On behalf of SAARA of Virginia we endorse Del. Hope's bill on Naloxone or other opioid antagonists onto its next stages. Thank you.

Michael Sizemore, Advocacy Manager of SAARA

Comments Document

Attached please find a letter from the National Safety Council (NSC) urging your support of HB 342, which would require state buildings to have opioid overdose reversal medications on site and train state employees on its use. This legislation is lifesaving and will help keep Virginians safe in the workplace.

House Health and Human Services - Health SubCommittee February 1, 2024 HB664 Abortion; born alive infant, treatment and care, penalty. The League of Women Voters strongly opposes this disingenuous bill, which makes up a problem that doesn’t exist. Doctors are already obligated to provide appropriate medical care. They are also the ones best suited to deciding what care is appropriate—rather than a group of legislators who are completely unfamiliar with the medical case and available options. We urge you to reject this bill which does nothing but further endanger and indeed, disregard, the health of Virginia women.

John 15:13 states, "Greater love has no one than this: to lay down one’s life for one’s friends." Elsewhere in the New Testament, we are reminded of the two greatest commandments: to love God and to love our neighbor. It is heartbreaking to see the culture of apathy and death we live in. A mother's and father's love for their child, born or unborn, has reached across religious lines for all of human history. There is no greater honor or sacrifice than putting aside temporary self-gratification to raise the next generation. And there is no greater satisfaction in this life than to watch your child grow and succeed. We must break the narrative of lies and deceit that have dominated the public square around this topic. A child is scientifically proven to begin their life at conception, and for Christians, we know our Father in heaven has known each of us before time began. To reject this fact is to reject reality. To perpetuate abortion in any form is to propagate the murder of an innocent child in its most vulnerable state. If we continue to allow the scourge of abortion to ravish our land, we will pay the price in this life and the next. Already, we have lost over sixty million boys and girls to this abomination. Imagine the inventions, creativity, athleticism, and love those sixty million souls could have contributed if given a full life. The love and care they could have provided to parents and siblings. We, as a culture and nation, are responsible for each of their deaths. I beg all of you to consider the cost and remember there is a God in heaven who is merciful and ready to forgive. But he will not be mocked, and his judgment can not be escaped. Christ is Lord. Repent and believe.

So-called ‘born alive bills’ are vehicles for anti-abortion politicians to push misinformation, stoke fear, and bully patients and providers — with the ultimate goal of banning abortion. These bills are completely unnecessary, as medical professionals are already obligated to provide appropriate medical care. To suggest otherwise is false, offensive, and dangerous. This is political theater and not how constituents want their elected leaders to spend their time in office. Instead of respecting every person’s decision and acknowledging the complexities of medical care, anti-abortion politicians are again resorting to inflammatory rhetoric to distract from their true agenda – to push abortion care out of reach and punish patients and their health care providers. Planned Parenthood Advocates of Virginia strongly opposes this legislation.

Madame/Mr. Chair, thank you for reading my comment on this very important bill. I am the survivor of three failed saline infusion abortion attempts. In attempt to end my life, my mother paid an abortionist to instill a deadly solution to burn me inside and out, not knowing that I may live through the procedure. The abortionist was unable to kill me using the prescribed method not only once, or twice, but a total of three times. All three times, the abortionist injected a toxic concoction into the womb with me, poisoning me and the amniotic fluid that was meant to sustain me in utero. To everyone's shock and surprise, I was subsequently born alive, almost 50 years ago today. Much of my childhood was spent with grand Mal seizures, and myriad health problems stemming from the chemical burns I endured in the womb. Thankfully, I've had the privilege of meeting and working with many other abortion survivors. In 1981, the CDC estimated that 400-500 abortions failed annually here in the US. Due to the lack of reporting requirements, no firm count is available, yet we know that Planned Parenthood reports that today 53% of all abortions are chemical/pill with up to a 13% failure rate, resulting in many more abortion survivors, such as myself. I am very much alive, even though laws did not require the abortionist report that I was born and care for me, just as any other human baby would receive. I ask that this committee vote in favor of this good bill to ensure that others like myself are given the care they so desperately need when they're born alive after one or more abortion attempts. Please vote YES for HB664.

General commercially available treatments for PTSD and depression went through research and development to provide treatments for mainstream pathoetiologies. These treatments were never designed to treat the types of severe and intense physical and emotional insults endured our armed forces. Having worked in children's residential care for 30 years, I can attest to the limits of mainstream medicine in the treatment of the population of severe child abuse. Drug addiction and suicide are notable outcomes here too. The treatment offered here by HB691 shows promice amoung the destitute medical offerings to treat the aftermath of these extream insults. Early results among our Veterans is promising. Pilot studies such as the one offered here can help define who benefits most from this treatment. Virginia Beach has a large Veteran population whose medical needs have been neglected. There may not be pharmaceutical profit in developing treatments for severe trauma. I urge passage of this bill. The safety data does not generate alarm.

I am expressing my support of HB763. This bill states "Requires the Board of Health to amend its regulations to require that every hospital where surgical procedures are performed adopt a policy requiring the use of a smoke evacuation system for all planned surgical procedures." Surgical smoke is generated by the electrocautery used to dissect tissue and cauterize bleeders during a surgical procedure. Studies have shown that the droplets within the smoke contain viruses, including HIV and HPV, carcinogens, bacteria, and blood contaminates. By having smoke evacuation systems within the OR the smoke is suctioned at the site of the incision and is contained with a HEPA filter that can be replaced when full. This decreases the smoke filling the OR suite thus lessening the hazard to the perioperative staff and the patient. I began my career as an operating room nurse in 1977 at 21 years old. I have been an OR nurse for 46 years. Data released by the Association of Perioperative Registered Nurses has shown that one day in an OR suite that surgical smoke is present is equivalent to inhaling 27-30 unfiltered cigarettes. This calculates to me having inhaled over 300,000 cigarettes in my career. I have never smoked in my entire life. After twenty years in the OR, after 3 bouts of bronchitis, and multiple upper respiratory infections, I was diagnosed with asthma. I thought this odd as I was living a healthy lifestyle, working out 5 days a week and eating a healthy diet. I now have chronic asthma that requires inhalers. The smoke within the OR aggravates my during procedures as well as making my eyes water. Several national organizations have made statements on the need for smoke evacuation including American National Standards Institute, National Institute of Occupational Safety and Health, Occupational Safety and Health Administration, and the Center of Disease Control. Please say yes on HB763 to protect the health and lungs of all perioperative staff, including nurses, surgeons, physician assistants, surgical technicians, surgical assistants, anesthesia providers, patients, and the tiny lungs of babies that are born by C-Section that take their first breath of life in a room with surgical smoke. Thank you. Janet Shortt, MHSA, BS, RN, CNOR

