AB 374 will be California’s sixth attempt to give dying patients a choice to end their lives

The California Legislature is poised once more to attempt political history, as physician-assisted suicide is back on the state agenda with the March passage of Assembly Bill 374.

This is the sixth attempt to establish physician-assisted suicide in California.
Also known as the “California Compassionate Choices Act”, the bill — approved by the Assembly Judiciary Committee on party lines with all seven Democrats supporting it and the three Republicans opposing—seeks to allow terminally ill California adults with six months or less to live the ability to receive a lethal prescription. A similar bill, AB 651, was unsuccessful last year, missing approval by one vote in the California Senate Judiciary Committee.

Co-authored by Assembly members Lloyd Levine (D-Van Nuys), Patty Berg (D-Eureka) and Assembly Speaker Fabian Núñez (D-Los Angeles), AB 374 is styled after Oregon’s Death with Dignity Act — the only state that has legalized physician-assisted suicide in the nation.

“According to Oregon’s Department of Human Services, 65 lethal prescriptions were issued in 2006 with 46 patients utilizing the prescriptions.”

“We know that when terminally-ill people are at the end of their lives they don’t want to die, but they also don’t want to have to suffer,” Levine said in a formal statement. “This bill puts forth a more humane way for people to make this very personal decision about how to end their lives. We look forward to continuing to move this legislation toward the Governor’s desk.”

Gov. Arnold Schwarzenegger has thus far deflected personal opinion about the matter, but has said he believes the decision lies in the hands of the voters — hinting at a potential veto.

The bill still has a lengthy process to undergo before reaching the Governor. It will go to the Assembly Appropriations Committee for a fiscal review, which must approve the bill by June 1. And then it will move to the Assembly, which must pass the bill by June 8 so it can then proceed to the State Senate. If the bill makes it through both houses, it could end up on the governor’s desk in September.

Stipulations of the bill, some of which differ slightly from Oregon’s, require patients to be evaluated by two physicians, to be enrolled in hospice or examined by a mental heath professional, and to make two oral and one written request for the prescription — which must be witnessed by two people unrelated to the patient.

Physicians must provide written alternatives, as opposed to Oregon’s law, which necessitates it be done orally. In addition, the bill requires a 15-day wait period after the first oral request and 48 hours after the second, when the prescription is written. Patients must self-administer the lethal dosage.

Since the March 27 approval, debate on the issue has been highly contentious, with proponents claiming that physician-assisted suicide is a matter of personal choice, while opponents have condemned the idea as medically and morally unethical. The Roman Catholic Church has been particularly vocal, with Cardinal Roger Mahony publicly criticizing Assemblyman Núñez — who is Catholic — after the two met in April to discuss the topic.

Yet it seems that Californians in general support the legislation. The most recent Field Poll (March 2006) found that 70 percent of adults believe “incurably ill patients should have the right to ask for and get life-ending medication.” Divisions did arise, however, based on political affiliation. Of those polled, 80 percent of Democrats were supportive of euthanasia, while only 59 percent of Republicans approved.

Dr. Clarence Braddock, Associate Chief of the Division of General Internal Medicine and Associate Professor of Medicine at the Stanford School of Medicine, believes physician-assisted suicide is a “viable addition” to the duties of a medical provider. Although, he says, “there would be a lot of physicians in the middle who in the abstract support patient rights, but are skittish to write the prescription themselves.”

Braddock is quick to add that there is a larger, overshadowed issue at hand — the condition of palliative and hospice care available, particularly for non-cancer illnesses that often lack similar visibility.

“There is still not as much recognition [of conditions such as emphysema or kidney failure] and we need to focus a lot of energy and attention on palliative care and symptom control,” he says.

Dr. Ezekiel Emanuel, oncologist and Chair of the Department of Clinical Bioethics for the National Institute of Health agrees with this point, but does so as his argument for opposing physician-assisted suicide. “The issue is how to improve care for dying patients. That’s what is really important. [AB 374] is not the answer to that question,” he says. “It is irrelevant public policy… For 90 percent this is not the answer. If you really want to improve end-of-life care, worry about palliative care, worry about education. That is a much more complicated thing — this is a big political statement with really no actual impact.”

Mandy Major is a freelance writer in San Jose.

—By Mandy Major

Posted on April 23, 2007 11:31 AM