Lawmakers in Maryland are again seeking to introduce a bill to legalize assisted suicide, after similar efforts have failed four years in a row. The legislation has drawn strong opposition from critics who argue it fails to uphold human dignity and will put the lives of the vulnerable at risk.

Despite being heavily amended in 2019, the assisted suicide bill failed by one vote to pass in the Senate, marking the closest the legislative effort has come to passing in the state.

However, advocates of the bill believe changes in the legislative body may be enough to approve the legislation this time around. Delegate Shane M. Pendergrass (D-Howard), lead House sponsor of the bill, says the effort has 53 co-sponsors in the House and 17 in the Senate.

Senator Jeff Waldstreicher (D-Montgomery), the lead Senate sponsor of the bill this year, is planning to work to sway lawmakers who may be unsure about their vote on the issue, the Washington Post reports.

Senator William Smith Jr., (D-Montgomery), who last year served as the bill’s lead sponsor in the Senate, is now the chairman of the Judicial Proceedings Committee. He said that he still supports the legislation, but believes it is two votes short of the support necessary to pass the Senate.

“We’re not interested in a moral victory in getting it out of committee and onto the Senate floor,” Smith said, according to the Washington Post. “We’re interested in passing a good piece of legislation. So if it doesn’t look like it’s going to happen, I’m not going to move it out of committee.”

Maryland Governor Larry Hogan (R) has indicated that he is open to considering signing the bill if it comes to his desk.

The bill is based on an Oregon law that allows physician assisted suicide for terminally ill patients with a prognosis of six months or fewer to live, the Washington Post reports.

In the U.S., assisted suicide is legal in California, Colorado, Hawaii, Maine, New Jersey, Oregon, Vermont, Washington, and the District of Columbia; and in Montana by a court ruling.

Critics of assisted suicide bills argue that they lack sufficient safeguards to protect against coercion and leave sick and elderly patients vulnerable to pressure and exploitation. They also argue that legalizing the practice could contribute to the nation’s ongoing suicide epidemic by normalizing suicide as a response to pain and suffering.

Catholic leaders have spoken out against assisted suicide as a grave offense against the right to life, saying that suicide fosters a throw-away culture.

Maryland Against Physician Assisted Suicide, a nonpartisan coalition of doctors, mental health professionals, disability rights advocates, and religious leaders, opposed the bill in a Jan. 28 statement.

The group noted that the American Medical Association voted last year to renew its opposition to assisted suicide, on the grounds that the practice is “fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”

Dr. Joseph Marine, associate professor of medicine at Johns Hopkins University School of Medicine and a member of the coalition, warned that the Maryland medical community has “widespread concern” about the implications of legalizing assisted suicide.

“Last year, state lawmakers attempted to present fixes for assisted suicide policy but failed to contend with this practice being inherently unethical, dangerous, and harmful to the communities where it is practiced,” he said.

“The dangers are no longer merely possible, they are real. There is evidence that insurance companies are already declining coverage of life-extending treatments for patients in states where PAS is legal and are instead approving coverage for these cheaper drug overdoses that end a patient’s life.”

Critics also warned that the legislation could have devastating effects on the state by introducing highly addictive and often abused opioids into the community.

“In states where physician-assisted suicide is legal we continue to see reports of large numbers of patients who receive yet never take the lethal dose,” said Christine Sybert, clinical pharmacist at St. Agnes Hospital in Baltimore and a member of Maryland Against Physician Assisted Suicide.

“We now know that as many as one third of prescription drug overdoses are suicides, and we continue to see the overall suicide rate rise in states like Oregon where this practice is legal. The lack of controls for large doses of lethal drugs is a grave danger to Maryland.”