Enhancing healthcare safety is crucial and implementing smoke evacuation in operating rooms is a key step. By investing in this technology, we prioritize the well-being of both medical staff and patients thereby reducing the risks associated with surgical smoke exposure. The device to properly remove surgical smoke is available in many operating rooms and does not require construction or HVAC renovations; however, the use wavers, as there is no mandate. Surgical smoke was first identified by OSHA in 1988 as a known workplace hazard - that was over 35 years ago! There are several devices in the operating room that produce smoke: lasers and cautery devices to name a few. These devices are used to cut, coagulate, desiccate, and vaporize tissue during an operating causing a smoke plume. Surgical smoke has been studied for years proving there are over 40 hazardous chemicals found in the smoke which is equivalent to inhaling the smoke of 30 cigarettes a day! As a non-smoker, I am unable to protect myself from surgical smoke as even the best surgical masks (including N95 masks) do not provide protection. In 2021 only 5 states supported smoke evacuation mandates. Since then, 10 states have adopted smoke evacuation mandates, and I am looking for your support to make Virginia number 16! This bill aligns without commitment to advancing healthcare standards and ensuring a healthier environment for providers and patients.

Dear Chair and Members of the House Committee on Health and Human Services - Health: On behalf of the Association of periOperative Registered Nurses (AORN) and our more than 1200 members in Virginia, we urge you to support HB 763, a bill that would ensure that operating room nurses, their surgical colleagues and their patients are protected from harmful surgical smoke in the operating room. Surgical smoke is the result of human tissue contact with mechanical tools and/or heat producing devices, such as lasers and electrosurgical pencils. In other words, it is the smoke from burning flesh. Many surgical procedures generate surgical smoke. Common smoke producing surgical procedures include cesarean sections, hip replacements and mastectomies. Surgical smoke contains over 150 hazardous chemicals and carcinogenic and mutagenic cells. It contains toxic gases and vapors such as benzene, hydrogen cyanide, formaldehyde, bioaerosols, dead and live cellular material, blood fragments, and viruses. In addition to causing respiratory illness, asthma, and allergy-like symptoms, surgical smoke contains live viruses like HPV. There are documented cases of HPV transmission from patients to providers via surgical smoke inhalation. Surgical smoke can cause cancer cells to metastasize in the incision site of patients having cancer removal surgery. Babies born by C-section breathe in their mother’s surgical smoke at birth. Like cigarette smoke, surgical smoke can be seen and smelled. Unlike cigarette smoke, surgical smoke is still prevalent in employee workplaces like the operating room. Surgical smoke can be safely and effectively eliminated with available technologies and the equipment that many facilities in Virginia already have. We urge the members of this subcommittee to support HB 763 and provide a safe environment for healthcare workers to take care of their surgical patients.

YES on HB 858. This bill provides an OPTION for those with terminal illnesses who are found eligible by two doctors to end their lives gently and on their own terms. Isn't that what we all wish for? It cannot be used by someone with a disability or a mental illness and there are safeguards to prevent anyone from being coerced into it (which hasn't been found to happen in states where these laws are in place). Your personal beliefs prevent you from using it for yourself? That's fine, you don't have to. Please look beyond the usual party lines and make this law for the few Virginians who need it. Thank you.

Comments Document

See Attached.

Comments Document

Honorable House Members: Please take the time to review the attached "The Ethics and the Dangers" concerning Physician-Assisted-Suicide (PAS). Thank you, Nathan A. Rowe, APRN, PMHNP-BC, CEN Virginia Director American Academy of Medical Ethics

Dear Chair Sickles and Committee Members: I beg you to vote NO on HB 858. 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, 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. I have emailed each of you a more detailed list reviewing additional dangerous provisions. 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.

As an older Virginian who has witnessed the needless suffering of terminally ill individuals unable to make end-of-life decisions with dignity at home, I am reaching out to you, a valued member of the Education and Health committee. I urge you to consider voting in favor of the end-of-life decisions bill HB858 to pass through the committee. Allowing individuals the choice to stay in their homes during such a challenging time is integral to Virginia's commitment to empowering its citizens to make decisions about their own lives. I implore you to recognize the significance of this legislation in preserving the liberty and autonomy of Virginians. Sharing this plea, I draw upon the desire to ensure that when the time comes, I have the empowerment to make such decisions within the comfort of my Richmond home, avoiding the necessity of doing so in a distant hotel room out of state. I respectfully acknowledge the committee's pivotal role in shaping policies that profoundly impact the lives of Virginians. Your thoughtful consideration and support for this bill would not only address a critical need but also stand as a testament to Virginia's dedication to the well-being and freedom of its citizens. Thank you for your time and consideration.

Hb858 vote yes. Terminally ill people deserve bodily autonomy and deserve to not live the rest of their life in pain of they dont want to

Comments Document

Sharon Quick, MD, MA (Bioethics)--Reasons to Oppose Virginia HB 858 I am President of the Physicians for Compassionate Care Education Foundation (PCCEF), an organization without religious or political affiliation. We advocate for the terminally ill, who often have compromised capacity to choose, making them vulnerable to abuse. I have expertise in pediatric anesthesiology, critical care, and medical ethics. On behalf of our Virginia members and as a physician residing in Washington State , where physician-assisted suicide was legalized in 2009, we urge you to oppose HB 858 which is the most radical, dangerous policy of its kind in the nation. Summary: 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 the bill contains multiple conscience violations. This bill is a set-up for elder abuse. Please see the attached document for a discussion of the problems with medically-assisted suicide in general and a more extensive, but not exhaustive, list of the specific parts of this bill that make it particularly reckless and dangerous.

