Please vote NO on this bill. Do not open the door to abuse of the vulnerable suffering which is already happening everywhere any type of assisted suicide is legal.

DO NO HARM! This bill is creeping paganism but Paganism ALWAYS increases cruelty - ask the Romans who practiced crucifixion. This bill is nothing more than legalized cruelty. People will be pressured into ending their lives with a Doctors imprimatur! This bill is NOT supported by those who work in hospice or palliative care. This bill is NOT supported by the disability community or those who suffer from mental illness. This bill corrupts the field of medicine and makes physicians lackeys for the government, insurance companies, and reduces human beings to numbers on a spread sheet. There are those that say this is not happening and will not happen and the bill protects against such abuses. "This is a person's choice to end their own suffering." If a person makes a decision to end their life, it is suicide. It is not compassion. It is not care. A physician has a moral obligation to prevent someone from taking their own life. When a patient dies from suicide, not only do the family and friends suffer, but the treating doctors also suffer. The unanswered questions are numerous and complicate the grieving process. I am fully aware of the diagnoses of terminal illness and the countless decisions that occur at the end of life. However, one is blind if they do not see that opening this door and having physicians corrupt their oath "to do no harm" by deluding themselves that they are providing "care and comfort" when in fact their action of prescribing a lethal medication results in death. This is the same logic that is used when an unborn child is killed in the womb and the child is minimize to "tissue". The harm is the direct killing of an innocent human being. The beginning of life and the end of life are the two most vulnerable times in life. if you do not respect the former, you will not respect the latter.

I am familiar with two nations’ programs of physician assisted suicide – the Netherlands and Canada. In both cases what began as attempts to relieve suffering of terminally ill patients have morphed into free ranging euthanasia, both voluntary and non-voluntary, including selective non-treatment of persons suffering from physical defects, assisted suicide of people not terminally ill, assisted suicide as an alternative to aging, disability, etc. In some cases, people are assisted in dying because they have simply given up and don’t want to be a burden on families or society. In both cases physician assisted suicide has gone far beyond its original intent. My actual experience involves Canada where, but for the involvement of my wife, my aged mother-in-law would have been “assisted” in dying (involuntarily) in the hospital simply because she was old. This occurred before passage of Canada's assisted suicide laws. The second situation - post passage - involved our nephew who had terminal cancer and died with physician assistance. His long bouts of suffering make him somewhat of a “poster child” (young adult) for assisted suicide, but also for deficient paliative care. Since the time of the two events above, the Canadian system has gone far beyond its original intent: Some examples - https://www.dailysignal.com/2022/08/24/canada-is-euthanizing-its-sick-and-poor-welcome-to-world-of-government-health-care/ https://www.nytimes.com/2022/12/03/opinion/canada-euthanasia.html From this article: “In recent years, Canada has established some of the world’s most permissive euthanasia laws, allowing adults to seek either physician-assisted suicide or direct euthanasia for many different forms of serious suffering, not just terminal disease. In 2021, over 10,000 people ended their lives this way, just over 3 percent of all deaths in Canada. A further expansion, allowing euthanasia for mental-health conditions, will go into effect in March 2023; permitting euthanasia for “mature” minors is also being considered.” https://www.patientsrightscouncil.org/site/canada/ This is a compilation of articles on “Euthanasia & Assisted Suicide in Canada” and documents many of the unintended consequences of its legalization. Every member of the committee should read the articles contained in it before considering a vote on this legislation. I am against physician assisted suicide for many reasons including those indicated in the articles above. This is a Pandora’s Box full of unintended consequences, all of them negative. It is also an exercise in playing God, a bad practice in every sense.

"Assisted suicide" is very seductive to some terminally ill persons. The ultimate results of such bills, however, is not in doubt. The experience of several counties in Europe and Canada shows us that we will very soon witness physicians encouraging assisted suicide, euthanizing chronically ill persons without their consent, and offering assisted suicide as a "best option". It is sad that we have come so far that Dr. Kevorkian would now be mainstream.

I object to SB 280. Life needs to be protected and lived from conception to NATURAL DEATH. Assisting in suicide is akin to murder, which will perpetuate the belief that state legislators, doctors, medical personal, religious leaders, family members and really any individual has the right to determine who will live or die. And we are flawed humans that cannot and should not play God! I ask that this bill be retracted in respect for life. All life - young, old, "handicapped", disabled, depressed, mentally ill, lazy, proud, rich, poor, etc - as we have the capacity to take care of one another, and we need to encourage each other to do so!

I am opposed to "SB280 - Hashmi," the bill in favor of suicide assistance, on moral grounds. The state should not be in the business of euthanasia, physician assisted or otherwise. No one should have the right to kill themselves. God is the only one who should determine the timing of the end of life of individuals, from conception to natural death.

Vote NO on Senate Bill 280. "Supreme Law is the Basis of all Law, All Fiction Of Law Is Null And Void." Nisi prius courts relay on statutes, which is fiction of law, which seeks to control the behavior of the sovereign people, who are under common law, not statutes, and who ordained and established the law. Therefore, legislators cannot legislate the behavior of the people. "No provision of the Constitution is designed to be without effect, Anything that is in conflict is null and void of law, Clearly, for a secondary law to come in conflict with the supreme Law was illogical, for certainly, the supreme Law would prevail over all other laws and certainly our forefathers had intended that the supreme Law would be the basis of all law and for any law to come in conflict would be null and void of law, it would bear no power to enforce, in would bear no obligation to obey, it would purport to settle as if it had never existed, for unconstitutionality would date from the enactment of such a law, not from the date so branded in an open court of law, no courts are bound to uphold it, and no Citizens are bound to obey it. It operates as a near nullity or a fiction of law." -- 16Am Jur 2d. Didn't you take an oath to defend and protect the Constitution of the United States and Virginia? You are a representative of the people not the man or woman to make decisions about their behavior especially when they are sick. Vote NO on Senate Bill 280. Thank You Carolyn Worssam

There is now more data as to the outcome of such assisted suicide laws. There has been a misuse, a stretching, of laws to include cases that the populace would not support, even if they initially supported a bill. Making the decision to stop a life is so great, affects so many more than the dying individual, that great caution needs to be taken. There is a problem this bill wishes to take care of. We do have other means to care for people in great pain. We can step back and allow a process of death to unfold. We can deal with this issue with compassion that does not include our acting like we know all the answers and have the right to take a life. It is not in our nature to take difficult paths when an easy one presents itself. But difficulty is not bad in itself. It is where most people grow and gain strength for the next hole in the road. Respect life. Anything else hurts us all. Admit we don't know it all. Don't pass a law that will encourage death, as such laws have elsewhere. Do help people deal with pain and illness. That might include allowing a person in hospice to continue a helpful medical intervention. (In 2015 my mother was denied a continuation of a medicine she received for free from Johnson and Johnson for MDS. Blood work was also required. I saw it as palliative. ) An expansion of our definition of palliative might be in order. Do not pass this SB 240.

SB280 would establish policy with catastrophic outcomes for people with disabilities. SB280 proponents want a process for people with terminal diseases to control when they die. Our opposition to SB280 is due to the impact such policy will have on the right of people with disabilities to live, their need for supports that are already lacking, and the additional negative consequences this policy will have on the ability of people with disabilities to live dignified, supported, and self-determined lives. We know the patrons of this legislation have no intention of harming people with disabilities. Yet as seen in other States and countries with policies like what SB280 would establish, these policies have resulted in harm to people with disabilities. While it is a noble goal to reduce the emotional toll of dying, SB280 would do so by risking the lives of people with disabilities who need support to live. Our focus should be on addressing the reasons why people seek death, not providing aid for dying.

I am writing to urge you to oppose SB 280: it undercuts the strong U.S. policy of suicide prevention, raises serious informed consent issues, and authorizes the use of experimental, lethal drugs for patients. I strongly oppose this draft legislation as a pro-life Virginian who cherishes the sanctity of human life and who holds traditional conservative values.

I am completely and utterly opposed to physician-assisted suicide. Life should be valued, even when the person is old and may not be obviously contributing to society. I have little hope my comments will be read and persuade anyone of the opposite view so I will simply write that I have learned about the MAID program in Canada and the way physician-assisted suicide is legal in a few European countries. From what I understand, some of the doctors are well-intentioned and want to minimize suffering but the end result is pressure on the elderly to die, sometimes over the objections of caring family members who are willing and able to care for the elderly. I have an elderly mother. I have attended the funerals of many older people both friends and family members. Funerals are healing for the living. Life should be valued. It is a gift from God.

Physician-assisted suicide would have devastating consequences for the residents of Virginia, especially for persons with disabilities and the elderly. Ultimately, it devalues human beings to be simply their economic worth. All human beings have the same value. Each life is priceless -- regardless of ability, self-image, or even pain and suffering. Physician-assisted suicide also undercuts the strong U.S. policy of suicide prevention, raises serious informed consent issues, and authorizes the use of experimental, lethal drugs for patients. Physician-assisted suicide goes against the purpose of physicians -- to save life and improve it.

There is no right to State sponsored killing of aged, sick or despondent people . There is an obligation to support their lives, not promote their expedient and cost-effective death. Life and death are not eqivalent. Do not hand this tool to government.

o the House Courts of Justice Committee Members: I ask you to vote NO on SB 280 physician-assisted suicide. Our healthcare professionals are called to heal--not to help kill their patients. For patients who feel like they and their illness/situation is a burden to others, who are told that they are a burden, they will most certainly be at risk of feeling that they have a duty to die. They may also be denied the care and resources needed to live because it will be assumed that they only have one alternative: death. We need and must do better by the most vulnerable in our community. Healthcare professionals and the healthcare community must do MORE to help relieve suffering, to give compassionate and competent care to each patient, helping them to value their lives. Rather than hastening a patient’s death, we must advocate for increased access to palliative care and hospice care. Please vote NO on SB 280 as more training for healthcare professionals becomes available in our collective efforts to protect life and the vulnerable in Virginia. If this bill is passed, we will not be able to go back and undo what is done. Thank you. Sincerely, Nicole D. Hayes Executive Vice President, American Academy of Medical Ethics

GOD determines the beginning and end of life. HE doesn’t need our (your) help!

Vote NO on SB 280. I am the Director of Disability Outreach for PRAF and I'm a Canadian emigre who has lived in Virginia since 2016, Canada's regime began the exact same way proponents have positioned SB 280: By making promises of safeguards they know they won't keep. From 2016 to 2023, approximately 60,000 Canadians have died from assisted suicide and active euthanasia. These are confirmed numbers, not numbers from furnished, big-money polls, and they aren't the numbers of a rare, seldom used option that proponents claim is "just a choice" and not a mandate. But that's not true either. NO states have passed new legislation in the last two years. ALL the bills that have been pushed this season aren't finding the support advertised by proponents. MARYLAND just said NO! despite the claims of support by proponents, because the truth is, we know assisted suicide bills are bad public policy. That's why for the past two years, not a single state has seen assisted suicide legislation passed. It's why since 1997, despite millions of campaign dollars aligned with the interest of insurance company profits, and hundreds of attempts, the other 40 states continue to say NO! We can and will do better! That's why not a single national disability rights organization supports it. And make no mistake, The AMA reaffirmed it's opposition last November, and with each year, we have found that when people have been given ALL the facts, they see past the quick, big money campaigns of professional activist organizations. Proponents claim that 70% of Virginians with disabilities "support" this bill. That's not the truth nor the whole picture. Proponents also claim that around 70% of Blacks and the Latinx population support assisted suicide. But in every state where that's claimed, the participation numbers tell a much different story. In the District of Columbia, ONLY 4% of Blacks and Hispanics chose assisted suicide. And it's the same in every state where proponents have managed to persuade politicians that it's something the population wants the participation clearly states the opposite. In the Feb. 7th edition of Maryland Matters, a D.C. proponent (for Compassion and Choices) director of diversity, inclusion and equity was quoted as saying: "“I know in [the Black] community, we’re still fighting to live,”… “We don’t get adequate health outcomes to begin with. So it’s hard to say, ‘OK, let me offer you this option’ when you haven’t been given the support you need to live.” Precisely. But it shouldn't be hard to say, it should be impossible to say. In no area of society do we ever knowingly offer injustice as a form of justice. 60,000 dead Canadians and counting, professional proponents look to Canada's example despite claims that it's an "apples to oranges" comparison. But that's not what a simple Google search yields with keywords: Thaddeus Pope, Barbara Coombs Lee and "Canada" yield. With new information should come new conclusions. It's that type of good faith change we expect of our selves and certainly from our lawmakers. We believe it's never too late on any number of life's realities, but most importantly, as with society-altering, policy regressive legislation like this that will negatively affect thousands who need support, not betrayal. Vote No on SB 280.

