California lawmakers recently approved a landmark bill, the “End of Life Options Act,” that would allow doctors to help terminally ill patients die with dignity. California joins Oregon, Washington, Vermont and Montana as the only states where physicians can prescribe life-ending medication. Many more states have considered legalization of other types of physician-assisted suicide, but none have successfully passed legislation on the issue.
The bill passed through the State Senate by a vote of 23 to 14 and was signed by Governor Jerry Brown earlier this month. The new law is similar to that of Oregon’s except for two notable changes. First, the law would expire after ten years and must be reapproved. Second, doctors must have private consultations with patients to ensure that the choice to end their life was not coerced. The bill would allow patients to request a prescription to end their lives if they were mentally competent and if two doctors agree that they only had six months to live. Further, patients would have to ask for the drugs three times before receiving them. One request must be in writing and in front of two witnesses.
The safeguards in the bill will hopefully prevent others from taking advantage of those choosing this option. However, a patient suffering from a terminal illness may be more vulnerable than a healthy person. Some patient advocates are concerned that family members of a patient might pressure them to pick this option, either for financial gain or to stem future medical costs. To address this potential problem, coercing or tricking the patient to opt into physician-assisted suicide would become a felony under the bill.
Death With Dignity
Proponents of the bill argue that it is necessary to allow those in the final stages of terminal illness to pass peacefully. This bill allows individuals who are in agony from the final stages of a disease to die with some dignity. Assemblyman Luis Alejo (D-Watsonville) voted for the bill due to his own family’s struggle with illness. His father is a Vietnam veteran who is slowly dying from terminal bone cancer. Before her physician assisted death in Oregon, California brain cancer patient Brittany Maynard also lobbied for the bill. As she put it: “I refuse to subject myself and my family to purposeless, prolonged pain and suffering at the hands of an incurable disease.”
While economic incentives should not be the primary considerations in ending a life, the bill will provide some families an alternative to skyrocketing medical bills. “As soon as this is introduced, it immediately becomes the cheapest and most expedient way to deal with complicated end-of-life situations,” said Dr. Aaron Kheriaty, director of the medical ethics program at the University of California, Irvine, School of Medicine. The expenses of keeping a relative alive through expensive treatments and hospitalizations dwarf the cost of the assisted suicide medication. However, as Dr. Kheriaty notes, the “underinsured and economically marginalized” did not necessarily back the bill. “Those people want access to better health care.”
For many years, the California Medical Association opposed physician assisted suicide, but has recently taken a neutral position. The American Medical Association, the California Catholic Conference, and the Disability Rights Center all opposed the bill. One group called A Hard Pill to Swallow warns that “legalizing suicide for the terminally ill and disabled, while offering anti-suicide resources for the rest of the population, teaches that the lives of the ill and disabled do not matter to our society.” Critics also say that some doctors will now be abandoning an important principle of medical ethics: “first do no harm.” What is needed, they say, is quality palliative care for all dying patients. Finally, in spite the checks and balances in place, they believe the bill may create conflict and unethical behavior within families— particularly where money is concerned.
The legislature and Governor Brown clearly had to wrestle with the moral implications of this bill. Governor Brown said: “in the end, I was left to reflect on what I would want in the face of my own death.” I believe that signing the End of Life Option Act into law was the right decision. Allowing patients to end their lives gives them the dignity to die the way they choose, not in a weakened state of suffering. It gives them power in a time of their lives when they are otherwise feeling quite helpless. Having this option available is a big stride for individual rights. Terminally ill individuals should be allowed the right to consider the options this new law provides.