My name is Ian McIntosh, Director of Disability Outreach for the Patients Rights Action Fund (PRAF), a leading national organization fighting assisted suicide legislation across the country. Assisted suicide is suicide and any active participation in causing the death of a person is malpractice. Assisted suicide is suicide by any acronym proponents choose. But to counter course on the terminological war waged by professional assisted suicide activists, plainly, suicide was also known as self-murder. And in a healthcare system concerned with true choice and autonomy, the just thing to do when irrational action meets compromised thought is to act and think on behalf of the vulnerable and rescue them from their wrong decision. And yet, in our broken healthcare system, where mistrust between patients and doctors (and doctors and doctors) increases year over year, jurisdictions with assisted suicide legislation steers people with disabilities towards assisted suicide instead of suicide prevention solely on the basis of an immutable characteristic; That is discrimination. Professional assisted suicide organizations like Compassion and Choices and Death with Dignity are not -- I repeat -- not disability rights organizations. If they were a national disability rights organization, they would fight for...disability rights! If they were a disability rights organization, records would catalogue efforts fighting for health equity and there would be a word-of-mouth reputation identifying them as champions for those causes and concerns that actual disability rights organizations champion; They wouldn't face public rejection in the way the Alzheimer's Association rejected C&C's "educational" relationship approach in what's surely one of the clearest examples of how unlike assisted suicide is to real end-of-life care, every bit as much how unlike these professional assisted suicide activist organizations are to actual disability organizations:. From the Alzheimer's Association website: "Their [Compassion and Choices] values are inconsistent with those of the Association. We deeply regret our mistake, have begun the termination of the relationship, and apologize to all of the families we support who were hurt or disappointed...As a patient advocacy group and evidence-based organization, the Alzheimer’s Association stands behind people living with Alzheimer’s, their care partners and their health care providers as they navigate treatment and care choices throughout the continuum of the disease. Research supports a palliative care approach as the highest quality of end-of-life care for individuals with advanced dementia." I believe with new information comes new conclusions. I believe that disability rights are the domain of disability rights organizations and lawmakers of good will who turn data into policy that protects civil rights. No national disability rights organization with a position supports assisted suicide. All with a position, oppose it. Please side with those organizations who have championed the civil rights of the disability community and take the time to find out why they oppose this insidious legislation and the "work" of professional assisted suicide activists. As a Canadian emigre to the US, the thought of seeing Virginians in the thousands come under this eugenical boot is terrifying. Please oppose HB 858

Comments Document

Please consider the attached 2-page testimony from a disability perspective in opposition to this bill.

I am a practicing physician who has held a Virginia medical license since 1984 (#0101037516). I respectfully oppose the amendment proposed in HB 858, which would provide exemption for physicians who wish practice medical aid in dying (MAID) in Virginia. MAID is euphemism for physician-assisted suicide (PAS), a practice and ethos that is out of step with the long history of the medical profession, which runs counter to majority opinion in all religions, and is ignorant of the sustained condemnation of the practice by both the American College of Physicians (2017) and the American Medical Association (2018 and 2023). Physician-assisted suicide inevitably leads to active euthanasia, as the Canadian program bears witness. It places the vulnerable, marginalized, exploited and aged at risk of coercion and manipulation. The practice is toxic to society and under a PAS paradigm, race-based healthcare disparities will be augmented rather than mitigated. What we administer to our patients, for sickness or health, well-being or death, we administer to society. I urge NON-PASSAGE of this bill.

I believe that everyone should have the option when they are faced with definitive demise to choose how they leave behind this world and their loved ones. Giving people the dignity to say “I am ready” and to allow their loved ones to gather before the time is near to say one final goodbye is far better, and a far greater mercy than forcing them to wait anxiously and in agony for death to finally take them. Although this may not remove the pain of loss, nor will it eliminate the sorrow that will inevitably follow for those left behind, this option can alleviate the mental agony and fear of wondering when, and worrying if they’ll be able to say one final goodbye. I am in full support of MAID because we should all have the option if faced with imminent death to leave when we choose and when we are ready. This is a choice, not a requirement. Those who wish to continue to fight through their anguish have the option to do so, but for those who wish to have control over what will inevitably happen will have that availability with dignity.

As an end of life doula, I've had the privilege of serving some of Virginia's finest men and women as they journey through what is perhaps the hardest part of their lives. Every case is different but many clients suffer greatly during the last days/weeks of their existence on this earth. These fathers, mothers, brothers, daughters, friends all have unique personalities, fascinating stories, and individual needs. Every once in a while, I get calls for people who have declined to a state of total suffering and ask the doctor, the nurse, me, sometimes even their loved one to die. They beg. If they were a pet, the vet would be gently telling the owner that it's the humane thing to do. But here, a suffering person pleads in desperate pain to end it, and it cannot be done. The only recourse is to hasten death on their own via VSED: Voluntarily Stopping Eating and Drinking. In a doula role, I've supported several clients through this, and it was 4-15 long and agonizing days of hunger, thirst, and bodily suffering. They did not die in dignity or peace. Caregivers, as well were tormented as they watched their loved ones suffer despite continuously providing comfort care. Ultimately the intent and result of VSED and Medical Aid in Dying are the same, just much greater suffering in VSED. Only the laws in Virginia can dictate and change that experience for our loved ones, and how humane we are legally allowed to be with them. HB858 also comprehensively and appropriately addresses the critical topics that I've seen pop up through my experiences with VSED, such as not precluding people who are dysphasic, deaf, or have communication disorders as having capacity, provisions of wills/contracts, prohibiting acts of coercion, intimidation, and falsifying/destroying documents of patient's request as a Class 2 felony, as well as immunity of healthcare providers. This is well-written and extremely well thought out. I strongly encourage the passage of HB858 as a humane and compassionate act to all future Virginia patients who find themselves in this tragic misfortune, and in honor of those who've sadly gone before. Amy Nixon, Comforting Hands End-of-Life Doula Services, 757-987-5991 amy@comfortinghands.com

Comments Document

As a licensed physician in VA, DC, and MD, I'm submitting testimony in support of HB858: medical aid in dying.