Not Dead Yet is the leading national disability rights group opposing assisted suicide. Assisted suicide exists in the context of a broken down, discriminatory healthcare system that puts everyone at risk. Under assisted suicide laws, the main witness to abuse is the deceased person. Behind closed doors, family and caregivers can do almost anything under these laws and be immunized against accountability. From the Oregon reports, it’s been clear that assisted suicide is about disability. End of life concerns reflect people’s “existential distress” in reaction to disabling features of their illness like “losing autonomy,” “loss of dignity,” “burden on others,” and “losing control of bodily functions.” In my debate with leading proponent Thaddeus Pope, he conceded that “everybody who's using medical aid in dying is disabled. And probably you could go to the next step and say the reason they want medical aid in dying is because of their disability.” Pope recently published “Top 10 New and Needed Expansions of US Medical Aid In Dying Laws,” in which he called for elimination of any time frame for predicting death. He explained that “many seriously and irreversibly ill individuals [i.e. disabled people] not within six months of dying may still suffer greatly every day from their disease.” Meanwhile, over ¾ of surveyed doctors think that disabled people have worse quality-of-life than nondisabled people. 2012 Massachusetts ballot results and patient demographics in states like California show a social class, race, and ethnicity component in use by and support for assisted suicide. A 2013 Pew study demonstrated Black opposition by 65%-29% and Latinos by 65%- 32%.Majority Latino Lawrence, Massachusetts voted 69% against the 2012 Massachusetts ballot question, while wealthier and whiter towns voted heavily in favor. In California, 88% of users of assisted suicide have been non-Hispanic white, more than twice their percentage in the state population. Almost no Black people have used the program. Black patients under legalized assisted suicide will be more likely to be “written off” as “better off dead,” just as happened with medical responses to COVID-19. Terminal diagnoses are often wrong. Example of Jeanette Hall, an Oregonian who sought to use the law, but was persuaded by her doctor to try more treatment. She is alive more than 20 years later. Oregon has revealed that 4% of people who qualify for an assisted suicide remain alive after six months. That matches the estimated 4% of people on death row who are innocent. Many progressives use this to explain their opposition to capital punishment. Virginia must not become a sponsor of people's suicides because other people consider them a burden, because people may believe they are dying when they are not, and because they have been denied the treatment and support services that would keep them alive. Please protect vulnerable people. Reject this bill and the discrimination it promotes.

Life is a gift from God. We are made in His image and likeness. Though doctors do not need to provide extraordinary means to keep a person alive, comfort care is necessary. No doctor should ever do harm or kill a person or provide a person the means to harm or kill themself. No one but God knows an individual's time to go. That power belongs to God alone. Killing is not mercy, it is an injustice. Suffering, pain, and even lingering on are all part of the whole process of getting one's soul ready to meet God. It is also part of the process of bringing others to a place of charity, by having to serve and help the afflicted. It is good for all. People are not garbage to be tossed out when they can no longer function. They are to be loved and cared for.

Dear Members of the Committee, The health and well being of all Virginians is fundamental to the mission of the Virginia Medical Freedom Alliance. All human life is sacred and must be protected from harm. Especially, when that harm may be initiated by the government, insurance companies, "healthcare institutions," or the individual themselves. This bill is NOT supported by those who work in hospice or palliative care. This bill is NOT supported by the disability community or those who suffer from mental illness. This bill corrupts the field of medicine and makes physicians lackeys for the government, insurance companies, and reduces human beings to numbers on a spread sheet. If a person makes a decision to end their life, it is suicide. It is not compassion. It is not care. A physician has a moral obligation to prevent someone from taking their own life. When a patient dies from suicide, not only do the family and friends suffer, but the treating doctors also suffer. The unanswered questions are numerous and complicate the grieving process. I urge all members to vote no on SB280. It is simply not right to support assisted suicide!

In theory this sounds like a bill that allows for choices that allows people the right to not suffer or be in pain, so how could that be a bad thing. I understand that no one wants people to suffer and that is something that hits us all in a different way when u look at states where this is an allowed option and a recent report from Oregon states this the three most frequently reported end-of-life concerns were decreasing ability to participate in activities that made life enjoyable (89%), loss of autonomy (86%), and loss of dignity (62%).” Those are not focused on pain but around barriers that impact people with disabilities, barriers that a person with epilepsy I have dealt with. When you truly look at the data and why people have chosen this think about - We are stating that when a person’s disability condition becomes more significant, and they cannot just go out to the mall or grocery shop we are now saying death is now an option. If you lose the ability to provide your own care and rely on care givers that may or may not be family that is hard and having to navigate that is not easy but now when it becomes hard or overwhelming and having to ask your loved one or someone to get you out of bed, or dress you or perhaps realizing that you cannot get out of bed for several hours when faced with those situations and emotions we are now placing death on the table People with disabilities face barriers, I myself have had to encounter a life that is constantly changing due to my seizures, and it is hard but when we discuss assisted suicide and what we are seining is when barriers and hard conversations have to occur it is death that is selected to resolve this and that is very different then choosing it to end physical pain. The data shows that those reasons are why this choice is used not primarily physical pain.- People are choosing Death because of barriers that are related to them having a disability. I will end by saying Most of us have heard someone say, “I could never live like that.” Do they say that because they do not believe it is dignified to live with a disability? Or because they believe they would not be supported by others? Lack of knowledge about how people with disabilities navigate life is huge and it is due to this lack of real world knowledge that we get movies such as million-dollar baby or Me Before You – They focus on how death over the possibility of a life with unknown experiences and barriers is better. People say all sorts of misguided things due to ignorance or bias. However, once a person actually experiences a severe disability and very importantly receives the needed supports, their outlook on disability often changes and they experience disability differently than they may have initially expected. If this bill passes when someone states I could never live like that will they be presented an option to allow that to happen. Will they be given the option to end their life rather than grow and learn and advocate for a community that has resources that will resolve the barriers that we face as we deal with our life ending, Assisted suicide will diminish already scarce supports, increase the potential for coercion, and end the lives of people simply because they have a disability. Our focus must remain on improving, not ending, the lives of people with disabilities.

Please vote NO on SB280. Nothing is more precious than human life and ending the life of another is murder. The moral and ethical decline of our nation is terrifying and must stop, God will judge.

a physician, I beg you to Oppose SB280 (Medical Aid in Dying). This legislation has been a slippery slope into backdoor euthanasia every place it has been implemented and threatens to undermine decades of mental health work. Canada approved assisted suicide in 2015 with similar criteria. Since that time, it was changed from terminal illness, to irreversible chronic illness, and they are currently proposing assisted suicide for MENTAL ILLNESS and DRUG ADDICTION with no physical debility required! The Netherlands, one of the first countries to legalize assisted suicide, recently changed their law to allow assisted suicide for children 1-17years old. In Belgium, Shanti de Corte, 23, used MAID for assisted suicide for depression/PTSD after loosing friends in a terrorist attack. Godelieva de Troyer, 64, also died with a primary diagnosis of depression. Will we give suicidal patients here the same “aid” in a few years? Assisted suicide undermines years of work to deal with suicide prevention and mental health. We don’t have to take this path. I was present at the Senate Health subcommittee hearing on 1/23 for SB280. I listened to the supporters tell heartbreaking fears of debility and death. I know these challenges first hand. I also know that this fear is existential and we can address physical and mental suffering without fatal means. The supporters of this bill present this as an informed process, only for competent adults with less than six months to live. However, as detailed above, it does not stay that way. I would like to add some context to the narratives stories told you will receive by the organized campaign for these services. It is not simple determine when someone has less than 6 months to live. It is often very challenging. Statistics, such as cancer survival rates, tell you about the population level, but not an individual. The hospice "graduation" rate (people who left hospice care alive) has been estimated at almost 20% (Dolan et al, Health Affairs 2017). When 18-19% of hospice patients are still alive after 6 months, it proves the challenge! Further, capacity assessment for informed decisions can be quite difficult, especially if there is co-existing depression, which is common. There are not good surveys available, but I believe that you will find that the number of physicians who support this are in the minority. That is why major medical associations such as the AMA and ACP have actively opposed this legislation in the past. The opioid crisis showed us that just because a patient requests something, it does not mean it is actually in their or societies best best interest to grant it. Physicians of good will continue to care for our patients in life and death. If you want to help us, continue supporting increased access for palliative care, remove onerous restrictions on opioid prescribing and pain management, and support our sadly lacking outpatient mental health services. But please do not support SB280. Sincerely, Dr. Benjamin Chopski Richmond, Virginia

Vote no. A physician has a moral obligation to prevent someone from taking their own life.

Virginia Representatives of the People, I implore you to cease consideration of this bill in the Virginia Legislature. The desire to do good or be well intentioned is far outweighed by the likelihood of unintended consequences. This bill purports to be patient friendly to "assist" people at the end of life. The creator of life is in charge of deciding when life ends, not mankind. Normalizing suicide (assisted or not) will lead to the continued degradation in the value of life. All life is of value. Mankind should never decide to end life for convenience as is done with abortion. This assisted suicide bill will result in insurance companies incentivizing doctors to pursue this route rather than costly life extension measures. Please postpone indefinitely any consideration of this bill. Please spend your time and energy (and our money) on legislation that builds families - the building block of a strong society. Focus on STEM education so that our Virginia and America can compete on the world stage in the 21st century.

Medical professionals should not be involved in the taking of human life. The public needs to have absolute trust in medical professionals to be advocates for their health and wellness. This is a “red line” which should not be crossed. The patient who is considering end of life matters needs to be aware of all of the resources that are available to them short of practices that hasten death. They need to be aware of mental health counseling, spiritual care, hospice and palliative care, among others. Virginia needs to continue to be a state that celebrates life until natural death.

