Will California follow Oregon with PAS bill?
Will California follow Oregon with PAS bill?
Legislation mirrors Oregon's Death with Dignity Act
A bill that would make California the second state in the country to legalize physician-assisted suicide (PAS) has worked its way through the state assembly's Judiciary Committee, but needs to clear the state House by June 8 to be eligible for consideration this year by the state Senate.
While committee voting so far has fallen along party lines, with Democrats endorsing the bill patterned after Oregon's Death with Dignity Act and Republicans voting against it, political observers say the bill stands a better chance of passage this year than it did last year, when a nearly identical bill failed to win assembly approval.
The state's two largest physician organizations, however, remain split on the bill.
"When physicians can no longer heal the disease or alleviate the symptoms, terminally ill patients have a right to control the circumstances of their death," said Wells Shoemaker, MD, medical director of the California Association of Physician Groups, based in Los Angeles.
The 35,000-member California Medical Association, which like the American Medical Association has consistently opposed physicians assisting with the suicides of patients, issued a statement in March reaffirming that opposition.
"Assisting someone to die is unethical and unacceptable, and is fundamentally incompatible with the physician's role as healer," said California Medical Association President Anmol S. Mahal, MD.
California bill mirrors Oregon act
The Oregon PAS act was passed in 1996, and has withstood attempts to strike it down at both the federal and state levels. Oregon voters passed the act via a referendum; California Gov. Arnold Schwarzenegger has said he believes the decision on passing a PAS law should be put directly to California voters, as was Oregon's act.
The proposed California PAS law would apply to patients who are terminally ill and within six months of death, only to residents of California, and only to adult patients who can make informed decisions.
Other points of bill AB 374 include:
- The patient must be evaluated by two physicians. A consulting physician must examine the patient and confirm the attending physician's diagnosis and prognosis and that the patient is mentally capable, fully informed, and acting voluntarily and free of coercion.
- The patient must be mentally capable. Both evaluating physicians must verify that the patient is mentally capable of making and communicating health care decisions; if either physician suspects the patient's judgment may be impaired by medication or a psychiatric or psychological disorder, the patient must be referred to a licensed psychiatrist or psychologist for a psychological examination. If a patient is referred for psychological evaluation, the process stops until the psychiatrist or psychologist has determined that the patient is mentally capable. If the patient is determined to not be mentally capable, he or she will be denied the medication.
- The patient must make two oral requests and one written request for the prescription. The written request must be witnessed by two people who attest that the patient is competent, is acting voluntarily, and is not feeling coerced into making the decision.
- The California bill proposes two waiting periods: 15 days after the first oral request, at which time the written request can be made, and 48 hours after the second oral request and the writing of the prescription.
- The patient must self-administer the prescription. No one else can administer the medication to the patient.
- Physicians may refuse to participate with the act, with no requirement to participate in any part of the process. (To read the bill in its entirety, go to www.assembly.ca.gov/acs/acsframeset2text.htm.)
- The California bill shares another similarity with the Oregon act — opposition from religious and right-to-life organizations.
The president of the 16,000-member Christian Medical Association (CMA), based in Bristol, TN, says the California bill "invites patient abuse, prevents investigation of patient abuse, and covers up incidents of patient abuse."
David Stevens, MD, CEO of the CMA, adds, "Instead of being called the Compassionate Choices Act, this bill should be called the 'Covert Abuses Act.'
"No one will ever know if patients were pressured to die because they had no health insurance, or because a greedy family member wanted to preserve his inheritance, or because a doctor or insurer calculated that suicide was more efficient than palliative care," Stevens insisted in a prepared statement. "The state health department relies on the very people who abuse patients to report their own abuse."
The CMA's statement opposing the bill is based on a number of concerns, including fear of:
- A misunderstanding of pain control. The CMA's position is that most pain can be controlled through appropriate medication and comfort care in a hospice setting, but it acknowledges that appropriate end-of-life care may include aggressive treatment of pain that, in some cases, such treatment may hasten death.
- The incapability of a doctor or other health care provider to truly determine consent of the dying individual; doctors could be forced to make highly subjective decisions that some patients' lives are no longer worth living, the CMA statement suggests.
- A lack of scientific certainty in determining the course of a patient's illness. Someone given six months to live may actually live several more years with a reasonable quality of life, the CMA position statement asserts.
- The possibility that doctors and other health care workers could find themselves "on a slippery slope that would extremely compromise medical ethics," should PAS become accepted as an ethical or appropriate activity, and arguments arise that PAS should be extended to patients who are disabled and suffering but not terminally ill.
Survey: Support for PAS among MDs
A national survey of 1,088 physicians conducted by the Louis Finkelstein Institute for Social and Religious Research, part of the New York, NY-based Jewish Theological Seminary, in 2005 revealed that a majority of those surveyed (57% percent) believe that it is ethical to assist an individual who has made a rational choice to die due to unbearable suffering. Thirty-nine percent say they believe it is unethical.
The Finkelstein survey revealed that while doctors tend to support legalization of PAS as a public policy, results were mixed when they were asked whether they would personally participate in assisting a patient. A plurality (46%) would not assist a patient for any reason, 34% would assist a patient in a few cases, and 20% would assist under a wide variety of circumstances. (To read the survey results, visit www.jtsa.edu/research/finkelstein/surveys/pas.shtml.)
Forty states have specifically outlawed PAS; six states prohibit it through common law, according to the Death with Dignity National Center in Portland, OR (www.deathwithdignity.org). Three states (other than Oregon) — North Carolina, Utah, and Wyoming — do not have laws prohibiting or permitting PAS.
A bill that would make California the second state in the country to legalize physician-assisted suicide (PAS) has worked its way through the state assembly's Judiciary Committee, but needs to clear the state House by June 8 to be eligible for consideration this year by the state Senate.Subscribe Now for Access
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