Diane Kraus can’t forget her mother’s moans of pain as she lay dying 30 years ago from breast cancer. Even though she worked with hospice patients as an occupational therapist, she was not prepared for the noises her mother made when someone tried to move her.
So when she was diagnosed with breast cancer in 2011, there was no question in her mind — she did not want to go the same way her mother, best friend and many of her patients had died.
“Everyone should have that option to have a smooth transition to death,” Kraus said earlier this week in her Baltimore apartment as she ate an Activia yogurt after her morning round of pills. “Because the pain and the agony at the end? No human should go through that.”
For the last two years, Kraus has testified in the General Assembly for the End of Life Option Act, which would allow terminally ill Marylanders to ask their physicians to prescribe them life-ending drugs. Lawmakers and advocates were hopeful about the controversial bill’s chances this year, but Senate President Bill Ferguson said Friday it again did not have the votes to pass.
It fell short by one or two votes, Sen. Will Smith, chair of the Judicial Proceedings Committee and a previous sponsor of the bill, told reporters.
“I think that as we slowly got closer to the vote and had more in depth discussions with their constituents, folks just expressed unreadiness to move on it at this time,” Smith said. “I’m obviously very disappointed, but you have to respect the decisions of the individual senators who were listening to their constituents and listening to their conscience.”
Ferguson told reporters Friday that lawmakers would “continue in the education process” and reintroduce the bill when they thought there was a better chance of it being passed. But in a reader commentary published Friday in The Baltimore Sun, Kraus said she might not be around next year to continue pushing for it. She said she’s considering moving to New Jersey or another state where it’s legal for physicians to prescribe life-ending drugs.
Kraus was cancer-free for more than five years, but that changed in 2021. She looked like a Christmas tree during her PET scan, she said — all lit up with tumors in her vertebrae, pelvis, sacrum, lungs and liver. Even more were in her brain, skull and elsewhere in her body.
Her doctors thought she’d be gone by December, but earlier this month, she returned to the State House to plead with lawmakers to pass the bill. Under the legislation, Marylanders would be eligible for physician aid-in-dying if they were capable of making their own medical decisions, still had the ability to self-administer medication and were expected to die within six months.
Physician aid-in-dying legislation was first proposed in Maryland in the 1990s, well before Kraus was diagnosed with cancer or moved to Baltimore to be closer to her son. It came the closest to passing in 2019, when that year’s run ended in a 23-23 vote draw on the Senate floor.
While the bill’s opponents say it flies in the face of medical ethics and could be used to exploit vulnerable Marylanders, its supporters say the bill has evolved to include stronger protections against abuse and more explicit directions for how the medicine must be prescribed and taken.
Under this year’s legislation, patients would need to first verbally request the end-of-life medication, and then submit a written request signed by themselves and two witnesses. They would be required to wait 15 days after their verbal request and two days after submitting their written request before making a second verbal request, which they would have to make with no witnesses present to ensure that they are not being coerced.
Patients would only be eligible if two doctors determined that their illness was terminal, meaning that it was expected to result in their death within six months. Either of the doctors could refer the patient to a mental health provider, if they are unsure whether the patient meets the mental competency criteria. Physicians would be protected from civil and criminal prosecution for prescribing the life-ending medication. They would not be required to participate in the process.
Sen. Jeff Waldstreicher, a Democrat representing Montgomery County and the bill’s Senate sponsor, said he’s always supported the idea behind the legislation, but opposed a previous version because he thought its language was too loose and could be abused.
“I have a disabled sister,” he said Wednesday. “I’d never vote for a bill that unintentionally could be used against people with disabilities or people who are not mentally competent.”
Opponents of the bill, however, worry what its passage would mean for vulnerable state residents. They include people who oppose the legislation based on faith, as well as disability rights advocates and elder abuse attorneys.
Dr. Joseph Marine, a cardiologist at Johns Hopkins Medicine and member of Maryland Against Physician Assisted Suicide, became involved in opposing such bills in the state in 2016. Since then, his resolve has only deepened that the legislation is misguided and dangerous.
Aid-in-dying is explicitly forbidden in the original text of the Hippocratic Oath, Marine said. He also described end-of-life medications as experimental, unregulated and untested, and noted that doctors do not have the power to accurately predict a person’s prognosis 100% of the time.
“What we should be supporting is access to excellent palliative pain management and hospice care programs,” he said. “We have some of the best health care in the world right here in Maryland. We should use it and not undermine our health care system with this dangerous bill.”
Kraus told her son about her breast cancer diagnosis when she was driving him home after his first semester of college in Pennsylvania’s Lehigh Valley.
It had been nearly two decades since she lost her mother to breast cancer. While she was dying, Kraus’s son learned to walk in the house where Kraus grew up. Even though her mother wore wigs almost all the time after losing her hair to chemotherapy, Kraus has a photo of her son sitting on her lap when she isn’t wearing one. Both are bald and smiling. It’s her favorite picture.
“My mother would never have used this — medical aid-in-dying,” Kraus said thoughtfully. “She was a good, you know, ‘I want my soul to be saved’ and stuff.”
In 2021, a decade after her first diagnosis, Kraus went for a mammogram after developing what she jokingly calls a “third breast” – a painful lump on her chest. That examination came back clear, but when she got a CT scan, a doctor diagnosed her with metastatic breast cancer.
Three rounds of chemotherapy didn’t work. She got radiation next, which was the worst treatment of all, she said. She could smell her brain frying and feel it burning.
The last PET scan Kraus received came back clear almost everywhere, but she still has a 4-millimeter tumor growing in her brain. She’s a “chemo lifer,” meaning she’ll continue receiving the drug cocktail once every three weeks until she dies or her body rejects it.
In many ways, the effects of the drugs prolonging her life are worse than the effects of the cancer that is killing her. She’s confused and has too short of an attention span to drive, read or watch movies during the week after she receives chemo.
Advocating for the End of Life Option Act has taken hours of her life over the last few months. But she spends as much time as she can with her son. They like to walk around the Inner Harbor and play Pokémon GO.
“I persevere because, in spite of it all, I like life,” she told lawmakers earlier this month, “and choose to continue to fight until I can’t anymore.”