Please vote NO on SB 280 This bill puts the decision to end life in the hands of the Government, Doctors and Insurance companies rather than with the creator of life, God! The potential for corruption and abuse is huge. • Government should not be in the business of who lives or who dies. • Doctors should uphold their oath to preserve life and do no harm...not play God.. A physician has a moral obligation to prevent someone from taking their own life. Life is sacred! • Insurance companies, who are in a position to decide what will and wont be medically covered, could refuse to support/cover medicines and treatment for a disease which would extend/preserve life and instead choose to only cover assited suicide medicines and procedures. Assisted suicide is not humane nor compassionate. You can not sugarcoat it by calling it "Medcal care and comfort" any more than you can say "Planned Parenthood" provides "Care and comfort" for unborn,soon to be aborted, babies. When a person makes a decision to end their life, it is suicide plain and simple The diagnoses of terminal illness and the countless decisions that occur at the end of life present difficult decisions but there are medical options available that respect life and the quality of life. Suffering exists and pain can be severe, however, pain can be managed in order to provide improved quality of life. Though some may say the bill protects against the aforementioned abuses I believe there are many unintented, unforeseeable consequences that could occur and the potential for corruption is tremendous! Please...it is imperative that you vote NO on SB 280. Thank you!

Assisted Suicide Testimony Va General Assembly 2024 I am Dr Donald Stern, retired after 36 years with the Virginia Department of Health including 18 months as Commissioner. The last ten years of my career was as Director of Public Health for the City of Richmond. I have 2 major concerns related to SB 280; the Physician Assisted Suicide (PAS). 1. The integrity of this decision. This bill will add to the growing mistrust for the health care system much less many providers by reducing supports and services for people with disabilities, while the non-disabled are offered suicide prevention. This action will also enhance mistrust among doctors - i.e., the primary care physician who may choose PAS for his patient, but the specialist who would not. According to a study of Oregon’s PAS cases, even after 22 years of this permissive law, “There was no monitoring in any form of the quality of the consultation in which the decision was made to prescribe lethal drugs.” These decisions may have been based on financial concerns, loneliness and depression even cohesion or simply the lack of family participation/involvement. Do you want the burden of HC costs influence your end of life decisions? You probably would like a physician who knows you and cares for you to help you make this decision. In Oregon there was a reduction in the length of the physician–patient relationship from 18 weeks in 2010 to 5 weeks in 2022. This steady reduction in the physician–patient relationship in Oregon “may have made it more difficult to identify treatable factors influencing the wish to die.” Dr. Hendin Selling, a psychiatrist, in an article titled Death and Dignity, demonstrated that patients may be encouraged or even coerced into a suicidal decision or action. He maintains that the empowerment which is supposedly directed to the vulnerable patient is really being given to that persons relatives and physician. 2. Medicine’s growing separation from its moral tradition and made into a business. The AMA’s Medical Code of Ethics states “Physician-assisted suicide is fundamentally inconsistent with the physician’s role as healer.” The caregiver has a great privilege and responsibility to compassionately care for those who are facing death. This does not include actively participating in causing the death of his/her patient. In my training and experience this would be called malpractice. Leon Kass in his article entitled "Suicide Made Easy” examined the increasing societal trend to favorably regard assisted suicide as a dignified, rational, humane, and a courageous act. Kass contends that the inherent wrong of such an act is thereby dangerously disguised by this rhetoric. I am apposed to PAS and ask that you choose not to pass this bill on to the full House. Thank you. Donald R. Stern, M.D., M.P.H.

Please vote NO to SB 280 with boldness and great conviction. All human life is sacred and must be protected from harm. Especially, when that harm may be initiated by the government, insurance companies, "healthcare institutions," or the individual themselves. This bill corrupts the field of medicine and makes physicians lackeys for the government, insurance companies, and reduces human beings to numbers on a spread sheet. There is grace available for every moment, and good comes even from, and in pain. Good medical care can mitigate the pain without killing the sufferer. Dying is a part of living that is holy and private. It is between the dying person, his/her family, physician, God and hopefully a good spiritual leader. I'm praying that you receive wisdom and respect for the Creator's work and ways before you cast your vote. Thank you for listening, and God bless you all,

All human life is sacred and must be protected from harm. Especially, when that harm may be initiated by the government, insurance companies, "healthcare institutions," or the individual themselves.

Euthanasia of our citizens is not in the best interest of our state. Medical professionals, while they may often have an idea of which patients are in danger of imminent death, do not always predict correctly. Doctors should not have the power to determine when and who is going to die.

This bill subverts the practice of medicine and our Hippocratic Oath "to do no harm." All life is sacred and the end of life is a sacred time and it should not be corrupted with hyperbolic dialogue playing at one's emotions. Pleas of pain and suffering should not be used to corrupt the field of medicine and make doctors henchmen for an act of perceived "care and compassion." Doctors were the killing machines in World War II. They began by killing the elderly, the mentally ill, the disabled and those "unsuitable." The doctors and nurses who participated in the killing sincerely believed that their actions were for the good of humanity. In reviewing the comments, many spoke of intractable pain. Pain and severe pain can be treated in a dying patient. Consultation with pain management, palliative care and hospice regularly address this manageable condition. As a physician who works with those disabled by pain without terminal illness, when will they be told that it is their option to kill themselves for the convenience of others. I have multiple patients who had previously been told they had no options but to remain in chronic debilitating pain. These patients sought new doctors and have found relief and renewed energy and life. Had they listened to their treating physicians and not sought alternatives interventions their lives may have been cut short. The diagnosis of a terminal disease and life expectancy can be and is wrong on a regular basis. I recently spoke with a man who was given 6 months to live with Stage 4 Prostate Cancer. He is alive 19 months later. He has severe pain, however, he continues to live and is engaged with family and friends. His family and friends will mourn when he does die, but each of them is grateful for the tremendous amount of time he has been granted with faith in God and the use of alternative treatments. Patients have been healed of terminal disease. It has been recently made public that the wife of Jordan Peterson, Tammy Peterson, was miraculously healed. Her story is not rare. I have heard the stories of many people who "should" have died, but are alive and thriving today. Physicians are not God and we should not engage or falsely pride ourselves that we have power over life and death or take that power into our hands and corrupt our vocation. In Canada and in other countries, medical assistance has expanded to include: the poor, the mentally ill, those with chronic pain or chronic illness, the disabled and now to children. People in Canada are routinely denied testing and treatment until their condition becomes advanced and no longer treatable. Further, those who are mentally ill or who have other non-terminal illnesses are encourage to donate their organs upon death. Thus, again, this is manipulation of those who are poor or marginalized in order to benefit the highest bidder. People often shrink from the comparison to the doctors and nurses in World War II. We are blind if we do not see the blatant link. Have our fellow human beings been reduced to being identified by their productivity status? This is exactly what the Affordable Care Act authored by Dr. Zeke Emanuel believes. 75 is the limit. No treatment. Time to go. Your purpose has been served. The world will better off. Get in line in take your shot. You have a moral obligation. This bill is legalizing murder by physicians. Please Vote NO.

Please vote NO to SB 280 with boldness and great conviction. All human life is sacred and must be protected from harm. Especially, when that harm may be initiated by the government, insurance companies, "healthcare institutions," or the individual themselves. This bill corrupts the field of medicine and makes physicians lackeys for the government, insurance companies, and reduces human beings to numbers on a spread sheet. There is grace available for every moment, and good comes even from, and in pain. Good medical care can mitigate the pain without killing the sufferer. Dying is a part of living that is holy and private. It is between the dying person, his/her family, physician, God and hopefully a good spiritual leader. I'm praying that you receive wisdom and respect for the Creator's work and ways before you cast your vote. Thank you for listening, and God bless you all, Christa duVon

All human life is sacred and must be protected from harm. Especially, when that harm may be initiated by the government, insurance companies, "healthcare institutions," or the individual Vote No on SB280

SB 280 offers a compassionate option to Virginians with a terminal illness in their final days and is carefully limited to prevent any type of abuse. Don't we all just want peace at the end and a little control over how we die? I'm witnessing a family member at the end of her struggle with ALS and wish this was available to her now--her choices are much more gruesome. Please honor her by making it an option for those who come after her. Thank you.

Dear Committee members, please do not support this MAID bill. As a former hospice volunteer, please understand that this bill is not supported by hospice workers, by the disability community, or by those who suffer from mental illness. As human beings, we are to care for those who are suffering or dying. Medical assistance in dying cheapens life, a gift from God, and allows others to take advantage of a person at the most vulnerable time in their life. Please honor the sanctity of life.

No to SB280 Submitted by: Bill Fertig, Virginia Beach Police veteran Director, Spinal Cord Injury Resource Center United Spinal Association Thank you for this opportunity to oppose assisted suicide legislation, proposed in SB280. Based upon my 30 years in law enforcement, 16 years as Director of the Spinal Cord Injury Resource Center and through my own family end-of-life circumstances these many life experiences have formed my judgement of the overwhelming value of human life and its need to be preserved and cherished, not summarily terminated. During my police career I worked diligently to help prevent suicide attempts over my work life yet also had to officiate at many scenes of successful suicides. Uniformly, I’ve found families are forever devastated by suicide, in any iteration! As Director of the Spinal Cord Injury Resource Center, I also led my team to intervene when informed about a new patient contemplating his/her future with a spinal cord injury. We supported that person and family until he/she had more time to adjust to their new life circumstances. I have also successfully lived with spinal cord injury, since 1999. Further, I’ve personally had two family members provided compassionate, palliative and hospice care, who died with dignity, surrounded by loving family. I find assisted suicide neither dignified nor compassionate but a selfish and self-centered act, leaving families hollow and lost. Theoretical ‘guardrails’ cited in the bill are insufficient and WILL be abused leaving this a dangerous legislation. In fact, we are to assume that a physician’s subjective judgement about the terminal nature of a patient’s condition will result in death in six months or less. Yet, there have been multiple physicians testifying both for and against assisted suicide proving that physicians DO NOT agree even on that. Physician’s decisions will be arbitrary and inconsistent and thus not to be counted on. Please continue to protect the lives of Virginians. Vote NO to SB280. It’s literally a matter of life and death!

This testimony is filed on behalf of Not Dead Yet, a national disability organization headquartered in New York with members in Virginia. Data from states where assisted suicide is legal show that all people who request assisted suicide have disabilities, even if some don’t think of their impairments that way, and that unmet disability related needs are their reasons for wanting to die. There’s not supposed to be coercion to request lethal drugs, but what counts as coercion? How about lack of insurance coverage for treatment? How about limits on pain relief due to provider fears about opioid oversight? How about limits on home care? What about family coercion such as, “Grandpa, this will just give you more options,” or “Mom, this is getting to be more than we can handle.” Or even “It’s this or a nursing home.” Coercion is too hard to detect, too hard to prevent. Doctors are supposed to detect any coercion, but how could they do so when, for example, Oregon’s state reports say that the median duration of the prescribing physician patient relationship was only 5 weeks in 2021 and 2022. In about half the reported Oregon cases, there is also no independent witness to consent or self-administration at the time of ingestion of the lethal drugs. If the drugs were, in some cases, administered by others without consent, no one would know. Research on healthcare disparities has also shown that medical providers are not immune to prevailing social biases. Making assisted suicide part of “end-of-life care” and designating doctors as its gatekeepers and administrators could only further undermine patient safety, particularly for older adults, disabled people, Black, indigenous, communities of color and other multiply marginalized people who already experience life threatening healthcare discrimination. And members of the Courts of Justice Committee should readily see the problem with the “good faith” standard of culpability for violations of the bill’s provisions. A claim of “good faith” renders any so-called safeguards empty and meaningless. Legislators should also be concerned about the pressures toward expansion in the broader euthanasia movement.