Comments Document

I am writing as a board-certified Hospice and Palliative Care physician, but mainly as a 71-year-old who has seen the power of hospice to alleviate suffering and hopes that it is still available when I transition from physician to patient, and then inevitably to end-of-life patient. This bill is not the Oregon paradigm— it is the Compassion and Choices paradigm, much more coercive. We need patient-centered care, not activist-centered care. I was moved by last weeks's Senate testimony, but in every case I could not help but think: "Why were they unable to get good hospice care?" Palliative sedation, legal everywhere, can lessen suffering better than MAID, because it does not require self-administration. The best way to improve end-of-life care is to support expansion of the Medicare Hospice Benefit so that patients and caregivers have more support. In Oregon, the availability of MAID has not impaired hospice care because conscientious objection is respected. So 55% of hospices there do not allow their staff to be present for ingestion of MAID drugs, and 16% do not allow any involvement at all. That would not be possible under HB 858, which requires not just tolerance but affirmation of MAID. Since a core principal of hospice is neither to delay nor accelerate a natural dying process, I can say with confidence that the vast majority of hospice doctors, nurse practitioners, and nurses find MAID not only unnecessary but abhorrent. Compassion and Choices used to claim that they supported hospice, but this is no longer credible. Under HB 858, if I as a hospice doctor have a patient request for accelerated death, which is not at all uncommon, am I free to explore the patient's sources of suffering and recommend alternatives to MAID? Or would that be considered "undue influence" and therefore a Class 2 felony? And would a patient's spouse arguing against MAID also become a felon? Is MAID to be a last resort, as still recommended by one of its principal supporters, Dr. Timothy Quill, or is it now to be a first resort, replacing hospice, based on the expertise of Compassion and Choices? Under this bill, there is no escape from complicity with MAID, even with the secular rationale that it is not the best care available to the patient. When hospice care can compete fairly with MAID and not be compromised by MAID, it's not even close. In Oregon, after 25 years, less than 1% of deaths are from MAID. Do we want to risk the care of the other 99% in bowing to some abstract principle of absolute autonomy? I have attached an article from Ezekiel Emanuel, the principal author of the Affordable Care Act, and definitely not a member of the "religious right." He observes that "Legalizing euthanasia and [physician-assisted death] is really a sideshow in end-of-life care— championed by the few for the few, extensively covered by the media, but not targeted to improve the care for most dying patients who still suffer." I completely agree. This should be a nonpartisan issue, it's far too important not to be. If it narrowly passes on strict party lines, or even if it narrowly fails, most of you will not have given it sufficient thought. So please read this bill carefully, and learn enough about hospice to compare it fairly with MAID. I am happy to connect with any Delegate or Senator, on either side of this issue, to answer any questions. William R. Anderson, MD wrandersonmd@icloud.com

No one should be denied the right to die with peace and dignity intact. It is cruel and inhumane to prolong suffering against a person's wishes.

Comments Document

I am writing today to offer my strong support for the passage of HB 858, the Medical Aid in Dying Act. I know you are very busy, so I will try and be brief.

Dear Chair Sickles and Members of the House Committee on Health and Human Services, 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 Sickles and members of the House Committee on Health and Human Services, 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)

BILL NUMBER – HB 858 Dear Committee Chair Sickles and Members of the House Committee on Health and Human Services, 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 HB 858. Sincerely, Robert H. Perkins MD (ret) dotandtin@gmail.com (774) 212-1007

Chair Sickles and members of the House Committee on Health and Human Services, 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>

Dear Chair Sickles and members of the House Committee on Health and Human Services: I write in support of House Bill 858 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 Sickles and members of the House Committee on Health and Human Services. 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 Sickles and members of the House Committee on Health and Human Services. 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

As a physician who is a former Canadian, I have attended the deaths of many patients during my 24 years in medicine. I have grieved at many funerals. Palliative Care and Hospice provide excellent services to our patients in the Commonwealth, and there are no significant barriers to accessing end-of-life care for patients from all walks of life. Medicaid and Medicare provide these services to patients who have fewer resources, and commercial insurance does the same. This is not an issue of the HAVES vs the HAVE-NOTS. When I had patients tell me that they wanted to end their lives, I have ALWAYS been able to meet them in their moment of need with medicine and therapy to wrap comforting care around them to ease their suffering. When patients want to end their lives because of the horrors of pain, we ALWAYS have ways to help. I have had patients, friends, colleagues and co-workers commit suicide, and I have wept with their families. WITH THE WIDE-AVAILABILITY OF FENTANYL AS A STREET- DRUG, INDIVIDUALS WHO CHOOSE TO COMMIT SUICIDE CAN DO SO WITH MINIMAL BARRIERS AND WITH MINIMAL SUFFERING. Individuals who want to commit suicide do so without the "help" of a physician every day in this country. As a Canadian turned Virginian, I can tell you the stories of Canadians being told by healthcare workers that they are a burden to society; that they should consider assisted suicide. It is not a matter of IF our most vulnerable patients are advised to commit suicide by healthcare providers, it is a matter of WHEN. Abuses will happen. The same thing happens in Oregon and Washington State. I did not train for 15 years (college, medical school, residency, fellowship) to kill patients. I trained for 15 years to save patients in their most vulnerable moments of need. When patients in Virginia choose to die with dignity, hospice and palliative care provide the right care at the right time. My cell phone is 434 401 8769 and my email is markdavidt@icloud.com Please don't hesitate to reach out to me if I can help in any way. Mark D. Townsend, MD, MHCM, Fellow of the American College of Cardiology

Dear Chair Sickles and Members of the House Committee on Health and Human Services. 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.

As a healthcare provider in Virginia for over 40 years I have seen the sadness and agony of watching family members and patients suffer awaiting painful death when there is no longer hope. A patient should be able to make the choice for themselves how they will die and avoid painful suffering. This law has been passed in many states, as citizens of Virginia we should not have to leave our state to receive assistance in dying. Thank you for voting yes for this bill

HB858 Written Testimony: Margo Figgins, 2/1/24 My name is Margo Figgins. I am a resident in Virginia’s Fifth District and support the provision of Medical Aid in Dying (MAID) as defined in HB858. It is too often assumed that hospitalization and its extreme measures to prolong a life, and hospice care with its palliative measures to manage pain, are sufficient options for arriving at one’s last breath. But they are not. As a hospice volunteer, I witnessed conditions that palliative care could not adequately address and that resulted in tortured deaths. There are cases in which intractable suffering exists, wherein effective palliative treatment is impossible. Consider, for example, the person dying of emphysema. This illness is a hopelessly slow process of suffocation. There are no palliative interventions to make gradual suffocation tolerable, let alone peaceful. Another consideration needed for the terminally ill patient: Their fear of dying alone. Having accepted the fact of a terminal diagnosis, there were patients I sat with who were terrified of not knowing when that moment of death would arrive, of not having family or other loved ones with them when it did, and wishing they could experience the peace of knowing someone close to them – not an anonymous “Eleventh Hour” Hospice Volunteer – was holding their hand and assuring them that they were loved and would be long remembered. What could be more important in a democracy than one’s choice to author the closing lines of life’s final chapter – a life that represents the sum total of the choices made? Every person deserves a death consistent with their beliefs and their values throughout. For the terminally ill patient to have someone else’s beliefs and values imposed on the end of their life is an egregious offense to the autonomy they have exercised up to the moment of their death. They deserve the choice of conditions that ensure the comfort and dignity they desire. As your constituent, and someone committed to a responsive healthcare system that offers adequate options to the terminally ill person, I urge you to support Medical Aid in Dying as articulated in HB858.

