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Should medical aid in dying be legal in N.H.?

The controversial proposal has dedicated supporters who believe it gives people suffering a way to die with dignity, while detractors say it would normalize suicide.

Father David Barnes pauses after anointing a patient dying of COVID-19 at Newton-Wellesley Hospital in Newton, Mass., April 30, 2020.RYAN CHRISTOPHER JONES/NYT

CONCORD, N.H. — It was 2016 when Rebecca Brown’s husband of 22 years, Harry Reid, decided to end his life. A veteran who had also worked for the New Hampshire Division of Parks and Recreation, Brown said a degenerative neuromuscular condition had made Reid’s life miserable.

Brown said her husband, who was 86 at the time, didn’t give her any indication about his plans, knowing the legal consequences for those who assist suicide.

After his death, Brown, who has previously served in the state legislature, said she felt a call to address the issue, and now, she is working with a grassroots coalition on a proposal that would give New Hampshire residents more control over end-of-life decisions by legalizing medical aid in dying.

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“If we could help anyone else avoid the anguish that my family felt, that would be a success,” said Brown, the executive director of the New Hampshire Alliance for End of Life Options.

She believes House Bill 1283 — a bill she helped shape — would accomplish that by providing what she sees as a tool for people to facilitate a dignified death.

A public hearing on the bill before the House Judiciary Committee scheduled for Wednesday morning has already prompted more than 1,600 people to weigh in through the legislature’s online portal, with 594 registering their support and another 1075 registering in opposition as of Wednesday morning.

Around 90 people came to testify, according to committee chair Bob Lynn, a Windham Republican, who is co-sponsoring the legislation. “It’s a matter of freedom,” said Lynn, 74, at a press conference before the hearing. “I want the freedom to make a decision.”

That argument resonated with at least one lawmaker who identified as a liberty Republican, Emily Phillips of Fremont. “I’ll be damned if the government doesn’t let me do what I want with my body, so I support this bill,” she said.

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The hearing also drew people who wished their loved one had the option or who wanted the option for themselves in the future. Mark Kaplan of Portsmouth wished the option had been available to his father, who died a year and a half ago at 93 after he voluntarily chose to stop eating and drinking to end his suffering. “We were unable to have the kind of goodbyes that all of us wanted,” Kaplan told lawmakers.

Upon learning of her husband’s death, Brown said her reaction was that he was free of suffering. “And I respected the decision to take control of his own life,” she said. She believes medical aid in dying is different from suicide because those who are eligible for medical aid in dying only have a few months left to live, discuss the decision with multiple doctors, and would want to keep living if not for a terminal disease.

Medical aid in dying was first adopted in Oregon in 1997 and is now legal in 11 jurisdictions: Washington, Montana, Vermont, California, Colorado, Washington D.C., Hawaii, New Jersey, Maine, and New Mexico. It’s been legal in Vermont since 2013 and in Maine since 2019. Since 1997, around 8,100 people have utilized it nationwide, according to Compassion & Choices, an organization headquartered in Colorado that advocates for the option.

About 37 percent of people request the medication and never use it. “They just receive a palliative effect of knowing that they are not having to worry about what their last days are going to look like,” said Melissa Stacy, the regional advocacy manager for the Northeast at Compassion & Choices.

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Brown said she looked to other state laws and spoke with clinicians when deciding what to propose in New Hampshire, where the bill has bipartisan support.

She said the New Hampshire bill mirrors the eligibility requirements that exist in all other states: a person must be older than 18, have a terminal condition with only six months to live, have the mental capacity to make the decision to end their life, and be able to self-administer the medication.

The prescribing health care provider must then determine that the individual is making an informed decision, and discuss the risks and likely outcome of taking the medication.

The bill requires the health care provider to inform the person that they can choose not to take the medication at any point, and they must discuss alternatives, like palliative care to relieve symptoms and reduce suffering. The health care provider also has to determine that the individual seeking care has not been coerced, a fact two other witnesses must also attest to in writing.

Only one witness can be a family member, according to the bill, and only one witness can be employed at a health care facility where the patient is getting treatment.

Brown said the lack of physicians is a big road block in other states, so New Hampshire’s bill also allows advanced practice registered nurses and physicians’ assistants to prescribe the medication.

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That’s different from Vermont, where only physicians are allowed to prescribe the medication. While Vermont has a 15-day waiting period between qualifying and receiving the prescription, New Hampshire’s bill is modeled after the law in New Mexico, where there is only a 48-hour waiting period.

There’s no residency requirement in New Hampshire’s bill, a requirement Vermont removed from its law in 2023. Since then, some New Hampshire residents have sought care in Vermont. A Vermont advocacy group Patient Choices Vermont said 600 Granite Staters have visited its website since the restriction lifted. Diana Barnard, a Vermont physician who provides medical aid in dying, said she has personally worked with three New Hampshire patients.

Those opposing New Hampshire’s bill include the NH Coalition for Suicide Prevention, a group made up of disability advocates and doctors. Several veterans organizations also opposed the bill, including the State Veterans Advisory Committee and the Disabled American Veterans of New Hampshire, pointing to the high rate of suicide among veterans. The Catholic Church is also opposing the legislation.

“The Church teaches that suicide is always a tragedy and that a caring community should respond with hospice and palliative care to better meet the needs of those facing the end of life,” the Diocese of Manchester said on its website, urging people to oppose HB 1283. The church calls the practice “a grave moral evil that is directly contrary to the infinite dignity of each human life.”

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In a press conference this week, members of the NH Coalition for Suicide Prevention said HB 1283 is a slippery slope that would normalize suicide and endanger people with disabilities.

Steven Wade, executive director of the Brain Injury Association of NH, said his organization also opposes the bill, which he believes “opens the door to the approval of suicide, and its legalization as an acceptable medical option for ending your life.”

Instead, he said, the state should expand access to palliative care.

Lisa Beaudoin, who founded Strategies for Disability Equity, agreed. She said the bill represents an inherent harm and danger to people with disabilities, noting that medical institutions are “inherently ableist” and doctors incorrectly believe people with disabilities have a worse quality of life than those who are not disabled.

“This deeply mistaken attitude leads to doctors abusing their authority by determining which lives are worth living and and which ones are worth saving,” she said. She believes a bill like HB 1283 would be abused, allowing insurance companies and doctors to deny people care.

Sean Crowley, a spokesperson for the Compassion & Choices which supports medical aid in dying, said there’s no evidence to show insurance companies or doctors would deny people care because of HB 1283. He noted a 1998 study in the New England Journal of Medicine, which found national savings from legalizing medical aid in dying would likely be small, although it could be “substantial” for a family. Crowley said people in hospice, a benefit of Medicare and Medicaid, have already stopped curative care.

Brown also said people with disabilities wouldn’t be eligible for medical aid-in-dying unless they also had a terminal diagnosis, such as cancer.

A poll conducted by University of New Hampshire in October 2023 found that of 1,130 people surveyed, 71 percent of Granite Staters supported medical aid-in-dying legislation. Among people with disabilities, the poll found 75 percent supported the legislation, as did 63 percent of Roman Catholics. Support was strongest in the North Country, where 85 percent of respondents said they agreed with the legislation.

After the House Judiciary Committee hears public testimony on the bill on Wednesday, they will vote on it and then it will go to the full House for a vote.

This article has been updated with additional comments from the hearing.


Amanda Gokee can be reached at amanda.gokee@globe.com. Follow her @amanda_gokee.