

“For most of them, there really is no gray area on this,” MacLean said.

While most health care networks are still pondering their response to the law, large religious organizations, such as St. Mary’s Health System in Lewiston and St. Joseph Healthcare in Bangor, both operated by Covenant Health, are likely to opt out.

A spokeswoman for Covenant, which runs systems across New England, pointed to the most recent directive on health care from the U.S. Conference of Catholic Bishops, which expressly prohibits what it considers euthanasia.

“Catholic health care institutions may never condone or participate in euthanasia or assisted suicide in any way,” the directive says. “Dying patients who request euthanasia should receive loving care, psychological and spiritual support, and appropriate remedies for pain and other symptoms so that they can live with dignity until the time of natural death.”

The Maine Hospice Council has long opposed death-with-dignity laws and advocates instead for the expansion of hospice services and improved access to hospice care, especially into the state’s more rural areas. Kandyce Powell, the organization’s executive director, said the passage of Maine’s death-with-dignity law was a huge disappointment.

She said that with more access to quality home care and hospice, fewer people would see an assisted death as the only option as they face a life-ending illness or disease.

Powell believes a more “equitable distribution of resources” would prevent much of the desire for aid-in-dying types of laws. She said she wished those advocating for the Death with Dignity Act had worked as hard to expand access to adequate hospice care.

“When we are making decisions about who lives and who dies, I think as a society, as a health care system, golly, we need to think about it before we vote to pass something like this. But we have this now in Maine. We’ll see,” she said. “It’s just sad to me. It’s sad that our energies haven’t gone toward a more equitable distribution of resources.”

Rogers, the cancer survivor from Gray, testified in support of the bill and takes a different view on assisted death. She says the friends and family of dying patients shouldn’t have to watch them suffer while also trying to say goodbye.

And she said she’s surprised so many doctors resist the notion of helping their patients die peacefully.

“It’s funny because they don’t mind pumping the morphine (into) you to let you hurry up and go faster,” Rogers said, explaining that she saw this happen with her own father’s death.

As grim as all that is, Rogers says she tries to relish each day, even amid the unending challenges of fighting cancer. She and a group of friends have created their own “bucket list” and are steadily ticking off their goals, like getting tattoos.

“I live life to the fullest,” Rogers said.

Hymanson, the physician and lawmaker who sponsored the bill, said doctors are trained to be careful and thorough, and that is part of why they are often slow to come to support the law.

Hymanson said it will likely be a patient asking for help from a longtime provider in a relationship of trust that will change a doctor’s mind.

“It will take that for a lot of physicians to be there for a particular patient that they have walked the walk with,” she said.

Amanda Carr, a Portland registered nurse who has worked in home care and hospice and is trained as an end-of-life doula, said how a person dies is important to him or her.

“This is really the climate of the era – people want their own choice of what happens to their body,” Carr said. She acknowledged that, for some people, assisted death is a slippery slope toward euthanasia, but she said such laws can be seen as providing a safety net.

“The power of the law is, for many people it just takes them out of that terrifying room where they are stuck,” she said. “I have no way out, with a terminal diagnosis, and I’m seeing my suffering and my death coming right at me with no control.”

Carr noted that in other states with assisted-death laws, many people obtain the fatal medication but don’t use it.

“But just the knowledge that ‘If my suffering becomes too much, I have that absolute way out under my control’ is extremely powerful for people,” she said.

Rogers said people in her position don’t want their lives to end in sadness, or for the lasting memories their loved ones carry until their own deaths to be of them suffering without hope. They don’t want money spent on fruitless treatments or on large amounts of pain medications.

Rogers also doesn’t want to have to go to another state or country herself to die peacefully without pain, if it comes to that.

“I want to be able to choose the way I die, and in my own state,” Rogers said. “I was born in Maine and I will die in Maine.”

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