I want this right at the end of my life. I am 80 and in good shape. But the last thing I would ever want is my family remembering me bed-ridden and slowly dying. That is not me. Thank you for supporting this bill. It’s long overdo!

Medical aid in dying is compassionate care for people who are suffering and the families who love them. Please pass this bill so that Virginians have the option to choose when they end their suffering and can do it at home.

I am one of your constituents, and at 61 years of age have concerns about future available heath related options. I am in support of compassionate care and fully support HB 858 because I want that choice if ever needed in the future. This is something that is very important to prevent unnecessary suffering for both the individual as well as their family as I’m sure you can appreciate. I hope you will support HB 858! Respectfully, Patricia McCormick Charlottesville, VA

I work with the dying. About 1/3 of the deaths I have witnessed have involved writhing suffering, despite Hospice's best efforts. Those with terminal illnesses are all too aware of the possibility of protracted suffering over which they have NO AGENCY, and this leads to an understandable avoidance of the fact of death's arrival. This avoidance, based in fear, prevents the dying from saying what needs to be said, completing the documents that need completing, stating the intentions that need stating. Too often, death "surprises" folks in Hospice and their families, and the result is family fracture, arguments, missed work, protracted grief. WITH AGENCY over the disease which is killing them, patients seem to translate that sense of control to other aspects of their final days. A prepared death results in so much less harm to society, and increasing access to prepared deaths is in the best interests of the Commonwealth. As a reminder: Pursuing, prescribing, and ingesting the medication is entirely optional, and is only available to those who are already dying. Disability is not a terminal disease. Mental health diagnoses are not terminal diseases. Patients in those categories would not be eligible for a prescription.

I strongly endorse House Bill 858. Medical aid in dying for terminally ill people is a proven medical practice that 7 out of 10 Virginia residents support implementing. This would allow a terminally ill, mentally capable adult with a prognosis of six months or less to live, to request from their doctor a prescription for medication they can decide to self-ingest to die peacefully in their sleep. It is completely optional; no one can be forced to use it, no doctor can be forced to participate, and at least two doctors must be consulted. The option is only available to an adult who is able to make an informed health care decision and is able to take the medication themselves. This is an incredibly personal issue for me. A peaceful death should not be illegal, and no one deserves to endure unnecessary, unbearable suffering at the end of their life.

Hearing Date: February 1, 2024 Bill Number: HB 585 Dear Chair Delegate Hope I am the Rev. Dr. Fred A. Soltow, Jr. I am a retired Lutheran Clergy person who served the church for 45 years. During the course of my ministry I witnessed first hand the passing of numerous people who would have welcomed the discussion of choice if Medical Aid in Dying had been an option. Medical Aid in Dying (MAID) as presented in this bill is an option, not a requirement. It is an option in the same manner that radiation, chemotherapy, stem cell replacement, and other medical procedure can be offered to patients with a terminal diagnosis. Patients have choices to make during their care and when faced with the end of their lives. Medical Aid in Dying should be one of those choices that is offered to a terminal patient with the input and the approval his/her 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 day 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 completely support Medical Aid in Dying as a voluntary option for terminally ill, mentally competent individuals. No one should have to suffer needlessly. Having Medical Aid in Dying allows a person to feel in control and thus relieve mental anguish as they navigate the end of life. Having Medical Aid in Dying should be available to all Virginians on a completely voluntary basis. Thank you.

Please support this bill. It provides a humane option for terminally ill, mentally competent individuals the option to end their life peacefully. It is completely voluntary. History has shown no abuse or coercion.

In an attempt to be brief: HB519: Hope I'm reading the title of this incorrectly, but with the far-right extremists out there I fear I am not. ABORTION CARE IS A NECESSARY PART OF HEALTH CARE AND SHOULD NEVER, NEVER, NEVER *EVER* BE CONSIDERED "UNPROFESSIONAL CONDUCT." If you vote for this, I don't vote for you. HB609: Children do much better when they are wanted children. It is ridiculous to attempt to control the sexual behavior of others by restricting access to birth control ... or indeed even at all. Everyone has a right to affordable, safe, effective means of preventing unwanted pregnancy. HB858: I hope very sincerely to see a right to physician assisted euthanasia at the end of life enacted in this state. I am a practicing veterinarian and perform this every day. It is very sad that human beings should have to suffer and linger when there is no more hope at the end of life when we would never treat an animal in this manner. I have also lost my husband to brain cancer, and while I don't believe he would have chosen that option, I believe others should have this right and the means available.

I am a primary care physician who has practiced in Virginia since 1986. – first in private practice and now as medical director of the Moss Free Clinic in Fredericksburg. I believe there is a lot of unnecessary suffering among terminally ill patients, because of lack of access to medical aid in dying. It is a small number of people who are appropriate for, or would choose to, foreshorten their dying process with the aid of medicines prescribed by their doctor, but I see this as the ultimate in patient autonomy and they should be the ones making this decision – and not have greater suffering forced upon them by the philosophical and religious beliefs of politicians and conservative medical organizations. The objection from some doctors that they are healers and not in the business of ending lives overlooks that these people are not healable. Are dying anyway. I see my duty as a doctor to minimize suffering. The evidence from states where medical aid in dying is legal already, shows the safeguards are effective in stopping people from being coerced into ending their lives. Or doing it capriciously. I urge you to support the cause of legalizing medical aid in dying in Virginia and support HB 858.

Over the past four years I have spent hundreds of hours educating people on the importance of advance care planning and explaining what medical aid in dying (MAiD) is and is not. If I told my Mother's story it would take at least 30 minutes, so, suffice it to say she wanted out so desperately due to the pain and suffering from multiple diseases that she attempted suicide with knitting needles. That action ultimately forced a move from assisted living to a nursing home where she spent her final two months sitting in front of the nurses' station kicking and screaming at every passerby "HELP ME, PLEASE KILL ME". Why did her life have to end this way? Mom's story is typical of both friends and family members whose worst nightmares were serving time on the "other death row". The observance of severe neglect at even the best rated nursing homes coupled with their pleas for a way out of life, left me emotionally distraught for days due to anger and sadness. I still get teary whenever I think about what I witnessed and my inability to do anything about it. If I were given the opportunity, I could fill a book with hundreds of end-of-life horror stories. There must be an alternative to this sad state of affairs. Please vote YES for the forwarding of HB 858. Once passed, the decision to use the law should be between the patient and the prescribing physician.

