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California Legislature Passes Bill Legalizing Physician Assisted Suicide

Right To Die

The California legislature has approved a bill that would allow physicians to assist terminally ill patients to end their life:

SACRAMENTO — In a landmark victory for supporters of assisted suicide, the California State Legislature on Friday gave its final approval to a bill that would allow doctors to help terminally ill people end their lives.

Four states — Oregon, Washington, Montana and Vermont — already allow physicians to prescribe life-ending medication to some patients. The California bill, which passed Friday in the State Senate by a vote of 23 to 14, will now go to Gov. Jerry Brown, who will roughly triple access to doctor-assisted suicide across the country if he signs it. Mr. Brown has given little indication of his intentions.

The California bill is modeled on the law in Oregon, with several notable changes. The California law would expire after 10 years and have to be reapproved, and doctors would have to consult in private with the patient desiring to die, as part of an effort to ensure that no one would be coerced to end his or her life — a primary concern for opponents of the law.

Leaders of the “death with dignity” movement said they hoped the passage of the California law could be a turning point.

“It allows for individual liberty and freedom, freedom of choice,” said Mark Leno, a Democrat from San Francisco who compared the issue to gay marriage.

Since Oregon approved the country’s firstassisted-suicide law in 1997, supporters have struggled to expand their reach, amid opposition from religious groups, some medical organizations and lawmakers whose skepticism crosses party lines.

“I’m not going to push the old or the weak out of this world,” Senator Ted Gaines, a Republican, said on the floor. “I think that could be the unintended consequence of this legislation.”

More than half the states, plus Washington, D.C., have put forward bills this year to legalize some kind of assisted suicide, according to the Death With Dignity National Center, which is based in Portland, Ore. So far, none of them have become law.

“If it becomes the law in California, that’s going to be very, very significant nationally,” said George Eighmey, vice president of Death With Dignity and a former state legislator in Oregon.

In spite of the bill’s provision about coercion, Dr. Aaron Kheriaty, director of the medical ethics program at the University of California, Irvine, School of Medicine, said that low-income and underinsured patients would inevitably feel pressure from family members to end their own lives in some cases, when the cost of continued treatment would be astronomical compared with the cost of a few lethal pills.

He pointed to a case in Oregon involving Barbara Wagner, a cancer patient who said that her insurance plan had refused to cover an expensive treatment but did offer to pay for “physician aid in dying.”

“As soon as this is introduced, it immediately becomes the cheapest and most expedient way to deal with complicated end-of-life situations,” Dr. Kheriaty said. “You’re seeing the push for assisted suicide from generally white, upper-middle-class people, who are least likely to be pressured. You’re not seeing support from the underinsured and economically marginalized. Those people want access to better health care.”

Mr. Eighmey said that the argument about pressure from families had the issue backward: “It’s always the loved ones who want the dying person to try one more round of chemo, one more treatment down in Mexico.”

Until after a Supreme Court ruling in 2006 threw out a Justice Department effort to block Oregon’s law, no other state permitted assisted suicide. Washington adopted its measure in 2008. Several northern European countries, including the Netherlands, Belgium and Sweden, also allow assisted suicide. The British Parliament on Friday voted down a measure that would have permitted physicians to help terminally ill people end their lives.

Previous bills to legalize assisted suicide have failed in California, including one this year, when pressure from the Roman Catholic Church helped stall a similar measure in the Assembly. (The bill was resurrected for a special session, where it could bypass Assembly committees.)

In addition to the fact that supporters of the bill utilized the special session to bypass the means by which previous bills had been stopped, this year’s push was also motivated in large part by a case involving a former California resident who became the public face for advocates of “death with dignity.” Last year around this time, the public learned of the case of Brittney Maynard, a woman who had lived in California but had moved to Oregon in part to take advantage of that state’s law allowing for physician assisted suicide. Maynard had been diagnosed with stage 4 brain cancer and was not given very long to begin with she made news in the fall when she went public with the news that she would end her life in November. Quickly, Maynard’s case became the focus of a national debate over assisted suicide that pitted those who believed that people with terminal illnesses should have the right to die with dignity, and the pro-life crowd and those who believed that allowing physician assisted suicide would be the beginning of the road toward mandatory termination of the sick and elderly.  After first announcing near the end of October that she had decided to push back the deadline she had set, Maynard took her life on November 1st just as she had planned. While the debate at the time was contentious, it was clear at the time that the vast majority of the public was supportive of Maynard’s right to make the decision that she did, and in May this was seemingly confirmed when a Gallup Poll revealed that 68% of Americans supported the idea of physician assisted suicide.