We wanted to share with you our stories of how each of our our spouses died of a terminal illness (pancreatic cancer and ALS) and the difficult road they had to travel as they dealt with growing, sometimes excruciating pain, in full command of their faculties, knowing that they would have to endure that pain (even in hospice care) until death came on its own terms. What a blessing it would have been had they had the option to decide when they would pass, But unfortunately, that was not possible under the law at the time. We strongly urge you to support SB 280. This bill, co-patroned by our own Senator Boysko, would allow terminally ill patients to end their lives on their own terms. It contains ample safeguards to prevent abuse and, contrary to the rhetoric of some opponents, neither allows so-called "assisted suicide" nor would lead to a rash of assisted suicides (as borne out by the experiences of other states such as New Jersey, with a similar (though not identical) statute. For example, in 2019, New Jersey (a state with about 500,000 more people than Virginia) reported only 12 terminally ill patients who had ended their lives through MAID, as you can see from this report. https://www.nj.gov/health/advancedirective/documents/maid/2019_MAID_DataSummary.pdf We urge you to vote yes on this measure, which compassionately allows a terminally ill patient who is suffering the option to decide when their life will end. Thank you, Stuart and Madeleine Gibson

Chair Hope and Members of the House Committee on Courts of Justice. Thank you for the opportunity to offer testimony before you today. I am here to urge you to vote yes on SB Bill 280 . I live in Norfolk and am one of the state organizers for Compassion and Choices. In 2004 I became a caregiver for my sister who died from lung cancer that metastasized to her brain and spine. She treated and looked for remission as long as there was any hope. Once it became clear nothing was going to work for her, she suffered. Every day was another blow to her autonomy, her independence and the dignity of life as she had lived it. Once death is inevitable, modern medicine can keep people alive a long time. If this is their choice, they deserve every intervention possible. But, if someone is at peace with their death, why not give them final control of their lives - to relieve their suffering and be allowed to pass at the time and place that will bring them and their families the greatest comfort. In the work I do, I frequently hear people express that they are at peace with the fact they are dying, but are terrified of what they and their family will have to go through in the final days and weeks or even months before death. They want to die while they are still “themselves”, not being a burden to their families, not using precious dwindling resources and not some diminished shell of themselves. No one will ever be forced to use this option, but it will bring great comfort to many. Some may use it, but for others, just knowing it is available may be enough. For the people of Virginia who want self control over their end of life, please pass Senate Bill 280 Medical Aid in Dying. Thank You for your consideration. Judy Welp 1209 Botetourt Gardens Norfolk, Va 23517

Dear Committee members, At this moment, our beloved family member is attempting suicide by food and water refusal. She had hoped that medical aid in dying would have been available now as she succumbs to the agony of ALS, Lou Gerhig’s disease, but your inaction has sentenced her to a slow, paralyzing decline and final suffocation. It’s probably too late for her but you can help ease the passing of others by voting in favor of SB 280, Medical Aid in Dying. Do you want your loved ones and yourself to have this choice? I do. Thank you.

I am a lifelong resident of the Richmond region, and I currently work with the dying and their families as a counselor and End of Life Doula. I am writing in support of HB 280. I have personally witnessed accounts of uncontrolled, predictable suffering prior to death (even under the vigilant care of Hospice). I have also witnessed the avoidance and terror that afflicts patients facing such an end. They often spend so much time preparing for suffering or considering suffering or arming themselves for suffering that they avoid the conversations and tasks that better prepare families for the wake of their loved one’s death. I believe this significantly contributes to our community’s mental health and workforce productivity challenges. In states where MAiD is legal, fewer than half of those with the prescription ultimately take it. But do you know what they DO? They make their apologies, complete their documentation, offer their forgivenesses, say their farewells, and help their families come into acceptance of their death. This individual freedom provides a sense of agency and confidence to turn to other, critical tasks. These tasks are free to the taxpayer, but result in profound benefit to our community. I am a lover of life, and believe this to be a life-affirming effort enabling families to better prepare and cope with all stages of life, including its inevitable end. The impact of grief is significantly reduced when already dying patients are allowed to say when their suffering is too much. This bill is for dying patients, yes, but it also for their families. Please allow families these moments of great grace amid their hardest days. Please support HB 280. Sincerely, Erin Bishop

I wish to inform members of this committee that I, and a majority of other Virginians, support the right for terminally ill individuals to have the option to end their lives if and when their suffering becomes unbearable. This bill provides that choice, with over a dozen safeguards included to ensure that coercion does not occur, and that anyone who makes the decision to end their life can do so only if they are deemed mentally capable. The history of similar legislation in other states indicates that there have been no substantiated cases in which these laws have been misused. If enacted, this law would allow anyone to change their mind at any time. Indeed, in many prior cases, persons who have asked for and received the drug that they are considering using have ultimately chosen not to use it. I want to live in a state that cherishes life. However, the freedom to end one’s life should be available to everyone, in specific and limited situations, if and when the prospect of enduring needless pain and suffering cannot be avoided, and when all hope for survival beyond six months has been lost. - Thank you

I support Medical aid in Dying because of the number of tragic endings of both family members and friends that I have witnessed. While waiting to die from 3 diseases my Mom attempted suicide by knitting needle. Her final two months she was forced to sit by the nursing station while kicking and screaming at passersby "Help me, please kill me". When she and other relatives learned about voluntarily stopping eating and drinking they chose that way to hasten their deaths. Certainly, who in their right mind would choose that prolonged method of dying if given the option of self-ingesting a sure kill cocktail when they were near death. Eighty-four percent of people who had the option of using MAiD were already in a hospice program. By the way, people who are in hospice can also elect for total sedation that leads to unconsciousness and death. These two methods of hastening death are legal in the United States. Medical aid in dying is highly regulated and ever so much more compassionate. PLEASE vote YES for SB280.

Thank you for the opportunity to comment in support of Senate Bill 280. I speak to you from a personal standpoint. Our daughter Sandi died in 2013, suffering from an autoimmune disease with neither a cure nor effective treatment. She was 38 years old. Near the end of her life Sandi was in terrible pain. On October 17th, her birthday, Sandi made the decision to enter hospice care. Even getting out of bed had become almost impossible. Her lungs and liver were failing. One of her attending doctors, upon hearing Sandi’s decision, agreed. He said that hospice allows a course of action not available if she remained in the treatment setting. In addition to emotional support (talking with us, playing music), hospice gave Sandi medication to deal with her extreme pain. It took time – several days – to determine the appropriate dosage. Eventually, this was determined and the pain apparently subsided. I say apparently because Sandi was now in a coma. She died shortly thereafter, two weeks after entering hospice. I can’t say with certainty Sandi would have chosen medical aid in dying if it was an available option. I can say with certainty that Sandi was a mentally capable adult. She would have strongly wanted the opportunity to make her own decision. She had made her own decisions throughout her adult life up to, and including her decision to enter hospice. What is death with dignity? I recently heard it described as “dying as me”. Unfortunately, our daughter Sandi was not given that respect. As expressed by Archbishop Desmond Tutu, “Regardless of what you might choose for yourself, why should you deny others the right to make this choice?” As then California Governor Jerry Brown said (2015) when signing the California End-of-Life Option Act, “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to consider the options afforded by this bill. And I wouldn’t deny that right to others.” Today, there is both an increasing number of medical entities and majority support among persons of faith who believe that mentally capable, terminally ill adults should have the option to request and receive medication to peacefully end their life in consultation with a medical practitioner acting according to the dictates of his/her conscience without this violating the medical practitioner's professional obligations. Endings matter, both for the dying person and for those left behind. As her father, I will forever remember the line sticking out of Sandi's body and the jaundiced look on her face in the closing days of her life. Sandi, her sister, my wife and I were deprived of the opportunity to share memories, a final smile among ourselves, tears, a kiss, and to otherwise say our goodbyes. In closing, I urge your support for the passage of Senate Bill 280. Thank you. Mike Pearlman Chantilly, Va.

Please vote yes in support of HB280! I am 92 yr. of age, have Stage 3 Triple Negative Breast Cancer that has spread to my liver. Also, I am dealing with a broken neck due to a fall out of bed on Dec. 25, 2023. I can no longer contribute anything worthwhile to society. Quality of life is more important to me than quantity, & I have had quantity! Even though I have worked hard from an early age, my finances are minimal, and my continuing to live will cause financial plus physical hardship on my children who have children of their own who should be their first concern. Legally available medical aid in dying in Virginia (I can't afford to move to a state where it is legal) would be the answer to my many concerns at this point. I beg you ---please support HB280. Sincerely, Sue C. Pigg

SB 280 – Medical Aid in Dying Chair Hope and Members of the House Committee on Courts of Justice. Thank you for the opportunity to offer testimony in support of SB 280, which supports terminally-ill adults who are suffering and literally facing their own life-and-death situation. It's now time for Virginians to join Americans of 11 other jurisdictions who, allow these adults, when determined to be mentally-competent are afforded the right to choose Medical Aid in Dying. Multiple studies have found that 70% of Virginians, and most Americans agree. This patient-centered medical practice is optional for both the patient and physicians involved. It requires strict eligibility requirements and proven safeguards, used since 1994. Most importantly, it gives patients autonomy to end severe pain and suffering by taking their prescribed medication, if and when they choose to do so. Certainly, there is strong opposition by some, whose personal or religious beliefs preclude them from considering this option – and I respect that. Yet, it’s important to note that they need not choose it for themselves. They need only to find tolerance, to permit other terminally-ill people to make their own life (and death) choices. My ask is that you summon up the compassion, or your own respectful tolerance, to support 70% of your constituents, as well as those Virginians suffering in dying. Please support, SB 280 Medical Aid in Dying Act. Respectfully submitted March 2, 2024 by: Christine Woods Volunteer with Compassion and Choices 14 Lighthouse Drive Hampton, VA 23664

I speak as a retired Family Physician and a patient diagnosed with acute leukemia several years and now in remission. I spent 4 months in the Oncology Intensive Care Unit, which entailed a lot of suffering. Being “in treatment” I was not terminal and MAID would not have applied. With a 5% chance of survival, I am grateful to be here. If the leukemia recurs, and it could, I want the option of MAID (Medical Aid in Dying) to prevent pointless suffering if I am “terminal” and will be dying in any case. Please support a bill to let this be possible for me in Virginia. The Medical Society of Virginia in November of 2022 changed its stance from opposed to “Engaged Neutrality” which leaves it up to a physician, up to a patient and up to a pharmacist. This is a bill to end suffering in a dying patient. Angela Herring, MD Newport News, VA 23602 March 2, 2024

Dear Chairperson of the Courts of Justice committee and members thereof, On the eve of the last day that written testimony can be submitted for Medical Aid in Dying legislation in 2024, I feel compelled to write this addendum to my earlier testimony. This is my last opportunity to advocate for legislation that I most likely will not be on this Earth to advocate for in 2025. Please pass SB 280 this coming week. If you kick the can down the road, people like your former colleague, Congresswoman Jennifer Wexton, and all my fellow pancreatic cancer sufferers in Virginia will lose the choice they may want at the end of their lives. Many of us will die before the next legislative session. You yourself may never choose the option to use medication to expedite a difficult death. However, until you walk in my shoes, you cannot know that. I hope you never are faced with this sort of decision and that you and all the people you love die peacefully and with grace. For those of us facing ongoing pain and indignity at the end of life, please vote this week for SB 280 in your committee and on the floor of the House of Delegates. Barbara Green Falls Church, Virginia