Honorable Committee: My name is Nathan Rowe, and I am a practicing Psychiatric Nurse Practitioner with a long history of working with mental illness not just as an advanced practice provider, but as an emergency and intensive care nurse as well as a paramedic over the past thirty years. Prior to being a medical provider, I am also a survivor of childhood cancer (1993) therefore can speak from one who faced a deadly disease early in life that presented as hopeless. Currently I work in a busy psychiatric practice in Southwest Virginia as well as a co-Director alongside Dr. Thomas Eppes and Dr. Jim Avery in the Commonwealth of Virginia for the American Academy of Medical Ethics (AAME). The AAME has a mission to promote the interests of medical educators, medical practitioners and scientists, the care and well-being of patients, the protection of public health, and the betterment of the medical profession, as well as to protect and promote the historicalvalues that have provided the longstanding foundation for Western healthcare.1 I am providing written testimony to briefly state an opposition to HB858. The National Council of Disability: Safeguards and Their Limitations The National Council on Disability (NCD), which is described on their website as “An independent federal agency committed to disability policy leadership since 1978”3 released a report to the President on October 9th, 2019, titled “The Danger of Assisted Suicide”. This report outlined at least six key issues that they found to be problems even with proposed “safeguards” of what is described as Physician-Assisted-Suicide. SAFEGUARDS AND THEIR LIMITATIONS: VERBATIM • Insurers have denied expensive, life sustaining medical treatment but offered to subsidize lethal drugs, potentially leading patients toward hastening their own deaths. • Misdiagnoses of terminal disease can also cause frightened patients to hasten their deaths. • People with the disability of depression are subject to harm where assisted suicide is legal. • Demoralization in people with disabilities is often based on internalized oppression, such as being conditioned to regard help as undignified and burdensome, or to regard disability as an inherent impediment to quality of life. Demoralization can also result from the lack of options that people depend on. These problems can lead patients toward hastening their deaths—and doctors who conflate disability with terminal illness or poorquality of life are ready to help them. Moreover, most health professionals lack training and experience in working with people with disabilities, so they don’t know how to recognize and intervene in this type of demoralization. • Financial and emotional pressures can distort patient choice. • Assisted suicide laws apply the lowest culpability standard possible to doctors, medical staff, and all other involved parties, that of a good-faith belief that the law is being followed, which creates the potential for abuse.4 Recenently Canada (who has laws such as PAS) are expanding to mental health patients who I am committed to treating. Unfortunately these bills are known to expand on a slippery slope. Let us in Virginia say NO to bills that allow providers to kill; please empower us to heal. Say No to HB858. 1 https://ethicalhealthcare.org/ 2 https://www.psychiatrictimes.com/view/medical-aid-in-dying-slippery-slope 3 https://beta.ncd.gov 4 https://beta.ncd.gov/report/the-danger-of-assisted-suicide

I am a nurse who has lived in the US for over 30 years, 22 in Canada and 8 in Germany. I have seen the health care from both sides. I took care of my elderly parents in my home for 12 years until they qualified for hospice and both suffered immensely before they died. I’ve seen nursing home horror stories. I just want to live my last years in peace and quiet without worrying who will take care of me when I can’t anymore and am bedridden. This bill passage can help so many when they know there is no more hope of living a quality life. On the practical side-it will help with the issue of SS running out, not enough nursing home placements and also the improvement of the quality of life for the caretakers out there. Please pass it

Honorable Committee: My name is Nathan Rowe, and I am a practicing Psychiatric Nurse Practitioner with a long history of working with mental illness not just as an advanced practice provider, but as an emergency and intensive care nurse as well as a paramedic over the past thirty years. Prior to being a medical provider, I am also a survivor of childhood cancer (1993) therefore can speak from one who faced a deadly disease early in life that presented as hopeless. Currently I work in a busy psychiatric practice in Southwest Virginia as well as a co-Director alongside Dr. Thomas Eppes and Dr. Jim Avery in the Commonwealth of Virginia for the American Academy of Medical Ethics (AAME). The AAME has a mission to promote the interests of medical educators, medical practitioners and scientists, the care and well-being of patients, the protection of public health, and the betterment of the medical profession, as well as to protect and promote the historicalvalues that have provided the longstanding foundation for Western healthcare.1 I am providing written testimony to briefly state an opposition to HB858. The National Council of Disability: Safeguards and Their Limitations The National Council on Disability (NCD), which is described on their website as “An independent federal agency committed to disability policy leadership since 1978”3 released a report to the President on October 9th, 2019, titled “The Danger of Assisted Suicide”. This report outlined at least six key issues that they found to be problems even with proposed “safeguards” of what is described as Physician-Assisted-Suicide. SAFEGUARDS AND THEIR LIMITATIONS: VERBATIM • Insurers have denied expensive, life sustaining medical treatment but offered to subsidize lethal drugs, potentially leading patients toward hastening their own deaths. • Misdiagnoses of terminal disease can also cause frightened patients to hasten their deaths. • People with the disability of depression are subject to harm where assisted suicide is legal. • Demoralization in people with disabilities is often based on internalized oppression, such as being conditioned to regard help as undignified and burdensome, or to regard disability as an inherent impediment to quality of life. Demoralization can also result from the lack of options that people depend on. These problems can lead patients toward hastening their deaths—and doctors who conflate disability with terminal illness or poorquality of life are ready to help them. Moreover, most health professionals lack training and experience in working with people with disabilities, so they don’t know how to recognize and intervene in this type of demoralization. • Financial and emotional pressures can distort patient choice. • Assisted suicide laws apply the lowest culpability standard possible to doctors, medical staff, and all other involved parties, that of a good-faith belief that the law is being followed, which creates the potential for abuse.4 Recenently Canada (who has laws such as PAS) are expandinging to mental health patients who I am committed to treating. Unfortunately these bills are known to expand on a slippery slope. Let us in Virginia say NO to bills that allow providers to kill; please empower us to heal. Say No to HB858. 1 https://ethicalhealthcare.org/ 2 https://www.psychiatrictimes.com/view/medical-aid-in-dying-slippery-slope 3 https://beta.ncd.gov 4 https://beta.ncd.gov/report/the-danger-of-assisted-suicide

My husband suffered immobilizing back pain for most of early 2019. In June, we received the diagnosis: metastatic cancer had invaded his spine. He died one long, agonizing month later, unable to move from the sofa in our den. Had he been the family pet, we could have legally saved him that miserable month. Obviously, moving somewhere that permitted a compassionate choice was out of the question. Please approve HB858 and permit those like my husband to have an option to end the pain when the end is so imminent. Thank you.

