California could become one of only a handful of states to allow physician assisted suicide. A bill allowing doctors to help terminally ill patients end their lives is currently awaiting approval from Gov. Jerry Brown.
The legislation, Senate Bill 128 known as the End of Life Option Act, passed the Senate in a decisive 23 to 14 vote earlier this month. Brown has not indicated whether he will sign or veto the bill; if he does nothing, the bill will become law 30 days after he received it.
The legislation is similar to other state laws in physician assisted suicide, which first became legal nationally in Oregon in 1997. Only four states currently have legalized physician assisted suicide: Oregon, Montana, Vermont and Washington. Similarities in the legislation include patient eligibility and protocol: patients must be at least 18 years old, able to make and communicate health care decisions, and have a terminal illness which leads to death within six months.
Patients must also make multiple oral request and a written request for assisted suicide with waiting periods of 15 days between each oral request. There are other safeguards intended to prevent abuse, as the laws require multiple physicians to diagnose patients’ physical and mental health and provide alternatives such as palliative care. The laws also specify that using physician assisted suicide cannot affect the status of life and health insurance policies. Hospitals and physicians are not required to provide physician assisted suicide and may legally refuse to participate in the practice.
State Sen. Bill Monning said California’s bill is intended to have more protections than other states’ laws. One of the provisions stipulated in California’s bill includes that the law will expire after 10 years and must then be reapproved. Further, the consultations between patient and doctor are to be private, in an attempt to eliminate influence from others in the patient’s decision.
For some, these safeguards are not enough. According to an article by Life News, Pro-life groups such as the National Right to Life Committee came out against the bill, describing it as euthanasia on demand and saying it disregards medically vulnerable patients’ lives. The article claimed that almost all terminally ill patients who desire death are in fact suffering from treatable depression, while citing that only 6% of patients were referred for a psychiatric evaluation. It is difficult to know whether patients seeking physician assisted suicide suffer from depression that is truly treatable, but a 2008 study titled “Physician-Assisted Suicide in Oregon: A Medical Perspective,” found depressive syndromes in 59 percent of terminally ill patients who expressed a desire for death, versus only 8 percent in patients who did not express a desire for death.
Another concern is a patient's financial situation. The New York Times reported the opinion of Dr. Aaron Kheriarty, director of the medical ethics program at the University of California, Irvine, School of Medicine. Kheriarty said low-income patients could feel pressure from family members to end their lives, because physician-assisted suicide would be a fast and cheap alternative to the high cost of long term medical care.
There is also concern about how physician assisted suicide can impact the doctor-patient relationship over time and create potential abuse. Dr. Ryan Anderson in an article published through the Heritage Foundation argues that while human life should not always be extended medically, doctors should not be able to intentionally kill patients or help them to intentionally kill themselves. Among other things, Anderson wrote that physician assisted suicide could reduce patients’ trust of doctors and distort doctors’ commitment to life and health of patients.
Taking a glance at Belgium, a country where euthanasia has been legal since 2002, could be useful for comparison. Belgium has recently been in the news as the number of requests for euthanasia have risen, as well as the number and percentage of requests that were granted. One study shows Flanders saw an increase in euthanasia from 1.9 percent to 4.6 percent, with 75 percent of requests granted in 2013, up from about 55 percent in 2007. These numbers may seem alarming, but it is difficult to know the exact causes for the increases. According to Kenneth Chambaere, one of the study’s authors, the growth is likely due to more knowledge about euthanasia from patients and greater acceptance from physicians.
It is important to note that there is a difference between euthanasia and physician assisted suicide. Euthanasia is the practice in which physicians, at a patient’s request, can administer lethal doses of medication to the patient. The difference is that in physician assisted suicide, the patient must self-administer the medication. California’s bill deals specifically with physician assisted suicide.
In terms of potential abuse, one study found a stable 1.7% of cases in Belgium where physicians hastened a patient’s death without an explicit request. It may be true to say that despite any number of safeguards and regulations, the potential for abuse will always exist in any system and any law. Current U.S. laws allow patients in every state to withhold medical treatment for themselves. Patients are also able to assign others, such as family, or even physicians the rights to make their healthcare decisions for them, which cannot be taken back once the patient is found to be mentally unfit to make decisions. So within current laws, too, there is potential for abuse, and physician assisted suicide could be evaluated similarly.
On the other side of the table, supporters of the bill argue that physician assisted suicide is an additional end of life option for those who seek it due to unbearable circumstances, such as extreme pain. Compassion and Choices, one organization that is part of the aid-in-dying or the death-with-dignity movement, hailed the bill as a victory. The movement had a public face last year in Brittany Maynard, who obtained physician assisted suicide after a brain cancer diagnosis. Maynard had moved from California to Oregon to legally end her life, and Maynard’s parents have become part of aid-in-dying movement since that time.
Another personal story has surfaced from Los Angeles Times’ Steve Lopez who wrote about his father. Lopez described the last months of his father's life: in pain, unable to move and unable to feed himself, feeling helpless in bed as his body slowly faded. Lopez wrote that the decisions both for the government and for individuals are difficult concerning assisted suicide, but it should be carefully thought about.
Certainly, these issues and their complexities will not be going away anytime soon. Apart from the rising euthanasia rates in Belgium, there is also rising tourism for euthanasia in Switzerland, with at least 21 people having gone from the United States. California’s current bill is the second to be introduced this year in the state on this issue, and it is the seventh since 1994. Meanwhile, more than half the states have put forward bills this year on the issue, though none have yet become law.
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