Dear Chair Members of the House Courts of Justice Committee, I would like to start by thanking you for allowing me to speak (albeit electronically) in support of Senate Bill 280, also known as the Death with Dignity Act that would legalize Medical Aid in Dying in Virginia. My name is Judy St George and I have lived and worked in Virginia since 1986 when my husband’s military career relocated our family to Virginia. I currently reside in Chesapeake and am a constituent of Delegate Leftwich. I am a licensed and certified family nurse practitioner who was raised in the Catholic faith. My support of Medical Aid in Dying comes from decades of experience working with patients where end of life options were rarely discussed. End of life has been medicalized in our society resulting in needless suffering and reduced quality of life for terminally ill individuals. Hospice and palliative care have made great strides and these services have definitely helped people facing terminal illness. Medical Aid in Dying does not seek to replace these services but allows a terminally ill, competent individual an additional option/choice in controlling how they spend their final days. I feel strongly that Medical Aid in Dying should be an option (and it is just an option and completely voluntary) afforded to all Virginians. Medical Aid in Dying is legal in 10 states and the District of Columbia. No one should need to leave their home state or the comfort of their home to avail themselves of Medical Aid in Dying while struggling with a terminal illness. There are many safeguards built into the legislation. To date, there has been no evidence of abuse or coercion. I urge you to support this legislation and thank you again. Judy St George 507 Madera Rd Chesapeake VA 23322 757-613-8107 Judystgeorge3@gmail.com

Good morning Senator I wish to request your vote and assistance in passing bill SB280 which is so important for all of us as we transition from this life. I have worked hospice for many years with people from all walks of life. The end is not pretty or painless when leaving this world, and one wants to live with the knowledge that we can leave when we want to if terminally ill, painlessly and without going through the agonizing pain that the terminally ill person feels and that of their families and friends standing by watching helplessly. Please help us to bring dignity to death and dying and allow your people the choice and option of obtaining compassionate assistance when terminal. Thank you for your time and efforts for our communities. Peace Lynne Finding 365 Mainsail Drive Hampton Va 23664 757 979 7555 Lynne.finding@yahoo.com

When my 92 year old father died he had terminal multiple myeloma and kidney failure. As a Virginia resident, his only option to avoid physical pain and suffering was to voluntarily stop eating and drinking. It took him almost 25 days to die instead of the roughly 2-3 hours it would have taken if medical aid in dying was available to him. For more than 3 weeks my mother, my sisters and I watched him wither away until he took his last breath. This should never be the only option to avoid a painful death. I’m asking you to allow this in Virginia. Please vote YES on SB 280 for my family, your family and all the families in Virginia. Stephanie Stringer Norfolk, VA

Dear Chair Hope and Members of the House Courts of Justice Committee. I support Senate Bill 280. Watching my mother, father, and aunt suffer and die from cancer was excruciating. My father's decline was particularly rapid; he went from being able to walk to the bathroom to being bedridden in a matter of weeks. I was able to give him morphine while he was in hospice at home, but eventually, it became less effective, and he experienced breakthrough pain. He developed bed sores but was too proud to complain. I will never forget the moment he took his last breath. The cancers that killed my parents were not hereditary. However, I understand that if we live long enough, the chance of developing cancer is around 40%. If I am diagnosed with cancer at some point in my life, I do not want to experience the same suffering that my loved ones did. I would like the option to reduce my suffering and not wait for the disease to take my life painfully and slowly.

Having practiced medicine for over 30yrs. I have seen too many end-of-life events. This bill will save a great deal of unnecessary pain and suffering and grant peace of mind to patients and loved ones. Please take the time to truly evaluate this bill and help Virginia to join the other eleven states who have enacted legislation with strict guidelines and no cases of abuse. 7o% + of Virginians favor this issue to improve end-of-life care which should not be in any way in conflict with religious of political beliefs. Thank you for your consideration for this bill. Respectfully, Robert H. Perkins MD (ret)

Hearing Date: March 4, 2024 Bill Number: SB280 Delegate Hope and Committee members: Thank you for this opportunity to speak in support of HB 858 I would be there in Person if I didn’t have Covid. I am the Rev. Dr. Fred A. Soltow, Jr. I am a retired Lutheran Pastor. During the course of my ministry I witnessed first hand the passing of numerous people who would have welcomed this discussion of choice, if Medical Aid in Dying, had been an option. Medical Aid in Dying, as presented in this bill, is an option, an option for all involved in making this choice. It requires no one to go against his or her core personal values. Patients have choices to make when confronted with a terminal diagnosis of 6 months or less to live. Medical Aid in Dying should be one of those choices that is available to terminally ill patients with the approval their medical team. My mother spent the last three years of her life in a nursing home hooked up to a breathing machine because she had COPD. She was in pain and feared the days ahead as yet another day of pain and suffering. As a family, we stood by her side in our pain as we watched our mother in her pain. As a family we prayed that she would leave this world of pain and misery and pass into a new life of peace, love, hope and joy. My mother and my family would have welcomed, with open arms, the opportunity to discuss Medical Aid in Dying as an option to relieve her pain and suffering on the threshold of a new life beyond this one. I do not know where the conversation would have taken us, but the option to have that conversation would have been a blessing for all. Rev. Dr. Fred A. Soltow, Jr 1301 S Providence Rd North Chesterfield, Va.

I am writing today to offer my strong support for the passage of HB 858, the Medical Aid in Dying Act, which will be heard on Monday, March 4, 2024. In July 2022, I was diagnosed with metastatic pancreatic cancer, and my world was turned upside down. My doctors told me that the average pancreatic cancer patient lives 8 to 11 months after diagnosis although many die sooner than that. Only 1% of people with my disease are alive 3 years after the cancer is found, and almost none are cured. As a Virginia resident who had been working for years on legislative outreach for Medical Aid in Dying, I suddenly realized that my own life-threatening diagnosis meant a move to DC was in my future to be able to use their Death with Dignity law. I found it absurd that the choices of Virginia legislators made it impossible for me to continue to live in Virginia where I’ve spent most of my adult life and that, in addition to dealing with a cancer diagnosis, I also had to start dealing with moving. Knowing that Medical Aid in Dying would be available to me once I moved to DC gave me some sense of control over a very uncontrollable illness that has no cure. As I worked to structure my move, finding both a suitable rental and a cooperative doctor, I suddenly realized that months had passed, and I’d surpassed the timeframe when I was told I would die. This complicates my decision-making. I really don’t want to move to DC but feel that I must to avoid months of suffering once treatments stop working or the side effects become intolerable. Since I have no idea when that will happen, it’s become a constant concern that I don’t wait too long and then become stuck in a state that will not honor my wishes. Twenty years ago, I watched my ex-husband die of esophageal cancer. He spent the last several months of his life in bed, worrying that he would choke to death as some esophageal cancer patients do. I don’t want the end of my life to look like his did. Don’t deny this end-of-life option to Virginia residents. It’s legal basically to poison me with chemotherapy drugs that eventually my body will be unable to handle but illegal in this Commonwealth to let me die on my own terms rather than waiting through months of physical and emotional suffering. I should not have to leave Virginia to achieve bodily autonomy and do not see how anyone who has watched a loved one suffer through a lingering death could vote against this legislation. Please think about this as you vote.

I’m an ordained Catholic priest and have served in clerical ministry for 15 years before resigning and marrying. I am now a minister with the Universal Life Church and a hospice visiting volunteer. In both of these positions I have been with people during their dying hours. For some, their transitions have been peaceful and relatively pain free. For others they have been marked by physical and emotional suffering for the patient and loved ones and by a loss of all personal dignity, an inhumane final passage which could have been avoided for some if medical aid in dying had been an option. Please vote YES on SB 280 Not all terminally ill patients in Virginia would be eligible for made because of the stringent safeguards in the law preventing misuse or abuse. But for those who are, it provides a compassionate and peaceful end of life alternative to what otherwise could be a prolonged time of senseless suffering.

I'm Dr. Sharon Quick, President of the Physicians for Compassionate Care Education Foundation (PCCEF). Please oppose SB 280. Medically-assisted suicide laws inevitably violate (rather than uphold) patient autonomy, create (based on subjective, error-prone criteria) a class of marginalized patients from whom the standard of medical care is withheld, allow lethal drugs to unnecessarily substitute for good palliative care and pain control, disproportionately prey on those with mental health problems and disabilities, and destroy the foundation of medical ethics, creating distrust among patients and the health care profession. Oversight is inadequate to enforce the law or detect abuse, and this bill contains multiple conscience violations. This bill represents the most radically dangerous policy in the nation: (1) unlike every other law that requires 2 opinions, at least one by a physician, it requires only one full opinion if a patient is in hospice, and that can be a non-physician; (2) the provision to eliminate the waiting period for those near death is unethical and medically contraindicated as patients typically have loss of both brain function (preventing informed consent) and swallowing ability (precluding ingestion) at this time; (3) conscience violations are extreme, including potentially accusing doctors and family members of a felony for "undue influence" in trying to prevent assisted suicide--perhaps for strongly trying to talk a patient out of obtaining lethal drugs? (4) evaluation of patient mental capacity is too narrowly defined in cognitive terms only, lacking the broad assessment of disability and social, psychological, mental health, and other factors that may compromise vulnerable terminally ill patients' capacity to choose; psychiatrists--those most qualified to make capacity assessments--are precluded from making this determination; and (5) it has no consent form validation of witness identity or voluntary patient signature, and doesn’t require capacity or a neutral party when the patient ingests lethal drugs, making this bill a set-up for undetected elder abuse or murder. Please see the more detailed testimony attached.

Hello, my name is Kate Vasiloff and I am writing in support of SB 280/HB 858 which would legalize Medical Aid in Dying in Virginia. My dad, George Vasiloff, a Marine Corp Veteran and Virginian wanted the option to die peacefully instead of suffocating or choking to death as is often the case with ALS. …and he’s not alone. For two years in a row, a Christopher Newport University Poll has found 7 in 10 (70%) Virginians support Medical Aid in Dying. This spans a majority of every gender, age group, race/ethnicity, region of the Commonwealth, and size community. Three-quarters (77%) of Catholics agree this should be an option in Virginia, as do majorities of protestants (56%) and other Christians (64%). Eight in ten (79%) of Democrats support Medical Aid in Dying as do more than one-half (56%) of Republicans in Virginia. In this tense political climate, it’s refreshing to find an issue on which both parties can agree. Please keep your constituents support for Medical Aid in Dying in mind when you cast your vote today. Thank you for your time, Kate Vasiloff Arlington, VA

Please find attached testimony. -Suicide by Physician Targets Already-Vulnerable Persons and Puts Them at Greater Risk of Abuse and Coercion -S.B. 280’s Supposed Safeguards Are Ineffective in Adequately Protecting Vulnerable Patients -Suicide by Physician Erodes the Integrity and Ethics of the Medical Profession -Physician-assisted suicide is not healthcare. Instead, it acts as a limited exception to homicide liability under state law and allows physicians to use experimental drugs directly upon patients without FDA approval nor clinical trials. Accordingly, the majority of states prohibit physician-assisted suicide and impose criminal penalties on anyone who helps another person commit suicide. Since Oregon first legalized the practice in 1996 more than “200 assisted-suicide bill have failed in more than half the states.”45 Likewise, this Committee should reject S.B. 280 and continue to uphold its duty to protect the lives of all its citizens— especially vulnerable people groups such as the ill, elderly, and disabled—and maintain the integrity and ethics of the medical profession.