Dear Chair Sickles and Members of the House Committee on Health and Human Services 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 HB858, Medical Aid in Dying to give Virginians this option.

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 HB.858 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

Comments Document

Dear Chair Faviola and members of Education and Health 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 SB280. 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

Comments Document

Dear Chair Hope and members of the House Committee on Health and Human Services, Subcommittee on Health, I am reaching out in support of House Bill 858 (being heard tomorrow in the Health Subcommittee). This bill would authorize access to Medical Aid in Dying (MAID) in Virginia for those who are terminally ill and of sound mind who wish to use this medical management tool during their end-of-life care. I am currently a 4th year medical student at Virginia Tech Carilion School of Medicine. In addition to being a future family physician in Virginia, I was also a caregiver for my mother during her 4 year battle with lung cancer, which had spread to her bones and brain. Given the nature of her disease, and having witnessed her own mother's painful final days combating this very same disease, my mom was very interested in pursuing Medical Aid in Dying. She wanted the autonomy and assurance of a painless death, something that I think all patients deserve access to given the vast medical advancements we are privileged to enjoy in the U.S. Unfortunately, the only jurisdiction near us at the time of her illness which had legally authorized Medical Aid in Dying was Washington, D.C. and we could not afford to relocate there from Virginia given the cost of housing (nor did we particularly want to leave beautiful Virginia). It is inhumane that we let one's zip code dictate the ease of suffering at the end of life… Virginians benefit from excellent academic medical institutions offering the best medical care across every specialty except for palliative medicine, which is hamstrung by the current legal status of MAID. I have seen many patients pass peacefully, but I have also seen many who have suffered unnecessarily. I hope you will consider supporting the bill which would provide patients the liberty they deserve in making choices about their care and which mirrors legislation that has been enacted in other states safely for many years. If you have any questions about Medical Aid in Dying, or would like to connect with physicians who offer this service in other jurisdictions please don’t hesitate to let me know. With gratitude for your service, Lauren Canary Roanoke, VA P.S. I have attached a picture of my family before my mom's passing. I advocate for MAID in her memory since she, like so many other late Virginians, cannot be here to do so herself. Their voices deserve to be heard and considered too.

My name is Brian Carlton, I live in Charlottesville, VA and I am here to show my support for SB280/HB858; Health care; decision-making; end of life; penalties. I am 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.

Testimony before the Virginia State House of Delegates Prepared & Submitted: 31 January 2024 Date of Hearing: 01 February 2024 Bill Number: House Bill 858 – Medical Aid in Dying Dear Members of the Health and Human Services Committee: I wish to inform members of this committee that I, along with 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. Delegate Hope’s 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 taking have ultimately chosen not to use it. I want to live in a state that cherishes life. However, I also believe that the freedom to end one’s life should be available to everyone, in limited and controlled 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, James Beasley Woodbridge, Virginia

Dear Chair Sickles and Members of the House Committee on Health and Human Services, My name is Shannon Hibbard and I am writing to urge you to vote yes to HB858, 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 states/district which has legislation in place. To be able to support my father’s choice to end his severe suffering was one of the most profound ways I could show my love for him and his decision. 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. He was a staunch supporter of palliative care and finding ways to make the last stages of life easier. Not only was my father a doctor, but he was the Director for Hospice in Boulder, Colorado. Given his work with hospice, he also was all too familiar with pain that was not responsive to medication or other treatment; seeing patients 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 legislation being introduced that would enable Medical Aid in Dying, he considered alternate means to end his life if suffering became unbearable. Those conversations were gut wrenching to have, leaving us feeling hopeless. Thankfully it did not come to that. 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. He was taking narcotics every two hours, yet he would still physically change colors from the pain he was experiencing. I sincerely hope no one ever has to witness a loved one go through so much pain and know that 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 to pass into the next world peacefully. He was 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 loved him indefinitely and supported his decision. Every person should have this choice available, should they meet the stringent requirements to use Medical Aid in Dying. This legislation provides safeguards and has a history of safe use. No patient--nor doctor or pharmacist--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 https://www.dailycamera.com/2023/04/07/guest-opinion-devin-hibbard-our-fathers-empowered-death/ https://www.compassionandchoices.org/stories/hibbard

Regarding HB 858 January 31, 2024 Dear Chair Hope and Members of the House health and Human Services - Health 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 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 HB 858 is well written and provides an appropriate framework to allow physicians to provide compassionate care at the end of life. Douglas Ward, MD

I am Dr. Angela Herring, a retired Newport News Family Physician, and an acute leukemia survivor. I have had four months in the hospital with three bone marrow killing chemotherapy treatments and am in remission. I ask that you support passing a law in Virginia (HB858) that would allow me that option and let Virginia join the 10 states and the district of Columbia that already have such a law. Oregon, the first has shown there is no abuse or problems since the 1990s-almost 30 years. As a physician I have had terminal patients in hospice who asked me for enough medication to end their suffering and I could not provide that relief for them. The Medical Society of Virginia changed their stance last year to join with the Virginia Academy of Family Physicians from opposed to “engaged neutrality” which means it is up to the individual doctor and individual patient to decide. Polling results from CNU (Wason Center) for two recent polls show 70% of Virginians support MAID with support across political parties, religions and ages. In the event the leukemia returns I would like the option of Medical Aid in Dying as do not want to go through that pain and suffering again. Please support a bill that would allow me that option. Thank you. Angela Herring, M.D. Newport News, VA

Dear Chair and Members of the House Committee on Health and Human Services - Health: 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 Thursday, February 1, 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. Sincerely, Barbara Green Falls Church, Virginia

February 1, 2024 Support HB 858 Dear Chair Hope and Members of the House Committee on Health and Human Services- Health: I support HB858 because I want the option of medical aid in dying, if I am diagnosed with a terminal disease. This bill is about compassion and providing terminally ill adults, body autonomy and the right to make the best decision for themselves. Medical aid in dying forces no physician or pharmacist to participate in the practice of aid in dying I want my physicians, health care professionals and pharmacist to know they will not be prosecuted if my terminal disease progresses at the end of my life. Having the option to consider my symptoms, and discuss medical aid in dying with my health care team, allows me to support my personal values of a gentle death and a peaceful passing. Watching a loved one suffer due to unmanageable symptoms in hospice care, is a common experience for families. I do not want the memories of my death to be traumatic for my family. Hospice is wonderful and they help patients as much as the law allows, but, in Virginia they cannot help people who want medical aid in dying. Please consider 70% of Virginians support medical aid in dying across all categories; age, gender, religion, race and political affiliation. Terminally ill adults in treatment, try to stay alive. When treatments no longer work, they are faced with a decision to stop eating and drinking in order to die. Starving to death is a very in- humane option, which is legal in Virginia. I do not want to move to D.C. but I will be forced to leave Virginia, like many other terminally ill adults, in order to have the option of medical aid in dying. Please vote for HB858, so the State of Virginia will allow me to have a peaceful passing. Thank you for your time and consideration on this timely bill. Every day, terminally ill adults pass without the option of medical aid in dying. Perry Patterson Virginia Beach

Comments Document

On behalf of Compassion & Choices Action Network, I'm submitting written testimony in support of HB858: medical aid in dying.

