For 13 years, Diane Kraus has parried her disease’s every blow with rounds of radiation and chemotherapy, some of them ineffective, all of them with a cost — nausea, confusion, vertigo, pain — which she also parried with more drugs.

“I want to live,” said Kraus, who was diagnosed in 2011 with metastatic breast cancer. “I want to be around. There is fun to be had and people to see.”

She began 2024 cancer-free, the disease in check if not in total remission. But in June, doctors discovered two brain tumors and, in August, three more. Some are too risky to treat.

The effort she has put into the fight speaks for itself. But she also wants an out, an option to peacefully bow out of the fight if the treatment options run out, if the pain becomes unbearable, if the effort becomes pointless. If death is unavoidable, she wants to control how it arrives.

To that end, the Baltimore resident has used her spare energy as an activist for a highly contentious cause with many names: physician-assisted suicide, physician-assisted death, assisted euthanasia, the right to die, death with dignity, medical aid in dying, end of life care. Even the terminology is debated, with each phrase evoking a different telling of the same story that ends with someone choosing to die on their own terms.

Those in favor of a legal avenue to end one’s own life avoid the term “suicide,” given its stigma. Similarly, those who oppose it make a point of using the loaded term.

Kraus, who recently turned 60, has written letters to lawmakers in support of a bill called the End of Life Options Act. She has called them and made the trip to Annapolis to make her case in person — so far to no avail.

“If I wanted to die, I would die,” she said. “I’d stop treatment, or I’d stop eating. But I don’t know if I could do that.”

She began 2024 with optimism. The math suggested the votes were there for the law to pass. Maryland’s Democratic governor was on board. But in March, the bill stalled in the Senate; it did not even get a full vote. But there was a wild card — Delaware, where Kraus also has a home.

In June, a similar bill passed both chambers of the Delaware General Assembly. House Bill 140 was sent to Delaware Gov. John Carney for his signature. Carney is a Democrat — the issue tends to be favored by Democrats — but leans toward the center, vetoing a bill, for instance, that would have legalized possession of a small amount of marijuana for recreational use. Carney, 68, also happens to be Catholic; much of the opposition to the legislation comes from the church.

Carney told a House committee in 2022 that enabling a legal, medical avenue to end one’s own life was a line he was not comfortable crossing. Kraus’ hope was that he would neither sign nor veto the bill, passively allowing it to become law. But in late September, Carney vetoed the bill.

“Hopefully, it will do better next year,” Kraus said. Carney’s term ends in January.

Kraus lives in Roland Park in a high-rise with views of a wooded ridge across the expressway. Life is bursting on her balcony with tomatoes, peppers, herbs and flowers in pots, and the birds at her feeder. Before cancer, she was an avid gardener. She cooks and relishes her appetite when it comes around, usually about a week after her treatment ends.

The rhythm of Kraus’ life is driven by chemotherapy. The first week, the chemicals reduce her to almost nothing. She mostly sleeps or tries to. She doesn’t eat much. She has a high threshold for pain, she said. Steroids buy her some time if she needs to be alert, but are hard on her body. Ritalin, a stimulant used to treat narcolepsy and ADHD, also helps clear her mind.

The second week, she starts to feel better. She begins to drive again. Her appetite improves, although her mind is still foggy. She’ll enter a room and forget why she walked in; she’ll open a cabinet or the refrigerator and forget what she wanted. The third week she savors, when she feels mostly normal before she starts chemo again. She expects this three-week cycle to last the rest of her life.

“I measure time in terms of events and activities,” she said.

She has given up many of them. Like kayaking. Her apartment is chaotic and cluttered, with open boxes and objects lying about as she decides what to throw out, what to sell, what to give away. The kayak rack for her car, the vintage cheese boxes she collected, her canning equipment, and her Lego sets — they were an avid hobby before the pieces became too difficult to manipulate.

“I live for today and tomorrow,” Kraus said. “I’m living my fullest as much as I can. Last year, I threw myself a 59th birthday party. I didn’t think I’d live that long.”

Nationally, the disagreement over the right to seek medical care to end one’s life loosely mirrors the abortion debate — support is generally found in blue states. Legislation is opposed by the church on the political right, and by the disability community on the left, said Donna Smith, the Maryland campaign director for the nonprofit Compassion and Choices, which “embraces expanded options for compassionate dying,” according to its website.

“Like with gun control, the support is strong, but the opponents are vocal,” Smith said, referring mostly to the Catholic Church.

The Maryland Catholic Conference is the official public policy entity that represents the archdioceses of Baltimore, Washington, and Wilmington, and unequivocally opposes a legal avenue to end one’s life. A spokesperson for the MCC said medical, mental health and disability experts share the church’s concerns that the elderly, mentally ill, and disabled will be put at risk by such a law. The MCC has been a longtime member of the Maryland Against Physician Assisted Suicide coalition.

“Every poll we’ve done suggests the problem is the church leadership opposes it,” said Sean Crowley, the national media relations director for Compassion and Choices, “but the people in the pews do not.”

Some advocates of disability rights have also argued against end-of-life legislation, arguing it will allow the medical establishment to steer disabled people toward death instead of treatment and care, although that opposition is not unanimous.

Disability Rights Maryland is neutral on the matter.

“Because the community is split on whether to support or oppose medical aid in dying, we as an agency do not have a position,” said the organization’s executive director Meghan Marsh. “Some believe medical aid to end one’s life is a compassionate and dignified way to avoid prolonged pain. Others believe it could be used without proper care or safeguards to encourage people with disabilities to end their lives.”

The states of Hawaii, California, Washington, Montana, Colorado, New Mexico, Maine and New Jersey, along with the District of Columbia, legally allow certain patients to seek medical assistance to end their lives, but only for their own residents, as the Delaware bill would have allowed. Vermont and Oregon do not have residency requirements. And about 19 other states are considering bills to legalize the practice.

On the other side of the issue, Kansas enacted a bill to criminalize anyone who helps someone carry out such a death. And West Virginia is asking voters to cement its current ban into its state constitution.

Smith is optimistic about the eventual passage of a law in Maryland. She cited poll data indicating a majority in the state support it, which would line up with national poll data conducted by Gallup, which has found about 70% of people support some option.

“We’ve been working on it for 10 years and we’ve made tremendous progress,” Smith said. “We finally have a governor that is supportive of it. But for one (vote), we would have passed the bill.”

Gov. Wes Moore has publicly stated he supports such a bill and would be willing to sign one into law.

In 2019, the End of Life Options Act finally cleared the House of Delegates after three previous failed attempts, but stalled when the Senate vote ended in a 23-23 tie, one vote shy of advancing, according to The Baltimore Sun. One member, Sen. Obie Patterson, a Democrat from Prince George’s County, could not decide, and did not cast a vote.

“We hope everyone dies a peaceful death, but that’s not the reality,” Smith said. “Some are kept alive and they’re miserable at the end. For those who need it, this is very much necessary. There comes a time when death is inevitable. I don’t know if I could do it myself, I don’t know. But I damn sure want the option.”

Kraus was 30 when her mother died of metastatic breast cancer. She was in her late 40s when she was diagnosed with the same. Her son was in his first year of college. The cancer had invaded most of her upper body and head. At the time, she worked as an occupational therapist. Her work entailed teaching someone how to carry coffee with a walker, among many other tasks.

She also worked in a hospice, where she witnessed many painful and protracted deaths. Her grandmothers both “died horribly,” she said, one from uterine cancer, the other as a result of dementia.

Her hospice patients, Kraus said, “were fighters. No one wants to die. It’s not in our nature.”