As I said at the time of the Maynard case and when the Gallup poll came out, it seems to axiomatic to me that individuals ought to have the right to determine how their life is going to end when they are diagnosed with a terminal disease. If individual liberty means anything, it means the ability to control one’s own destiny and one’s own body, and there is nothing more fundamental to that right than the ability to say that you would rather die with dignity than after having gone through months and months of suffering that can be relieved only by massive dosages of powerful narcotics. Obviously, there are tremendous ethical concerns surrounding the entire idea of physician assisted suicide, including the concern that older and poorer people will be pushed into making a decision for economic reasons rather than personal reasons. Additionally, most people would likely object to the idea of someone who is not terminally ill making use of the options to end their lives for what might be reasons tied to mental health problems. There are ways of dealing with these issues, though. Oregon’s procedures, which require a person seeking physician assisted suicide to seek clearance from a series of physicians before being given access to the necessary drugs, seems to work quite well notwithstanding the concerns that raised by the cases noted above. Reforms to that procedure could address other concerns. In the end, though, allowing people who are going to die anyway to do so on their own terms strikes me as being something that is not only right from the perspective of individual rights, but also the humane thing to do.

As far as California goes, it’s unclear where things go from here. Governor Brown has not taken a position on this bill and, as the article above notes, he expressed reservations about the move to push it through in a Special Session of the legislature. That doesn’t necessarily mean he will veto the bill, though. If he does sign it, then the nation’s largest state will become the latest state to legalize physician assisted suicide, and it would likely provide significant political momentum for those in other states seeking to get their legislatures to pass similar measures. While it wouldn’t be the first state to allow people to die with dignity, California’s influence across the nation could help provide momentum for the movement nationwide in a way that the passage of similar measures in state’s such as Oregon has not. If Brown vetoes the bill, advocates are promising to begin an effort to put the measure on the ballot as a referendum. Given the fact that polling has consistently shown strong public support, it seems likely that such a referendum would pass. Hopefully, though, that step won’t be necessary and Governor Brown will allow California citizens to have at least some control over one of the most personal decisions a person can make.

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About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May, 2010 and also writes at Below The Beltway. Follow Doug on Twitter | Facebook

Comments

  1. JKB says:

    Well, the whole state has politician-assisted suicide for more than a decade now, so this is just the natural evolution.

    And now maybe they’ll shut up about gun control If you have a right to suicide then the 2/3rds of firearms deaths which are suicides are now a right. Besides most of those 2/3rds are old, White, cis-gendered, heterosexual men.

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  2. michael reynolds says:

    I imagine there will be some pressure on sicker old people. I’m not sure that’s a bad thing – we are assuming, on what basis I can’t imagine, that old folks have a divine right to spend whatever it takes to cling to another week of life. I would absolutely take my family’s economics into consideration and would consider it immoral and irresponsible to fail to do so.

    The larger issue, as you point out, Doug, is that we should have control over the writing of the last chapter of our lives. The idea that we carry the responsibility for our lives until the end, at which point we are deprived of agency and reduced to dependency, is obnoxious. My life is my story, the story of Michael Reynolds and no other, and to the extent possible I’ll write the ending.

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  3. @michael reynolds:

    The only people who are really going to object to this are the radical pro-life crowd and the people who think their religion tells them that there is some dignity in needless suffering. The polling seems to indicate they are in the distinct minority, but that doesn’t surprise me given the fact that there’s hardly any family that hasn’t had someone suffer with a terminal illness before dying. Having seen it more than I care to already in my life this is a pretty easy one for me.

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  4. bill says:

    i support it, seen way too many people die long after they should/could have.i told my kids that if i ever slip into some kind of “wacked out old guy” state that they need to tell me so i can take up recreational heroin and od.
    i just wonder how the life insurance industry will act?

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  5. Ron Beasley says:

    Oregon was the first state to legalize Doctor assisted suicide. Although many have gotten the drugs few have actually used them. When my own mother became terminally ill at 90 I signed her up for home hospice. When she was having problems breathing at the end the hospice people had me give her a massive dose of morphine which ended her life. The same thing I think.

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  6. Hal_10000 says:

    @michael reynolds:

    This is one of the reasons I think making a living will should be required for Medicare recipients (i.e., everyone). Often when it comes down to making these decisions, the patient is incapacitated. The family won’t make a decision because they don’t want to kill grandma. The doctors and hospitals won’t because they’re afraid of getting sued. The only way for someone to keep their death from being dragged out is to a) have a lot of money for private care; b) leave a living will.

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  7. PJ says:

    In spite of the bill’s provision about coercion, Dr. Aaron Kheriaty, director of the medical ethics program at the University of California, Irvine, School of Medicine, said that low-income and underinsured patients would inevitably feel pressure from family members to end their own lives in some cases, when the cost of continued treatment would be astronomical compared with the cost of a few lethal pills.

    Oregon publishes yearly data about DWDA deaths, I had a look at it last year:

    Of the 71 DWDA deaths during 2013, most (69.0%) were aged 65 years or older; the median age was 71 years (42 years – 96 years). As in previous years, most were white (94.4%), well-educated(53.5% had a least a baccalaureate degree), and had cancer (64.8%). In 2013, fewer patients had cancer (64.8%) compared to previous years (80.4%), and more patients had chronic lower respiratory disease (9.9%), and other underlying illnesses (16.9%).

    Most (97.2%) DWDA patients died at home, and most (85.7%) were enrolled in hospice care either at the time the DWDA prescription was written or at the time of death. Excluding unknown cases, most (96.7%) had some form of health care insurance. The number of patients who had private insurance (43.5%) was lower in 2013 than in previous years (64.7%), and the number of patients who had only Medicare or Medicaid insurance was higher than in previous years (53.2% compared to 33.7%).

