Medical Ethics Professor: Roll Back Assisted-Suicide Law Before It’s Too Late

On Oct. 5 Governor Jerry Brown signed ABx2-15 (Eggman) the so-called “End-of-Life Option Act,” authorizing physicians to prescribe life-ending drugs to patients who are determined to have a terminal illness and less than six months to live.

“What happened” that day “was an enormous culture shift in our country, not unlike Roe v. Wade,” said Dr. Aaron Kheriaty, associate professor of psychiatry and director of the Program in Medical Ethics at UC Irvine School of Medicine, at the Sacramento Catholic Forum on Oct. 15.  The law also changes the “culture of medicine” from a focus on saving lives to helping end them, he said. 

The California Catholic Bishops predicted that the law will put “the elderly and disabled” in “great peril.”

But “it’s not too late,” Dr. Kheriaty asserted.  “We should work even harder at rolling this law back.”

There are several measures being considered that could still block or diminish the impact of law, which is scheduled to go into effect at the end of the current legislative extraordinary session – at some point in 2016.

A day after the governor signed the bill, Seniors Against Suicide filed papers with the state attorney general’s office to seek a referendum to overturn the measure.  The group must obtain 365,880 signatures by January 3 to put the measure on the November 2016 ballot. 

In addition to the referendum, there are other ways to counteract some of the worst impacts of the law.  How to “opt out” should be a main focus now, he suggested.   Most doctors do not want to be involved in prescribing the lethal medication, in fact, they consider the practice "disreputable."  He also hopes “entire institutions” will opt out, and “offer palliative care, instead.”

The California Catholic bishops, in a statement on passage of the bill, pointed out that, “All 48 Catholic hospitals in California provide excellent palliative care services as all medical facilities for terminally ill patients should but often do not.”  The answer is to expand these services to more Californians “to provide compassionate, quality care for those facing a terminal illness,” the Bishops said – not to prescribe a lethal dose of drugs to assist terminally ill patients to take their own life.

If a referendum is placed on the ballot to overturn the law, there is reason to believe it would succeed.  Although polls show that the majority of Californians support assisted suicide, Dr. Kheriaty thinks that this is a function of “limited information.”

He believes that when more of the public understands the specifics of the law and the many implications for the poor, disabled, seniors and other vulnerable populations, the measure has a good chance of being overturned.

Since January 1994, there have been more than 175 legislative proposals authorizing assisted suicide in more than 35 states, according to the Patients Rights Council, and almost all have failed.  Only Oregon, Washington and Vermont have enacted legislation authorizing the practice.

When such proposals are introduced, polls at first show public support.  But after the arguments about what is truly involved are made, they have almost always failed.  For example, in Massachusetts, when a doctor-assisted suicide measure was placed on the ballot in 2012, polls initially showed 68 percent support, but after the public debate on the dangers of the law, the measure failed to pass.

Unfortunately, the public debate about ABx2-15 in California, to which its citizens were entitled, was cut off by a legislative maneuver. 

“Nothing illustrates what is wrong with this bill more than how it got to Governor Brown’s desk having failed to even get out of committee in the normal legislative process,” the California Catholic Bishops wrote in a statement after passage of the bill.  Instead, the bill was introduced in a special legislative session called to help fix a $1 billion gap in Medi-Cal funding and other health-financing issues, a session supposed to be limited to that topic.  But proponents rammed the assisted suicide bill through by reconstituting committees with members favorable to the bill. 

“We are particularly disappointed that the very real concerns and risks posed to our brothers and sisters in vulnerable communities of the disabled and elderly have been consistently ignored by our state’s elected officials,” the California bishops said.

For example, how many people know that physicians need only show a “good faith” effort to comply with the law to avoid liability?  Or that the death certificate will cite only the underlying illness, and make no mention of death by a lethal dose of drugs, making it difficult to monitor the consequences?

Dr. Kheriaty also noted that if the measure is not overturned, it can nevertheless be primarily ignored – with people making a choice not to use it once they become more aware of the negative consequences.

Here are some additional points that the public needs to know about this law, according to Dr. Kheriaty: 

  • We need to be concerned about how the law affects the weakest and most vulnerable.  Many people have told him that they want to die, but “even among those with terminal illness, it’s a cry for help.” 
  • It is the duty of doctors to look at the underlying cause of such statements.  If it’s pain, the patient needs pain treatment.  If it’s a mental condition, it needs to be treated. 
  • Yet in Oregon, whose assisted suicide law was the model on which the California law was based, only five percent of those requesting the lethal dose were given a psychological evaluation.
  • Legalizing doctor-prescribed suicide will have negative consequences on public health – generating a “copy-cat phenomenon.”  According to the Center for Disease Control, suicide rates in Oregon have increased by 49 percent between 1999 and 2010 - compared to 28 percent nationally.  (Note: A rigorous study in the Southern Medical Journal (ironically published on the same day the Governor signed the bill) controls for other factors that could account for this rise in suicide rates. This research demonstrates that permissive assisted suicide laws have led to at least a 6 percent rise in overall suicide rates in Washington and Oregon, and a 14 percent rise among the elderly.)
  • The law will likely erode efforts at suicide prevention.
  • Economic and social factors will cause pressure on people at the end of their lives.

In addition, Dr. Kheriaty asks, will arguments for “death on demand” stop with “the terminally ill?” Twenty-eight percent of requests for euthanasia in the Netherlands, where it is legal, were granted for people who said they were "tired of living," a new study published in Journal of American Medical Association Internal Medicine, found.

In the end, we must ask ourselves, said Dr. Kheriaty, what kind of society we want.  “Do we want to abandon social solidarity with the poor, mentally ill, the lonely and disenfranchised, while the elite have the means to acquire the care they need?”

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