Dear Chair Hope, Vice Chair Simon and members of the committee, I am a retired physician resident in Henrico and I have practiced Cardiology for 50 years, starting in 1972 at the Veterans Hospital and the Medical College of Virginia. I strongly support SB.280. At the beginning of my medical career I could not imagine any measure that would hasten a patient's death. During my long career I have witnessed many patients struggle with their pain and suffering in a prolonged slow death when curative and palliative treatments have failed. I have also seen my younger brother plead with his son to let him go when he was suffering multiple organ failure and facing mutilating surgery. My late colleague, Dr. Latane Ware, a very conservative physician who was honored with a citation by this legislature became an ardent advocate of patient autonomy in decisions regarding their own life after one of his close friends became involved in a murder suicide because he could not bear the suffering of his wife. Dr. Walter Lawrence, former Chairman of Oncological Surgery at VCU mentored hundreds of young surgeons and treated thousands of patients with cancer until his death at age 96. At the urging of these 2 eminent physicians the Medical Society of Virginia withdrew it's opposition to Medical Aid in Dying and joined several medical organizations in a similar stance. Today most of the U.S. public as well as physicians support patient autonomy in matters of life and death and MAID is allowed in 11 U.S. jurisdictions including the District of Columbia. I have come to strongly support this bill if it includes appropriate safeguards including the benefit of appropriate pain management, palliative care and hospice care. Just the knowledge that one has control over one's pain can provide immense relief with few patients actually exercising the option. This is borne out by the experience in other States where this is allowed. I believe it is the rational and conservative position. It can prevent much pain and save unnecessary loss of life. Best regards Zubair U. Hassan MD, FACC (em.) 200 Brookschase Lane Henrico, VA 23229 804.285.4329 momlbh1@yahoo.com

Dear Courts of Justice Committee Members: I beg you to vote NO on SB 280. Please do not report this bill to the House floor for vote. The bill’s fundamental wrong is to promote suicide—doubly wrong when we already have an epidemic of suicide. But its provisions also open the door to coercion, abuse, and lethal harm of our most vulnerable citizens. From falsified death certificates and overlapping roles to lack of Board review transparency and more, the bill is very dangerous. For example, the same provider can receive both of the oral requests, select a capacity reviewer (IF the provider feels it’s needed), approve the suicide request, fill the prescription (if the provider also is a licensed pharmacist), and even sign the death certificate, which must be falsified to hide the fact that the real cause of death is suicide by overdose/poisoning. It is hard to imagine a combination of provisions more dangerous than that. This clearly would allow bad actors to manipulate and abuse vulnerable persons who do not consent to assisted suicide. The danger would be especially high in settings like hospitals or long-term care centers that may have the provider, patient, pharmacy, witnesses, and even capacity reviewers under one roof. The risk of abuse is astonishing and must not be allowed. Falsified death certificates in particular are a huge red flag and are unspeakably dangerous because later no one will be able to determine how people actually died. To require lying and falsification of official documents is totally unethical and a betrayal of the public trust. Meanwhile the Board's findings on compliance will remain secret "[e]xcept as otherwise required by law." This means that in cases of concern or controversy, we may never be able to determine what happened, justice may be denied, and future patients of the providers or entities may be placed at tremendous risk. Please see my email containing a more detailed list of dangerous provisions and defects in conscience protections. I urge you to take time to read that email in full. Suicide is always wrong because it is a form of taking innocent human life. Condoning the taking of innocent human life damages society, entrenching a mindset that sees taking innocent human life as a solution to suffering and difficulties. The harm caused by expanding that mindset must not be underestimated, especially when we already see increasing attacks on innocents breaking out in public places, and we already have some voices promoting the idea of involuntary euthanasia. I implore you to take all these threats seriously and vote NO to this appalling bill. Health care providers should never be dealers in death but always life, healing, and life-affirming care. And we have the best palliative care the world has ever seen. There is always a better path than suicide, even for the terminally ill.

Please do not support SB280, the self-killing-with-medications bill. We’ve all known people whose final days were marked by pain and distress. We shouldn’t be complacent about these things, but hastening death is not the answer. We do not need a self-killing-with-medications law in Virginia. Not that Senator Hashmi or other advocates use that wording. The older phrase “physician assisted suicide” was accurate, but confused legal authorities and life insurance companies. Now euphemisms like “medical assistance in dying” and “death with dignity” are often used instead. “Medical assistance in dying” sounds a lot like hospice or palliative care – but isn’t. “Death with dignity” implies that only a self-controlled death is compatible with living with dignity. Not true. Actually, almost all people with advanced disease maintain self-worth and dignity without overdosing. We should scale-up the availability of evidence-based interventions such as “Dignity Therapy” and high-quality palliative care, rather than buy into the idea that only hastening death preserves dignity. Some advocates refer to surveys that supposedly indicate a majority of people think they would want access to lethal overdoses. If that's true, let’s not jump to the conclusion that the Commonwealth should enable that. Rather, let’s infer that people do not trust their doctors or palliative specialists to help them adequately with their pain, anxiety, distress or self-perceptions they are a burden. We should address those real and perceived shortcomings, not help them rush toward death. I am glad that Virginia is working to reduce veteran suicide and improve access to mental health services. The Commonwealth should continue to pursue those goals, without sending the conflicting message that self-killing via overdose is state-sanctioned. I am a lifelong Democrat but I have no interest in state-sponsored mechanisms making it easier for people to end their lives. We don’t need to legalize self-killing with medications in Virginia. Instead, we need more research, clinical innovation, education and advocacy to increase the quality of life for people with life-limiting diseases, and better reimbursement for palliative care providers. We don’t need purposeful overdoses in Virginia, but more careful stewardship of powerful medications such as opioids. We don’t need physicians and pharmacists to enable hastened deaths in Virginia; we need them to provide better care for people without hastening death. We do not need false dichotomies in Virginia that suggest one can have pain or dignity but not both. We do need a more mature conversation about maintaining our humanity and dignity throughout life and into death, even in the presence of pain and existential distress. There is much in life that we would prefer to avoid, such as pain and being a burden on our families. Let’s work together to minimize those things without asking medical professionals to help us end our lives prematurely.

Chair and members of members of the committee, My name is Alice Alvord, from Virginia Beach. I support this bill, and only wish it had been available earlier. My 75-yr. old husband ended his life by suicide two years ago … after valiantly fighting cancer for years previously. He probably would have only lived another month or two. He was an “Old-School Gentleman.” He clearly believed his role was the “Family Protector.” Prior to his death he had frequently mentioned he did not want his family to watch him suffer with his continually escalating physical pain. I believe he simply “switched gears,” from fighting cancer to accepting the reality that his death was a part of his life. By his choice he said “I am ready to die.” Although shocked to my core at the manner of his passing, I was never once angry at him for his decision to choose the timing of his own death. However … I do remain extremely sad that he died alone. Had Virginia already passed such a law that is before you now, there is no doubt in my mind that he would have preferred that gentler option. Being together with his family when he took his last breath would surely have been a comfort to him. And … without a doubt … also a comfort to his family. I would not wish the trauma our family endured by his dying a violent death, alone, on any other family in Virginia. There is a more compassionate choice for those individuals like my husband, and for their families. I beseech you to grant them your compassion. Thank you for your understanding.

I am writing today to offer my strong support for the passage of SB280, the Medical Aid in Dying Act. I know you are very busy, so I will try and be brief. We are all going to die. It is part of life, but how we die, and in what setting, is not so certain. Ten states and Washington, DC have passed some form of medical aid in dying legislation, ensuring 20 percent of Americans have control over end-of-life choices if they have a terminal disease. As someone in her 50s, in excellent health, the thought of my own death seems very far away, but after going through both my dad’s battle with leukemia and my best friend’s battle with small intestine cancer, I know having options available in the event of an incurable, terminal disease is very important and will give me, and my family, peace of mind. I spent the last two days of my dad’s life with him in the hospital, holding his hand as he gasped for breath from the pneumonia that was filling his lungs, making him unable to breathe. He was in horrible pain, suffering needlessly, when he should have had the option to be home with his family, on medications to ease his suffering, with the ability to terminate his life with the same level of dignity he had during his 78 years on earth. His death made me mad because it was such a terrible and disrespectful end to his amazing life. Sitting there holding his hand as he passed, I made a promise that I would do everything in my power to advocate for compassionate, humane options for terminally ill people.

Chair and members of the Committee: My name is Barbara Green and I am here today in support of SB280: Health care; decision-making; end of life; penalties) In July 2022, I was diagnosed with metastatic pancreatic cancer, and my world was turned upside down. My doctors told me that the average pancreatic cancer patient lives 8 to 11 months after diagnosis although many die sooner than that. Only 1% of people with my disease are alive 3 years after the cancer is found, and almost none are cured. As a Virginia resident who had been working for quite a while on legislative outreach for Medical Aid in Dying, I suddenly realized that my own life-threatening diagnosis meant a move to DC was in my near future to be able to use their Death with Dignity law. I found it absurd that the choices of Virginia legislators made it impossible for me to continue to live in Virginia where I’ve spent most of my adult life and that, in addition to dealing with a cancer diagnosis, I also had to start dealing with moving. Knowing that Medical Aid in Dying would be available to me once I’d moved to DC gave me some sense of control over a very uncontrollable illness that has no cure. As I worked to structure my move to DC, finding both a suitable rental and a cooperative doctor, I suddenly realized that months had passed, and I’d surpassed the timeframe when I was told I would die. This complicates my decision-making. I really don’t want to move to DC but feel that I must in order to avoid months of suffering once treatments stop working or the side effects become intolerable. Since I have no idea when that will happen, it’s become a constant concern that I don’t wait too long and then become stuck in a state that will not honor my wishes. Twenty years ago, I watched my ex-husband die of esophageal cancer. He spent the last several months of his life in bed, worrying that he would choke to death as some esophageal cancer patients do. I don’t want the end of my life to look like his did. Don’t deny this end-of-life option to Virginia residents. It’s legal basically to poison me with chemotherapy drugs that eventually my body will be unable to handle but illegal in this Commonwealth to let me die on my own terms rather than waiting through months of physical and emotional suffering. I should not have to leave Virginia to achieve bodily autonomy and do not see how anyone who has watched a loved one suffer through a lingering death could vote against this legislation. Please think about this as you vote. Barbara Green Falls Church, VA

Chair and members of the committee: My name is Brenda Goodman and I am here today in support of SB280: Health care; decision-making; end of life; penalties. I have been a caregiver for multiple family members. I am also trained as an end-of life companion and am a hospice vigil volunteer. I live in House District 78 and Senate District 14. I support this end-of-life option and want this bill passed because I have spent considerable time with a wide range of people at the end of their lives and helping others develop advance plans that capture what matters to them at the end of their lives. The fear of a period of intense, unmanageable pain and suffering at the end of their lives is a thought that almost always arises in discussions. The contemplation that they will either have no control over how their own pain is managed or will have to watch a loved one suffer indefinitely is its own unique and torturous concern. I have never recommended medical-aid-in-dying to anyone in any situation. However, when asked about choices, I have and will continue to explain what it is and that it is currently an option with very stringent guidelines in other states. I consider it my responsibility to present all options available to both those who have received a terminal diagnosis and ask about options as well as those making advance plans who want to consider what choices they have that align with their values in various end-of-life scenarios. We do not have laws that prevent a person with a terminal illness from choosing to discontinue treatment that will likely shorten their lives. That is as it should be, in my opinion. Preventing people from choosing to end their lives with appropriate medical oversight when their pain and quality of life has become unacceptable is a choice that should be available to everyone meeting the requirements in Virginia.