    Of the 105 DWDA deaths during 2014, most (67.6%) were aged 65 years or older. The median age at death was 72 years. As in previous years, decedentswere commonly white (95.2%) and well educated (47.6% had a least a baccalaureate degree).

    Most (89.5%) patients died at home, and most (93.0%) were enrolled in hospice care either at the time the DWDA prescription was written or at the time of death. Excluding unknown cases, all
    (100.0%) had some form of health care insurance, although the number of patients who had private insurance (39.8%) was lower in 2014 than in previous years (62.9%). The number of patients who had only Medicare or Medicaid insurance was higher than in previous years (60.2% compared to 35.5%).

    For the entire period (1998-2014):
    97.1% White
    45.9% Baccalaureate or higher
    60.2% Private insurance

    End of life concerns:
    3.2% – “Financial implications of treatment”
    vs.
    91.5% – “Losing autonomy”
    88.7% – “Less able to engage in activities making life enjoyable”
    79.3% – “Loss of dignity”

    So. White, well-educated, and insured.

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  8. @Hal_10000:

    Living Wills, or as they are usually called Advance Medical Directives, are absolutely essential for situations where someone is unable to communicate with their physician or other medical personnel, but they wouldn’t necessarily cover a situation like this. That’s why the law needs to be changed to allow people who are terminally ill, but otherwise fully conscious, to decide their fate.

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  9. An Interested Party says:

    If you have a right to suicide then the 2/3rds of firearms deaths which are suicides are now a right. Besides most of those 2/3rds are old, White, cis-gendered, heterosexual men.

    Perhaps you will move to California and purchase a gun…

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  10. Slugger says:

    @PJ: Thank you for documenting factual material. Our public discourse seems to be heavily laden with all sorts of ideological prejudices. Facts are refreshing.

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  11. MBunge says:

    I don’t think it should be too much of a surprise that “death with dignity” is largely the concern of middle and upper-middle class white folks. They’re the ones that have the resources to extend their lives but not enough to afford the highest quality care.

    It’s hard to argue with anyone trying to avoid the ugly end of a terminal illness. On the other hand, redefining life itself as just another form of property seems more like a step backward in our moral and ethical development. I’m kind of amazed that people are blind to the libertarian/Randian tinge to all this.

    Mike

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  12. JKB says:

    @An Interested Party:

    Why? I live in a state with as traditional American gun liberties as are available in the US today and, though perhaps unlawful, if I decide to suicide, I don’t have to worry about my dead body being dragged through the streets as an example to people not to cheat the State of their rights to your life and labor, even in old age.

    It’s not that the State doesn’t see value in getting rid of old people, in England they’ve moved to deny the old drugs and treatments of proven efficacy, but the “Progressive” State does not want individuals to get the idea that they have the liberty to determine the end of their own life.

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  13. PJ says:

    @JKB:

    if I decide to suicide, I don’t have to worry about my dead body being dragged through the streets as an example to people not to cheat the State of their rights to your life and labor, even in old age.

    No, but someone will have to clean up the mess you leave. Are you going to shoot yourself in the head, to, you know, make certain that you don’t survive? Someone is going to have to clean that up after you.

    And someone is going to find you. With your brains blown out.

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  14. Your source has done you a disservice. Assisted suicide is a homicide in Montana. Our MT Supreme Court ruled that if a doctor is charged with a homicide they might have a potential defense based on consent. The Court did not address civil liabilities. No one in Montana has immunity from civil or criminal charges. Does that sound legal to you? Oregon model bills have been rejected by our legislature in 2011, 2013 and 2015 because of gapping loopholes that expand the scope of abuse of elders and folks with disabilities of all ages. Passage would have established dangerous public policy.
    In Oregon and Washington heirs are allowed to participate from the start to the end, eviscerating intended safe guards. Everyone involved in the lethal process gets immediate immunity and family members are not required to be contacted. A witness is not required to confirm the dose was self-administered so if they struggled and changed their mind who would ever know? In addition these laws prohibit investigations or public inquiries leaving no recourse for surviving family members who were not contacted. Does that sound like good public policy to you? This is very dangerous public policy that does not serve the common good. All of these loopholes are embodied in California’s ABX2-15.
    Oregon and Washington should amend their initiative-sound-bite driven dangerous laws.

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  15. CrustyDem says:

    @Bradley Williams:

    That’s some quality fearmongering. If you actually read the Washington statute, you would know that most of what you are describing is utterly false, coercion is a class A felony. No one besides the patient is allowed to make the request. There is a 15 day waiting period between the written request and the dispensation of medication. A doctor must make the determination that the patient is A) terminally ill and B) self-aware enough to make the request.

    Why should the doctor be liable? Why should the family be allowed to demand an investigation? Ridiculous.

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  16. Grumpy Realist says:

    @JKB: hey, if you want to commit suicide with a gun, go head. The problem is a large number of guys who commit suicide do it after they’ve shot their spouses and children. That’s what we’re bitching about.

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