YORK, Maine — State Rep. Patricia Hymanson said it can take a while for people to come to grips with the concept of physician-assisted dying for terminally ill patients. It’s wrapped in all sorts of individual layers, as each person brings his or her own life experiences to the discussion. But she sees many signs that the citizens of Maine are likely ready now to embrace a “death with dignity” initiative.

“This is a difficult, difficult subject,” said Hymanson, D-York, the House chairwoman of the Health and Human Services Committee and a retired physician. “People need time to reflect on this. Maybe there are incidents that have happened in their own families, with their own loved ones. It can take a while. But I am seeing momentum now, and maybe there’s enough momentum to move forward.”

Tandem efforts are currently taking place in Maine to pass death with dignity legislation. A petition effort is ongoing to put a citizen’s initiative on the November, 2020 ballot; and Hymanson and state Sen. Roger Katz, R-Augusta, are also introducing legislation this fall that follows verbatim the language in the initiative.

Modeled on the 1997 law passed in Oregon, the bill sets up protocols for people who are terminally ill and have less than six months to live. To make a request for medication prescribed for ending life, the patient has to go through two waiting periods, make one written and two oral requests for medication and get a second opinion from a physician.

In addition, the patient has to be determined to be competent, and not suffering from a psychological disorder or depression. The medication is prescribed by a doctor and filled by a pharmacy, and is to be taken by the patient at his or her discretion. No physician or pharmacist is required to participate. And adults do not qualify solely because of age or disability.

To date, seven states, including Vermont, have passed death with dignity legislation, as well as the District of Columbia.

Among the reasons Hymanson senses momentum, an April 2017 poll conducted by Public Policy Polling indicated 73 percent of Mainers support specifically this kind of legislation involving terminally ill patients. On Election Day Nov. 6, volunteers gathered 45,000 signatures on the citizens initiative – about 20,000 shy of the expected 63,000 to 65,000 that they will have to gather to put the initiative on the ballot.

This gave real heart to Valerie Lovelace of Westport Island, chairwoman of the steering committee for Maine Death with Dignity, the organization formed to support the measure.

“It was so heartening to see people see our sign and come up to the table” in Bangor, where she was collecting signatures, said Lovelace. “They couldn’t wait to sign it. There was a physician who signed and put MD after her name because she wanted people to see it.”

Legislative past

Death with Dignity bills have been introduced and failed in the Legislature since 1994, even before Oregon passed its bill. In recent years, bills have been introduced in nearly every legislative session since 2013.

In the last session, which ended in June, two similar bills, one introduced by Sen. Katz and one by outgoing South Berwick state Rep. Jennifer Parker, were combined. At the public hearing, said Lovelace, upward of 80 percent of the people testifying favored passage of the bill. But in the end, the legislation failed in the House by a vote of 85-61, after passing in the Senate by a single vote.

Still, said Hymanson, “I was really impressed that the large majority favored the idea and favored the bill.”

Not everyone was supportive. In testimony, the Maine Hospice Council, the American Nurses Association of Maine and the Catholic Diocese of Portland, among others, testified in opposition.

The Maine Hospice Council stated in written testimony that before physician-assisted dying should even be considered, there should the “just, equitable health care for every person from birth to death” – something that is not the case in Maine. Hospice and palliative care services are unavailable to huge swaths of Maine, and that should be remedied first.

The American Nurses Association opposed the bill “because care for the dying should never put the nurse in the position of having to violate our code of ethics,” it stated in written testimony. Hospice care, on the other hand, does provide “quality end of life care.” And the Catholic Diocese stated, “To sanction the taking of innocent human life is to contradict a primary purpose of law in an ordered society.”

On the other hand, the Maine Medical Association took no position for or against the bill – significant, said Lovelace and Hymanson, as it has opposed legislation before. In written testimony, the MMA stated it conducted a poll of its physician members, which “suggest that physician opinion on this topic is evenly divided – and this division undoubtedly reflects our broader society.”

Many individual Maine residents testified in favor. Among them was Cyndie Rogers of Gray, who has gone on to become active in the citizens initiative process. She has been diagnosed with follicular lymphoma and just learned two weeks ago that she has breast cancer.

“So my desire to support this has become a personal mission for me. But I also noticed collecting signatures that people want this. You can’t believe how many medical professionals want this. The need is there,” she said. As for her, “I pray this bill is passed before it’s my time to go. I just want this so badly. As long as I’m alive I’m going to fight for this, for me and for others who want this.”

Hymanson echoed Rogers’ sentiment that legislators appear to be out of touch with the citizens on this issue. “I was aware that the sentiment expressed in the hearing was very different than the sentiment expressed in the House, against the bill,” she said.

Hymanson’s own interest in this legislation comes from her years as a practicing neurologist and as a member of the ethics committee at Portsmouth Regional Hospital for 10 years. In both capacities, she dealt with end-of-life decisions, she said.

“Some people think the enemy is death, and some people think the enemy is suffering. That’s a very personal decision," she said. "People are in charge of their own lives and that means being in charge of their own death. If that means continuing to fight to live, fantastic. If you want hospice and palliative care, that’s your decision. But many people reach a time when the suffering is so severe, suffering is the enemy and death is comfort.”

She said she and Sen. Katz decided to introduce a bill one more time in the Legislature because “we’re a representative democracy and we need to do our job. So putting forward this bill again and letting the conversation mature is important.”

Meanwhile, said Lovelace, Maine Death with Dignity will continue to collect signatures, with the goal of submitting them to the secretary of state next May for the 2020 election. Initially, the group was going to put the issue on the 2019 ballot, but would have had to get all remaining signatures in to the state by January, “which would have been a slog for us.” Also, she said, 2020 is a presidential election year, so the turnout will be much larger.

Lovelace said she understands the need for the conversation to mature, as Hymanson suggests. “When you bring it down to a personal level, I’m not terminally ill. It’s very hard for me to put myself in those shoes,” she said. “For me, this is simply expanding end of life options to have another tool in the toolbox if you want this at the end of your life.”

And its time has come, said Hymanson. “The conversation has to go forward, and it will.”