Chair Tran and Members of the House Committee on Health and Human Services; Subcommittee on Social Services: Thank you for the opportunity to offer testimony before you today. I am here to urge you to vote yes on HB Bill 858 . 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 House Bill 858, Medical Aid in Dying. Thank You for your consideration.

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 on HB 858. Barbara Green Falls Church, VA

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.

Comments Document

I am writing in support of SB 280/HB 858 which would legalize Medical Aid in Dying in Virginia. Perhaps the most important and often overlooked aspect of this bill is it is It is 100% voluntary – from the patient initiating the conversation with their doctor to the second or third doctor needed to sign off on a patient’s prognosis and mental stability to the doctor writing the prescription to the pharmacist filling the prescription – no one is required to participate in the process and can remove themselves at any time. This is just an option for those who want it, like my dad. 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 support Delegate Hope's HB 858 to allow an adult diagnosed with a terminal condition to request an attending health care provider to prescribe a self-administered controlled substance for the purpose of ending the patient's life. The bill requires that a patient's request for a self-administered controlled substance to end their life must be given orally on two occasions and in writing, signed by the patient and one witness, and that the patient be given an express opportunity to rescind their request at any time. Those whose religious beliefs condemn this practice should NOT be imposing their beliefs on everyone else. My husband's grandmother in a nursing home would beg me to put a pillow over her face and sit on it, something she wouldn't dare ask family members for fear of distressing them. For them she put on a brave face and said things were fine, but everyday for her was full of meaningless suffering and loss of the autonomy she cherished so dearly. She lived to help others, to be useful. All I could do was wring my hands and say that one day a lawmaker will make a bill that will make this possible. She was ready to get off the bus, she'd led a good life, loved and been loved and now had had enough. Thank you, Delegate Hope, for introducing this bill in the Virginia Assembly.

Please support Delegate Hope's HB 858 to allow an adult diagnosed with a terminal condition to request an attending health care provider to prescribe a self-administered controlled substance for the purpose of ending the patient's life. The bill requires that a patient's request for a self-administered controlled substance to end their life must be given orally on two occasions and in writing, signed by the patient and one witness, and that the patient be given an express opportunity to rescind their request at any time. Those whose religious beliefs condemn this practice should be imposing their beliefs on everyone else. My husband's grandmother in a nursing home would beg me to put a pillow over her face and sit on it, something she wouldn't dare ask family members for fear of distressing them. For them she put on a brave face and said things were fine, but everyday for her was full of meaningless suffering and loss of the autonomy she cherished so dearly. She lived to help others, to be useful. All I could do was wring my hands and say that one day a lawmaker will make a bill that will make this possible. She was ready to get off the bus, she'd led a good life, loved and been loved and now had had enough. Thank you, Delegate Hope, for introducing this bill in the Virginia Assembly.

Comments Document

See attached testimony in opposition to HB 858.

Please do not pass this bill. As a wife to my husband of 49 years, his recent diagnosis of Altzheimer's has been difficult, however, loving him for 49 years does not give me the right and is not the compassionate thing to do - end his life. We have three adult children and 9 grandchildren who also love their father and grandfather. They are grateful for every single moment they have with him. We also believe each one of us were created in the image of God and to kill intentionally any person, is an act against the Almighty......God have mercy on your souls should you pass this legislation out of committee.

I wholeheartedly support HB1295. I am currently on the board of a group in Grayson County Virginia called Preserve Grayson. We formed because of the rapid influx of large corporate tree farms being planted in our area who spray massive amounts of chemicals. One particular company - Bottomly Evergreens - has been in trouble in other states (NC, Oregon)due to their lack of environmental best practices, mainly filling up trout streams with sediment after they clear and burn for christmas tree planting. So they have moved to our area in VA where they are getting away with all sorts of poisonous activities such as aerial spraying on windy days, planting right up to creeks and wells of neighboring properties, dumping in the creeks and the rivers, etc. Our community is super concerned about our water - most folks in this rural area have wells and springs which are now subject to leeching poisonous chemicals. People living next to these farms are getting cancers but nothing can be done to prove it's the contaminated water they are drinking. So please - we need this bill so our communities are safe and protected from the bad agricultural actors who only think about money and not a lick about poisoning their neighbors, water, wildlife, and pollinators.

Comments Document

Hello, I live in Southwest Virginia, where most of us get our water from wells and springs (unregulated by the EPA). The Health Department will not give a permit for a well to be dug any closer than 50 feet from agriculture. The EPA recommends 100 feet. We have gotten along just fine in this county (Grayson) until a giant corporation started buying up thousands of acres here and planting Christmas trees. Said corporation has no respect for the land or the people living nearby, and clearcuts and plants right up to people's wells and springs. They use aerial spraying of pesticides on our steep mountainsides in our unpredictable and gusty mountain winds. Since it is "agriculture" in a right to farm state, landowners can not find out what they are being exposed to, and have absolutely no recourse for their health or property damages. Enforcement is virtually non-existent -- we have one pesticide inspector for 17 counties. One 85 year-old lady had her land sold out from under her by her conservator, with right of occupancy. Said corporation planted trees within 12 feet of her spring, which is at the bottom of a funnel shaped land form. They spray herbicides and pesticides regularly. Nitrates in her drinking water are off the chart, and the whole family, consisting of her bedridden husband and her two special needs adult children, are all very sick. The smell of pesticides near spring is sickening, but of course testing for pesticides is virtually impossible because you have to know which of the 17,000 pesticides on the market to test for, and the cost is in the neighborhood of $200 per chemical. The Health Dept says that they can help her if we prove that her levels of acetylcholinesterase are depressed. We can get her that blood test, but the only way that the results could be valid is if we had a test before exposure. Which, of course, doesn't exist. All we can do is bring her bottled water, but the whole family bathes in that nasty water. We desperately, desperately need funding to test wells and springs. Please, please approve HB1295