Chair and Members of the Committee: My name is Brian Carlton, I live in Charlottesville, VA, and I am here to show my support for SB280: Health care; decision-making; end of life; penalties). Now a retired Certified Financial Planner and formerly a licensed nursing home administrator (worked in 5 different homes around the state). I want to share two personal events in my life involving end of life situations: My father died of pancreatic cancer in Culpeper Va at the age of 67. He worked 35 years as an engineer at IBM and he and my mother raised 7 children. Dying of cancer is a traumatic experience, one filled with angst and pain. I witnessed his last month of life lying in a hospital bed in our family home living room. His suffering took a great toll on him and my mother. He knew the end of life was near but it was a prolonged, uncontrolled event. I wish he would have had the choice in those final weeks to end his life peacefully by his own hand. He could have called all his children together, said the proper goodbyes and had a “good” death. That was not to be - he did not have a choice. I worked in many nursing homes around this state in my first career as a nursing home administrator. People don’t like to think of these places as “the place you go to to die”. I tried to make the facilities as happy and life promoting as possible. I do recall though that there were always a handful of people who were suffering and near the end of life. It is an impactful situation when you are holding someone’s hand and they are begging you to help them end their life. I could see it in their eyes that they were ready to go and they did not want to prolong the impending suffering that was in store for them. If they only had a choice! Choice! That is exactly what medical aid in dying is! It is not for everyone, but for those who see and feel impending suffering and death and want to avoid the suffering part (and not put their families through it!), they deserve that choice. I want that choice in the future if I end up in an end of life suffering scenario. Please.

Dear Chair and Members of the Committee, I am a now-retired physician, currently living in Woodville (Rappahannock County). I practiced medicine for thirty-five years in Washington, DC, specializing in the treatment of HIV/AIDS. In the 80’s and early 90’s there was no effective treatment for HIV, and it most commonly resulted in death. During this period my practice averaged one death per week. When we think of death we have images of gently passing away at home, surrounded by our family. However this is not always the case. There are “good” deaths and there are “bad” deaths. With AIDS I frequently saw the bad deaths: patients unable to breath from Pneumocystis pneumonia, lying in pools of diarrhea from cryptosporidium diarrhea, or in severe pain unresponsive to narcotics. In these circumstances, when I had no treatment available for the condition causing their suffering, I did feel the obligation to help them end their suffering. Given my experiences I am a supporter of Medical Aid in Dying. I would hope that a physician today would be able to aid patients at the end of life, and do so within the constraints of the law. I believe that SB 280 is well written and provides an appropriate framework to allow physicians to provide compassionate care at the end of life. Douglas Ward, MD Woodville, VA

Dear Chair and members of the Committee, I was raised and currently reside in Norfolk, VA, and I practiced Internal Medicine and Gastroenterology here in Norfolk for 30 years, retiring in 2008. I have been a Community Faculty Member at EVMS since 1975 and am still active, interviewing medical school applicants almost weekly in season. From both my personal and professional perspectives, I support passage of the VA End-of-Life Option Act. Having seen many patients, friends and my mother over these years suffer needless pain and suffering in their final days of life, I have sincerely hoped that Virginia would join the other states in our country that offer this option to control their final time on this earth. The Hippocratic oath, which I swore to uphold, compels me to do no harm, to heal and to help eliminate suffering. I call on your and your colleagues to enable physicians to be of service to their patients by having this option. A majority of physicians and Virginia citizens join me by being in favor of allowing the doctor to go beyond the excellent care given to hospice patients now available by allowing the patient and the doctor to use medication to end the patient’s life. The strict requirements for protocol in this bill assure that this approach is given when no other measures can help, with a proper waiting period, when the patient is of sound mind and can decide independently and when another physician agrees with the approach. I’m sure you are familiar with the other arguments both for and against taking this measure, and I trust after careful deliberation your committee and the General Assembly will enact this compassionate approach to aid the dying patient. Edward L. Lilly, MD, FACP One Colley Avenue, Apartment 1509 Norfolk, VA 23510 757-440-5535 (home) 757-438-7715 (Ed cell)

I am a primary care physician who has practiced in Virginia since 1986. I am testifying in support of SB280.. From my experience of dealing with terminal patients, I believe there is a serious and urgent need to help those few, whose intolerable pain, nausea, air hunger, loss of autonomy and other suffering cannot be fully relieved even by the most skilled palliative care. I believe a doctor’s primary task is to help reduce suffering, even if that involves shortening the dying process with the help of medications. This is the compassionate and realistic path where I cannot fulfill my role as a healer as these patients are, sadly, beyond healable. The evidence from states where medical aid in dying is already legal is reassuring that the multiple safeguards built into the proposed legislation invalidate any concerns that people will take their own lives capriciously, without truly having a terminal condition, or without fully understanding what they are doing. Or that they will be coerced into ending their own lives by family, insurance companies or others, possibly for financial reasons. Well below 1 percent of terminal patients request medical aid in dying, and only about half actually follow through. Knowing an end to their suffering is available is sufficient comfort. And denying legally sanctioned aid in dying promotes uncontrolled “back street” alternatives. This is the ultimate in autonomy and patient’s rights. The terminally ill should be able to choose for themselves. The religious and ethical beliefs of medical professionals or law makers should not override that autonomy. Any doctor or pharmacist who believes medical aid in dying is in conflict with his or her ethics is under no obligation to participate. I therefor urge you to have compassion on the terminally ill and suffering and provide this option to the people of Virginia. Patrick Neustatter MD Medical Director Lloyd Moss Free clinic Author of Managing Your Doctor - The Smart Patient's Guide to Getting Effective Affordable Healthcare. Website managingyourdoctor.com

Dear Committee Chair and Members of the Committee, I reside in Midlothian and having practiced medicine for 30 years, I have experienced too many end-of-life events. Often the prolonged pain and suffering for patients and their families or caregivers becomes overwhelming and robs them of any quality of life. In addition, as doctors, nurses, and hospitals are conditioned to heal patients, so many tests and procedures are performed which have no chance of improving one’s condition, while seriously raising the cost of care and depleting family financial resources as well as government assistance programs. The Medical Aid In Dying option in those states that have legislated it has been well proven to offer great peace of mind for patients and families, even for those who never make that choice. I strongly urge the passage of Bill SB.280. Sincerely, Robert H. Perkins MD (ret) dotandtin@gmail.com (774) 212-1007

As a Gerontologist and Family Caregiver, I have seen countless examples of individuals and loved ones barely existing, with no quality of life. I have also witnessed first hand healthcare professionals challenging an individual's DNR when said individual has diminished capacity. We live in a state with very few options for productively dying. And even those limited options are often challenged or ignored by healthcare professionals. We need legislation with some teeth that supports dying on our own terms. Jay White <info@gerojay.com>

I would like to start by thanking you for allowing me to speak (albeit electronically) in support of Senate Bill 280, also known as the Death with Dignity Act that would legalize Medical Aid in Dying in Virginia. My name is Judy St George and I have lived and worked in Virginia since 1986 when my husband’s military career relocated our family to Virginia. I currently reside in Chesapeake and am a constituent of Senator New-Craig. I am a licensed and certified family nurse practitioner who was raised in the Catholic faith. My support of Medical Aid in Dying comes from decades of experience working with patients where end of life options were rarely discussed. End of life has been medicalized in our society resulting in needless suffering and reduced quality of life for terminally ill individuals. Hospice and palliative care have made great strides and these services have definitely helped people facing terminal illness. Medical Aid in Dying does not seek to replace these services but allows a terminally ill, competent individual an additional option/choice in controlling how they spend their final days. I feel strongly that Medical Aid in Dying should be an option (and it is just an option and completely voluntary) afforded to all Virginians. Medical Aid in Dying is legal in 11 states and the District of Columbia. No one should need to leave their home state or the comfort of their home to avail themselves of Medical Aid in Dying while struggling with a terminal illness. There are many safeguards built into the legislation. To date, there has been no evidence of abuse or coercion. I urge you to support this legislation and thank you again. Judy St George 507 Madera Rd Chesapeake VA 23322 757-613-8107 Judystgeorge3@gmail.com

Dear Chair and Members of the Committee My name is Julie Hastings and I live in Chesapeake. I provided testimony in person last year, and am heartbroken to be unable to make it in person this year. Please accept this written testimonial in support of SB280, an act to support medical aid in dying. When my father became ill in 2021, we searched for any doctor who could give us a definitive diagnosis and a treatment plan. When we received a diagnosis of Amyotrophic Lateral Sclerosis (ALS) and Corticobasal Degeneration (CBD), the months forward were clear: He would lose his ability to use any muscles to his extremities, then the disease would affect his ability to eat, move his eyeballs, and eventually he would either suffocate or starve to death depending on which muscles went first. He died from starvation. Hospice was wonderful but in the end, they couldn’t manage all of his pain. He was suffering from muscle spasms and cramps that would pull him into a sitting position with guttural moans so deep they still give me nightmares. A 73-year-old man — who grew up in a farm town in Ohio, a devout Catholic, raised two children, worked hard every day of his life, gave to everyone he knew, always had a smile on his face and a kind word for everyone — in the end he couldn’t communicate his needs to us, his doctors, or even his Priest during weekly visits. My dad begged for a merciful death when he could still talk. His hospice doctor said that while they would do their best to keep him comfortable, getting him to DC, where Medical Aid in Dying was available would be almost impossible. The thought that he could have self-administered medication that would put him to sleep followed by a peaceful death — on his own terms — would have been a dream, but was an impossible one in Virginia. My dad did not want to die; my dad was living an incredible life. But as he said in the letter he left for me after his death, “simply being alive is not the same as living.” Disease took away his control over his life and death; having an option in the manner of his death would have given him peace. I urge you to report favorably on SB930, Medical Aid in Dying to give Virginians this option.

Dear Chair and members of the Committee, As a physician who obviously cares deeply about my relationship with patients I want to refer to a portion of the modern version of the Hippocratic Oath. “ I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.” Medical Aid In Dying (MAID) is very much consistent with the Hippocratic Oath that we as physicians take. When everything that is tried to improve our patients’ quality of life fails, the question arises when do we then turn to warmth, sympathy and understanding. When a patient is fully competent mentally with a predicted life expectancy of 6 months or less, has exhausted every possible modality to give them relief of their suffering, it is then time to respect a patient’s wishes if they are no longer able to cope with their illness. Should a patient decide to end their life with medical assistance, the proposed law requires two health care professionals, as a safeguard, to evaluate the patient to assure they are fully competent to make and understand their decision. If it is determined in the affirmative it is certainly the “warmth, sympathy and understanding” that is due the patient. I ask all members of the State Legislature if this was you, a parent, a spouse or a child would you not want to help them end their suffering if all possible treatments had failed? I urge you to give this legislation strong consideration with an open mind and a sympathetic heart. KENNETH OLSHANSKY, M.D. Cell: 8046901635 olshanskyken@gmail.com

Dear Chair and members of the Committee I write in support of SB280 which proposes medical aid to the dying. I am a citizen of Norfolk, a registered voter, and a retired physician. I am board-certified in psychiatry and neurology. Early on, I vowed to respect the natural inevitable, rhythms of life, i.e. birth, life, and death. I further vowed as a physician to do no harm. In my opinion it is a failure of these vows to allow pain to continue or to interfere with patient autonomy in a terminal situation. Both responses would interfere with life’s normal course and cause harm physically and mentally. Thank you for considering these thoughts. Larry Bernert MD (retired) 1 Colley Ave Apt 404 Norfolk, VA labjr@cox.net 757-620-2580

Dear Chair and members Committee Thank you for the opportunity to comment in support of SB.280. I speak to you from a personal standpoint. Our daughter Sandi died in 2013, suffering from an autoimmune disease with neither a cure nor effective treatment. She was 38 years old. Near the end of her life Sandi was in terrible pain. On October 17th, her birthday, Sandi made the decision to enter hospice care. Even getting out of bed had become almost impossible. Her lungs and liver were failing. One of her attending doctors, upon hearing Sandi’s decision, agreed. He said that hospice allows a course of action not available if she remained in the treatment setting. In addition to emotional support (talking with us, playing music), hospice gave Sandi medication to deal with her extreme pain. It took time – several days – to determine the appropriate dosage. Eventually, this was determined and the pain apparently subsided. I say apparently because Sandi was now in a coma. She died shortly thereafter, two weeks after entering hospice. I can’t say with certainty Sandi would have chosen medical aid in dying if it was an available option. I can say with certainty that Sandi was a mentally capable adult. She would have strongly wanted the opportunity to make her own decision. She had made her own decisions throughout her adult life up to, and including her decision to enter hospice. What is death with dignity? I recently heard it described as “dying as me”. Unfortunately, our daughter Sandi was not given that respect. As expressed by Archbishop Desmond Tutu, “Regardless of what you might choose for yourself, why should you deny others the right to make this choice?” Endings matter, both for the dying person and for those left behind. As her father, I will forever remember the line sticking out of her body and the jaundiced look on her face in the closing days of her life. As then Governor Brown said (2015) when signing the California End-of-Life Option Act into law, "I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn't deny that right to others." In closing, I urge your support for the passage of SB.280. Thank you. Mike Pearlman Chantilly, Va.

