Judy Govatos can still hear the beeps of the heart monitor and the wheezing ebb and flow of the ventilator that kept her aunt Helen alive more than 50 years ago.
She sat in disbelief and cloaked in guilt for more than two weeks after Helen’s massive stroke left her with a brain bleed that rendered her unconscious. At that time, the doctors weren’t legally allowed to unplug the machines keeping her alive.
“It just felt like we were in some way betraying her and her values,” Govatos said, explaining that Helen had watched her father slowly die in a nursing home for 18 months and she made her family promise that she would not endure the same way.
That experience led her to join the advocacy movement in the 1980s for living wills, which can make do-not-resuscitate orders to forgo unwanted medical treatment. For decades afterward, Govatos thought her foray into politics was over.
But in 2014, she was diagnosed with stage 4 lymphoma and began chemotherapy to fight the cancer. Remission was short-lived, when the cancer returned just four years later and her second bout with chemotherapy was particularly difficult. She was left emaciated, partially blind and unable to walk or write through parts of the treatment.
Ultimately, the Wilmington resident recovered but at 76 years old now, she knows her future chance of remission will be lower and she can’t bear the thought of going through chemotherapy again. Today, she’s among a number of advocates for legislation that would give them the right to die.
“To spend six months hallucinating, vomiting and being sick from medications … I may not have been the very best person in my life, but I don't deserve that,” she said last month at home in her garden. “When my time comes, I want my family around me and to know all the love I've given them is in them. I want them to remember that, not my terrible death.”
A legislative journey
The first attempt to pass medical aid in dying legislation in Delaware occurred back in 2015, and Rep. Paul Baumbach (D-Newark) has been persistently shepherding the measure through advancements and failures ever since.
This year, House Bill 140, also known as the Ron Silverio/Heather Block End of Life Options Law, named in honor of two advocates who died before its passage, has wound its way through the Delaware General Assembly. On Wednesday, the Senate Executive Committee advanced the bill to a Senate floor vote – its final step before heading to the desk of Gov. John Carney, where its future is uncertain.
The debate over physician-assisted death in the current legislative session has already seen some dramatic moments though, including its first approval by the House of Representatives in April. That vote was made possible in part by the vivid testimony from Middletown Republican Kevin Hensley, who changed his longstanding opposition after his own mother exercised the medically assisted death option last year in California, where it is already legal.
Just two weeks after her passing in April 2023, Hensley supported the measure through the House Health & Human Development Committee. Testifying through a choked-up voice, Hensley noted that he disagreed with her decision but came to understand that it was her choice to make.
“Her last words to me two weeks ago today were ... ‘I respect you. I respect your opinion. I know you would not choose to do this if it were you ... But you know what, Kevin, it's my life, and I ought to have the opportunity to make the choice,’” he recalled last year.
What does the bill do?
HB 140 allows an adult Delawarean with a terminal illness, or those who have been given a prognosis of six months or less to live, to request and self-administer medication to end their life to avoid continued suffering.
Mental illness and disability are not considered terminal illnesses under the definition of the bill, and the medication cannot be requested by anyone other than the patient. The bill sets two waiting periods – 14 days after the initial verbal request and 48 hours after the final written request for medication – that aim to avoid hasty requests to end one’s life.
Physicians or institutions would be able to opt out of the program, and many have indicated that they would. Both physicians and advanced practice registered nurses (APRNs) would be allowed to consult and prescribe the medication – and each would be indemnified from civil or criminal liability or professional discipline for assisting in the death.
A slippery slope
Many of the legislation’s longtime opponents have voiced concerns over its departure from the historic Hippocratic oath for physicians of “do no harm” and that the legislation would open the door to future changes that would make accessing the deadly medication easier.
Many pointed to Canada, which amended its physician-assisted death laws in 2021 to add people with incurable, but not terminal, conditions. Furthermore, it added longtime anorexia among conditions to qualify, which has alarmed many opposition advocates in America.
Dr. Neil Kaye, a past president of the Psychiatric Society of Delaware who was called to testify to the committee by Senate Republicans, emphasized that doctors have been found to correctly predict a six-month prognosis less than a third of the time.
“Doctors can be wrong, and we often are. This is a time for physicians to be humble,” he said.
He also questioned why the drug cocktail prescribed in Oregon, which has allowed physician-assisted death since 1997, has changed nearly every year. While the median time to death is about 53 minutes in Oregon as of 2023, the longest death took nearly six days.
Moira Sheridan, the president of Delaware Right to Life, the largest anti-abortion organization in the state that has long opposed physician-assisted death, questioned the intent behind the bill and how it will be practically carried out.
“This bill makes people see themselves as burdens or financial liabilities and incentivizes health care providers to view them likewise,” she said. “What happens when, as in fully half the cases in Oregon in 2023, no medical staff or volunteer is present when a person dies. Who is to know if there were complications or the person was coerced to take those pills, or if the death was an excruciatingly painful one? They're not all humane and dignified as this seems to offer.”
Personal testimony
For many of those in support of the option, they came to that advocacy through personal experiences.
Susan Lahaie, the widow of the late Ron Silverio who advocated for years on the issues and has his name attached to the legislation after dying from metastatic prostate cancer in 2018, lamented that her husband had to endure a difficult end of life.
“I ask you to help people of Delaware to have fewer moments of worry and more moments of joy,” she testified while a photo of her husband was held aloft.
Robert Varipapa, the president of the Medical Society of Delaware, recalled the death of his wife from ovarian cancer.
“She was unable to take oral substances and she basically starved to death … She ended up going into what's called terminal delirium for a two-week period of time before she passed away. It was not a good death,” he said, noting that many of his patients as a neurologist in Dover have expressed a desire to have autonomy over their care.
Toby Johnson, the Rehoboth Beach widower of Martha Johnson who died less than a year ago from endometrial cancer, recalled his wife’s painful four-year struggle, enduring two strokes and emaciation.
“Hospice supported morphine to control the pain, but it removed her from the present. She mostly rejected it, saying, ‘I need to be with you,’ but then flailed helplessly with the pain that had to be endured to avoid becoming comatose. This shouldn't have been necessary. She should have been able to die with dignity, assisted by a doctor with family present instead,” he recalled. “When she died, I had no idea if she even knew I was with her. We treat pets better than that. Let's provide the option, which I acknowledge, she might not have accepted. We are in a civilized society, aren't we?”
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