When advocates of “death with dignity” legislation descend on Annapolis later this month, it will be the sixth year running that they have attempted to persuade the General Assembly to pass legislation giving terminally ill people the right to end their lives.

Although they came tantalizingly close last year — a 74-66 victory in the House of Delegates and the narrowest possible defeat, on a tie vote, in the Senate — they head into the 2020 session facing the distinct possibility they will fall a vote or two short again this year.

The uncertainty centers, again, on the Senate.

The chamber deadlocked 23-23-1 a year ago, and the personnel changes that have taken place since then don’t appear favorable.

The two senators who retired in late 2019 both supported the “End-of-Life Options Act,” as it’s known in Maryland, to one degree or another.

Former Sen. Shirley Nathan-Pulliam (D-Baltimore County) has been replaced by Charles E. Sydnor III (D-Baltimore County), a former delegate who voted against the bill in 2019. Former Sen. Robert A. Zirkin (D-Baltimore County), who chaired the Judicial Proceedings Committee during the past several annual debates on the issue, has yet to be replaced.

Even if Zirkin’s successor supports the legislation — Dels. Jon S. Cardin (D) and Shelly L. Hettleman (D), who are applying to fill the vacancy, were both supporters in the House — advocates would appear to be at least one and perhaps two votes shy.

The legislation would allow patients thought to have less than six months to live the ability to take a fatal dose of drugs, provided the person is deemed mentally competent and takes the pills themselves.

Advocates claim the measure would provide people who are in severe pain an alternative to a lengthy, painful decline.

Critics call such legislation “physician-assisted suicide.” They worry that people who require significant care would feel pressure to end their lives, to relieve the burden on others.

Del. Shane M. Pendergrass (D-Howard), chairwoman of the Health and Government Operations Committee and the measure’s lead sponsor in the House, said she intends to introduce her bill the night before supporters rally in Annapolis.

While she claimed to be generally “optimistic,” she said the Senate holds the cards.

“We need to count the votes there first before we make any real statements, but we’re going to hope,” Pendergrass said.

Public support, as measured in surveys, has been on the rise in recent years. A 2019 Goucher Poll found that 62 percent of Maryland residents supported “aid in dying,” with 31 percent opposed.

The practice is legal in eights states and the District of Columbia.

Advocates do not lack for friends in high places. Their lead Senate sponsor, William C. Smith Jr. (D-Montgomery), now chairs the Judicial Proceedings Committee. And the Senate’s new president is Bill Ferguson (D-Baltimore City), another supporter. Former Senate president Thomas V. Mike Miller Jr. (D-Calvert) was a “no” vote last year.

“Time is definitely our friend on this one,” Smith said, a reference to the upswing in public support. “People have evolved. Each year it ticks up.”

Last year’s loss in the Maryland Senate carried an extra sting.

Sen. Obie Patterson (D-Prince George’s) was in the chamber but voted “present” rather than up or down, an apparent violation of Senate rules. He had not been excused from voting by the presiding officer.

“I could not bring myself to move right or left on the bill and therefore I didn’t vote at all,” Patterson told reporters afterward. “I had to vote my conscience,” he added, somewhat paradoxically.

Last week Patterson said he remains undecided, but he told Maryland Matters he expects to cast an up-or-down vote this session if the bill hits the Senate floor.

“I think I will make a decision but I’m just not sure what the decision might be,” he said.

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