Dear Chair and Members of the Committee My name is Shannon Hibbard and I am here today to urge you to support and pass SB.280, which would give Virginians the right to use Medical Aid in Dying. For me, this is a subject I am very familiar with. In April of 2021, my father, Dr. David Hibbard, used Medical Aid in Dying in Colorado, one of the 11 other states which has legislation in place. To be able to support my father’s choice to end his severe suffering was one of the biggest gifts I could ever give him. My father had an immense affinity for life. He was one of the first Peace Corps volunteers in 1961, he was a mountain biking enthusiast, and he loved his career as a medical doctor, being one of the last to make house calls. When my father was diagnosed with Parkinson’s in 2007 and later leukemia, he wondered what the last few months of his life would be like. Not only was my father a doctor, but he was the Director for Hospice in Boulder, Colorado. He was a staunch supporter of palliative care and finding ways to make the last years and months of life easier. However, he also was all too familiar with pain that was not responsive to medication or other treatment; seeing someone in such pain, while knowing what likely awaited him given his prognosis, gave him great fear about what his last months and days would be like. Prior to the bill passing in 2016, he considered alternate means to end his life if suffering became unbearable. These conversations were gut wrenching to have. As a result, my father became one of the lead medical activists in Colorado to pass legislation in 2016. The last few months of my father’s life were extraordinary – both in how much I cherished my time with him and also how much I saw him suffer, with no options. He was taking narcotics every two hours, yet he would still physically change colors from the pain he was experiencing. I sincerely hope none of you ever have to witness a loved one go through so much pain and know there is nothing that any doctor can do, as your loved one is in fact dying and has less than six months to live. Instead of continuing through months of unrelenting pain, my father was able to take control of his life, to use Medical Aid in Dying medication and to pass into the next world peacefully, in his home of 50 years, surrounded by flowers, photos of a life well lived, and his family who told him it was okay to go, that we supported his decision. Every person should have this choice available, should they meet the requirements to use MAID. This legislation provides safeguards and has a history of safe use. No patient nor doctor is forced to use or be part of this law. But everyone should have the choice. I thank you for your time, and my father certainly thanks you for your consideration. Shannon Hibbard Alexandria, VA resident 2004-2014 Washington, DC

Please see attached testimony. Dear Chair Favola and Members of the Senate Committee on Education and Health - Subcommittee on Health I have been a voting resident of Virginia since 1964, currently reside in Virginia Beach and I support the Virginia Medical Aid in Dying Act (SB280). This is my written testimonial: I have lived 92 years. I’ve had a good quality of life until the past year and a half when I was diagnosed with colon cancer (surgery, recovery successful) followed by (one month later) metastatic breast cancer (Stage 3—lesions found in my liver). As suggested and counseled by my oncologist, I have undergone three separate chemotherapy treatments over the past 12 months, each one being more potent to not cure the cancer but prolong my life. I was not concerned about prolonging my life since I have had over 90 years of life already. My choice was based solely on the fact that a retiring daughter and her husband were willing to begin the process of selling their farmstead of 40+ years in Indiana and relocate closer to me in Virginia to be able to help me as I enter the final phase of my life. That was going to take some time and my health decision was based on giving them that time. Luckily for me, I have good health insurance but only because I was able to obtain a secondary (supplemental) insurance that I am grandfathered in and this insurance is, in fact, no longer available because it was ‘too good’ (for the patient, not so the insurance company).

Chair Sickles and members of the House Committee on Health and Human Services: My name is Wayne Swatlowski and I live in Richmond, VA. My involvement as a volunteer with Compassion and Choices is a result of my personal experience. I’m an ordained Catholic priest and served in clerical ministry for 15 years before resigning and marrying. I now minister as a hospice visiting lay volunteer. In both of these positions I have been with people during their dying hours. For some, their transitions have been peaceful and relatively pain free. For others they have been marked by physical and emotional suffering for the patient and loved ones and by a loss of the highly personal pieces that make up quality of life for them; an inhumane final passage which could have been avoided for some if medical aid in dying had been an option. I support SB.280 so that dying individuals can be in charge of their own end of life care in order to ensure a more humane and compassionate transition for all eligible Virginians. Please vote yes on SB280 today. Wayne Swatlowski Richmond, VA gravski@aol.com

Dear Chair Sickles and members of the House committee on Health and Human Services, I am a retired physician resident in Henrico and I have practiced Cardiology for 50 years, starting in 1972 at the Veterans Hospital and the Medical College of Virginia. I strongly support SB.280. At the beginning of my medical career I could not imagine any measure that would hasten a patient's death. During my long career I have witnessed many patients struggle with their pain and suffering in a prolonged slow death when curative and palliative treatments have failed. I have also seen my younger brother plead with his son to let him go when he was suffering multiple organ failure and facing mutilating surgery. My late colleague, Dr. Latane Ware, a very conservative physician who was honored with a citation by this legislature became an ardent advocate of patient autonomy in decisions regarding their own life after one of his close friends became involved in a murder suicide because he could not bear the suffering of his wife. Dr. Walter Lawrence, former Chairman of Oncological Surgery at VCU mentored hundreds of young surgeons and treated thousands of patients with cancer until his death at age 96. At the urging of these 2 eminent physicians the Medical Society of Virginia withdrew it's opposition to Medical Aid in Dying and joined several medical organizations in a similar stance. Today most of the U.S. public as well as physicians support patient autonomy in matters of life and death and MAID is allowed in 11 U.S. jurisdictions including the District of Columbia. I have come to strongly support this bill if it includes appropriate safeguards including the benefit of appropriate pain management, palliative care and hospice care. Just the knowledge that one has control over one's pain can provide immense relief with few patients actually exercising the option. This is borne out by the experience in other States where this is allowed. I believe it is the rational and conservative position. It can prevent much pain and save unnecessary loss of life. Best regards Zubair U. Hassan MD, FACC (em.) 200 Brookschase Lane Henrico, VA 23229

To whom is may concern, I am writing you to voice my disgust with the idea of this state making efforts to legalize assisted suicide. We should call it what it is, the cheaper option. The state is not concerned with bettering its people’s lives, it’s concerned with getting rid of the problem with the least amount of coin spent. If you were to legalize assisted suicide, insurance providers would have a massive incentive to deny access to care, to counseling, to the more expensive option of actually paying to have their customers become healthier and happier. If this bill is passed, it will open the floodgates for the poor, the elderly, and the disabled to be systematically killed through soft financial bullying. Assisted suicide is unamerican, it’s cheap, it’s lazy, and it’s cowardly. You will empower selfish, apathetic, downright evil insurance providers, who already prioritize $ over the wellbeing of their customers, to now choose an even cheaper, permanent option. Vote no on assisted suicide.

My name is Ian McIntosh and I'm the Director of Disability Outreach for the Patients Rights Action Fund (PRAF), and a member of the Executive Committee for the Virginia Alliance Against Assisted Suicide (NSVA), and a Canadian emigre with disabilities living in the great commonwealth of Virginia, and I urge you to oppose SB 280. I submit that what has been represented in this bill is not what will be produced contrary to what many understand the bill to entail. Proponents, like Dr. Thaddeus Pope have recently called for outright expansion calling safeguards "barriers". Just like we opponents have been repeating for years. In his most recent submission, to be found at his blog: The Good Death Society on Feb. 11th, 2024, he cites the example of countries like Canada as examples the US should follow. And the map in it's most basic form follows: 1) Assisted suicide (AS) bills have always presumed expansion. The idea of a safeguard has always been a myth, sold as a promise, and labeled a "barrier" once initial legislation gained a foothold. 2) AS legislation has expanded in every jurisdiction where legal. And in the case of residency requirements, proponents sue states to expand to remove residency requirements. 3) AS expansion leads to Active Euthanasia (E). 4) AS/E laws target people with disabilities because AS/E laws have been created solely for people with disabilities. And that's discriminatory. Pope concludes by saying, "While most of us won’t use MAID..."...Now please pause here for a moment. By "most" Pope also invokes Canada as an example worthy of replication in the US. As of this moment, 60,000 Canadians, between 2016-2023, along two tracks of eligibility, with active euthanasia being the primary delivery system, are dead. That's "most" in any modest definition of the word in a healthcare system of a just society. When you can measure deaths by national percentages, that is "most". At present, that's over 4% of Canada's total deaths and growing, with Mental Illness as a sole criterion for eligibility set to launch. Surely that is not what Virginia lawmakers believe they are considering. But that is PRECISELY what proponents mean when they call safeguards, "barriers" and sue for expansion despite initial promises to the contrary. And take proponents' poll representations and balance them against actual participation numbers. Like in D.C. where 45% of the population is Black, but only 22 of 24 people who used D.C.'s AS provision were WHITE. One was Black, the other Latina. Does that look like 70%? Another PEW poll says, 65% of Blacks and Latinx OPPOSE AS laws. Which poll confirms the participation numbers? What's the obvious inference? In fact a Compassion and Choices diversity, equity, inclusion advisor in D.C. was quoted in a Feb. 7th Maryland Matters article saying, “I know in [the Black] community, we’re still fighting to live,”… “We don’t get adequate health outcomes to begin with. So it’s hard to say, ‘OK, let me offer you this option’ when you haven’t been given the support you need to live.” Precisely. It shouldn't be hard to say, it should be impossible to say. Because it is an obvious moral failing to offer society’s most vulnerable the cheaper option to die, when you haven’t lifted a pen to fight for better, cheaper healthcare in order for them to live. Oppose this Trojan Horse. Oppose SB 280 and keep Virginia safe.

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The first legislation addressing animal cruelty as a felony in Virginia was enacted 25 years ago. The patron then, Senator Ken Stolle who was chair of Senate Courts of Justice, understood the necessity to address all cruelty, notwithstanding the victim, as a serious offense. The correlation between animal cruelty and domestic violence and child abuse has been well documented both in research and in reality. It is essential that there be a consistent and comprehensive approach to deterring cruelty irrespective of the circumstances or the nature of the victim. History and experience over 25 years has shown that the public believes the acts outlined in SB369 deserve a more severe treatment than a misdemeanor . Cruelty cannot be minimized without threatening the safety of all Virginians. Twenty-five years is long enough to wait for us to treat these offenses as serious ....and felonies.