Physician-assisted death option nears finish line in Delaware

After a decade-long fight, advocates are on the verge of legalizing physician-assisted deaths in Delaware. 

House Bill 140, which would allow terminally ill adults with six months or less to live to request prescription medication to end their lives, passed both chambers of the General Assembly last week. The vote in the State Senate was close at 11-8, seeing three Democrats — Spiros Mantzavinos, Nicole Poore and Jack Walsh — join Republicans in opposition.

It now awaits the signature of Gov. Matt Meyer, who has publicly endorsed the bill and is expected to sign it into law in coming days.

In September, former-Gov. John Carney vetoed a nearly identical bill after it passed both the House and Senate, saying in a statement that he was “morally opposed” to it.

The conversation around end-of-life options at Legislative Hall began in 2015, when former Rep. Paul Baumbach (D-Newark) first introduced legislation around the topic.

Since then, support among Delawareans has grown, as a statewide study found that 72% back the option referred to by advocates as medical aid in dying.

The latest version of the bill was sponsored by longtime advocate Rep. Eric Morrison (D-Glasgow).

Officials from the governor’s office say Meyer is unlikely to sign the bill until after the legislative session resumes on May 6.

When he does, Delaware will become the 12th U.S jurisdiction to legalize a version of physician-assisted death.

A long journey

For critics, the end-of-life measure is morally fraught. Legislators opposed to it have cited the possibility of abuse, coercion for those with disabilities, and incorrect prognosis as potential downfalls.

But for residents like Judy Govatos, a longtime supporter of the option, it represents peace.

The 80-year-old Wilmington resident has been battling stage four lymphoma since 2014.

If the governor signs the bill into law, Govatos said she would feel “incredible gratitude” that she could get doctor-prescribed medication and have “a loving, compassionate, caring death, not crying out for pain meds.”

After intense cycles of chemotherapy that left her severely ill and with short-lived remissions, Govatos’ cancer has returned again for the third time.

Rather than relive the toll of those treatments, she’s now opting for immunotherapy. If that doesn’t work and she receives a six-month prognosis, Govatos said she would invoke her right to the life-ending medication.

Before advocating for end-of-life options, Govatos was active in a 1980s movement for living wills.

Her passion was sparked by the painful loss of her aunt, who suffered a massive stroke and brain bleed. With no advance directive in place, Govatos and her family spent 17 agonizing days watching her aunt slowly die.

“So I see medical aid in dying as simply another point of advanced directives. If I have six months or less to live, I should be able to say I want a prescription and I don’t want to linger and suffer,” Govatos said.

As the bill comes close to becoming law, Govatos feels relief that she doesn’t have to use the dollars she saved up to travel to Vermont, where physician-assisted death is already legal and doesn’t require residency. Instead, she’ll be able to use the medication at home, surrounded by loved ones.

How will the law work?

According to Morrison, once signed, residents like Govatos will be able to access the life-ending medication on Jan. 1, 2026. But he says the measure could kick in sooner if the final regulations under the act are created before then. 

Individuals requesting the medication would have to administer the drugs to themselves, but to be approved, a doctor or advanced nurse practitioner has to confirm the person’s terminal diagnosis and a prognosis of six months or less to live.

A health care provider must also confirm that the individual can make informed decisions for themselves.

Mental illness or mental health conditions do not qualify as terminal illnesses under this bill, and those with such conditions would not be eligible to receive the medication.

Individuals requesting the medication must be Delaware residents, and practitioners approving those requests must be licensed in Delaware.

To receive the medication, which usually consists of high doses of barbiturates, a patient must make two verbal requests at least 15 days apart and then submit a written request to an attending physician or advanced practice registered nurse. A prescription can then be written 48 hours later.

Morrison said patients can opt out of taking the medication at any time.

The Department of Health and Social Services will be in charge of regulating the act and must complete an annual statistical report of the information they collect on the measure. The Department of State will be responsible for compliance of state regulations.

The current bill does not require additional training or certification for medical providers, but Morrison said DHSS may work with the Division of Professional Regulation to develop forms and protocols for health care providers.

He also noted that doctors and nurse practitioners can seek resources from organizations, such as Compassion & Choices, a national nonprofit that has helped pass end-of-life options legislation in other states.

Doctors and hospitals are also able to opt out of the program, and those who agree to participate would not be subject to civil or criminal liability for assisting in the death.

During the legislative debate, the Delaware Healthcare Association, an industry group for state hospitals; the Medical Society of Delaware, an association for state doctors; and ChristianaCare, the largest health care system in the state, remained neutral on the bill.

The Delaware Nurses Association has expressed support for the measure.

Remaining hurdles to overcome

According to Morrison, the medication will cost patients between $800 and $1,200.

Medicare and Medicaid dollars cannot be used to purchase the medication – a result of a federal ban on physician-assisted deaths that Congress imposed in 1997.

In 2023, about 40% of Delaware’s residents received either Medicaid or Medicare coverage, according to the KFF organization.

Tim Appleton, senior campaign director at Compassion & Choices, said his organization is currently pushing members of Congress to remove the federal ban.

Appleton asserted that many fears people have about potential abuse and coercion in physician-assisted death are unfounded, noting that states where it is legal have implemented safeguards to prevent misuse.

He said 10,000 people have utilized the end-of-life option since 1997 in the states where it has been legal.

“To suggest somehow that that’s a slippery slope is completely false and does a tremendous disservice to those desperately seeking access to this law,” he said.

Although Appleton is thrilled about the passage of HB 140, he reflects on the journey with sadness, noting that some of his friends who hoped for this option didn’t live to see the bill become reality or to share the success with him.

For Govatos, she says she hopes Meyer keeps his word, so that she can have the option to die a “good death.”

“There’s a lovely poem by a writer, Mary Oliver, who tells us: ‘There are three things we must learn to do in life — to love what is mortal, to hold it to our bones as if our lives depend on it — because it does. And then, when it’s time to let it go, to let it go.’ And that’s what I want to do,” Govatos said.