Maine lawmakers recently amended Maine's Death With Dignity law, giving physicians the discretion to shorten the mandatory 17-day waiting period before providing life-ending medication.
Since its passage in 2019, Maine’s Death with Dignity Act has sparked ongoing debate over the ethics of allowing terminally ill patients to end their lives. The amendment, which will allow physicians to shorten the waiting period to as few as seven days, sparked weeks of emotional testimony at the State House.
Supporters argued that the change will spare eligible patients unnecessary suffering. Since the law was first enacted, nine individuals died before they could complete the required waiting period of 17 days.
Holly Dominie's husband David chose physician-assisted death last November after a long battle with ALS. During a public hearing, she testified that the mandatory waiting period forced him to endure unnecessary suffering in his final days.
“Every day David sunk deeper and was so hard to tolerate all of these assaults on his body and it was hard for him to stay alive, yet he couldn't change that,” Dominie said.
David lost his ability to speak and swallow. A year into his diagnosis he had a feeding tube inserted and later lost his dexterity and ability to walk. For David the experience was intolerable.
“David had claustrophobia, so it was really hard for him to feel like he was drowning, and suffocating at the same time,” Dominie said.
After he was unable to breathe on his own, David qualified for physician assisted death. But by the time the waiting period began, Dominie said the disease began a rapid progression. She said they lived with constant anxiety, not knowing if David would be able to administer the drugs himself which is required by law. Through his pain, David practiced every day to make sure he had the necessary strength to do it.
“We weren't thinking that a disease that had been slowly eating away at him was all of a sudden going to just make it so hard to exist, and that 17 days was excruciating,” Dominie said. “I've lived through some hard things. That was the hardest thing I've ever lived through.”
Opponents of the bill raised concerns about its potential effects on vulnerable populations, including individuals with disabilities or mental health challenges. Jessica Rodgers, coalitions director for the Patients' Rights Action Fund, a nonprofit that advocates against assisted death, said the emphasis should be on strengthening healthcare and social support systems rather than assisting death.
“Right now, we're having conversations around making it easier for patients to die when patients aren't getting the support that they need to live and to have the adequate and equitable supports that they deserve,” she said.
For example, she's concerned that disabled patients who believe they are a burden on their families may feel pressure to use the law. By shortening the waiting period, she said the law removes a critical safeguard — time that can help patients fully consider their decision.
When the bill was first introduced, it allowed the waiting period to be waived completely But after a stalemate between the House and Senate, it was amended to include a minimum waiting period of seven days as a safeguard.
Rodgers and others are also concerned about how the definition of "terminal" is applied to patients and about the right to refuse treatment. In some states, she said patients who refuse treatment may experience a decline in their condition and then diagnosed as terminal. In one instance, an Oregon woman who was diagnosed with Alzheimer’s, a condition that usually does not qualify as terminal, began to refuse food and water, after which she qualified for the physician assisted death.
Valerie Lovelace, executive director of Maine Death with Dignity, said there is no evidence in Maine to suggest coercion or malpractice has occurred. Instead, she said end of life decisions are made with great care and involve both the doctor and the patient.
A longtime advocate for end-of-life choice, Lovelace is not swayed by opponents' arguments.
“What I want to say to opposition is, mind your own death,” Lovelace said. “Don't interfere with another person's end of life process if this is something they want to choose.”
Dr. Mark Wrona, a palliative medicine physician with New England Cancer Specialists, prescribes patients the drugs required for physician assisted death. He says physicians who participate in the law are cautious about making sure patients meet eligibility requirements and won't risk it if they think someone does not.
Because he has a longstanding relationship with many of his end-of-life patients, he said he's never seen anyone make a rushed or rash decision.
"The vast majority who come to me to start to have this conversation have already been thinking about this for a very long time,” said Wrona, “What people are really seeking at the end of their lives is control.”
Dominie said her husband David didn’t take the decision to end his life lightly. A longtime adventurer and passionate environmentalist, David faced his illness with grace and humor. And she said he would have been proud to see the new legislation finally passed.
“He was such a kind man, he would not want anybody to suffer more than they had to,” Dominie said.
The new legislation will continue to be observed by those on all sides. It takes effect in September.
