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The path to assisted suicide
Contrary to an Aug. 11 Times editorial, AB 2747 is a legally confused solution to non-existent problems that opens the way to doctor-assisted suicide. This legislation is not cut and dry; rather, it raises substantive policy questions relating to bioethics and health law.
The bill's author, Assemblywoman Patty Berg (D-Eureka), and sponsor, Compassion and Choices, have led three unsuccessful efforts in as many years to legalize assisted suicide. Fortunately, none of these previous efforts found significant traction in the Legislature and were roundly rejected by Democrats and Republicans. It is only after these defeats that Berg introduced this legislation that largely duplicated existing law while attempting to codify and normalize palliative or terminal sedation and the withdrawal of food and fluids.
Fortunately, state Sen. Gil Cedillo (D-Los Angeles) sought the removal of some of these controversial provisions during a Senate Judiciary Committee hearing earlier this summer. These changes did water down the bill -- but not enough, as it still is opposed by groups such as the California Disability Alliance, California Foundation for Independent Living Centers, California League of United Latin American Citizens, La Raza Roundtable de California, Disability Rights Education and Defense Fund and numerous other organizations.
Although weakened, AB 2747 is still dangerous -- and completely unnecessary. Patients are already legally entitled to whatever information they request from their physicians. Since the California Supreme Court's 1972 decision in Cobbs vs. Grant, state courts have hammered home the law stating that patients are entitled to all the information they request. And when it comes to treatment, they are entitled not only to all information about the treatment but all information about treatment alternatives, including information about the alternative of doing nothing.
The Legislature, through the Intractable Pain Treatment Act, has already mandated that physicians voluntarily advise patients about pain-management treatment. Contrary to what The Times states, physicians have no right to reply to a patient's request for information with "stony silence." If some physicians fail to provide patients with end-of-life information, it is because they either do not know about or do not want to follow existing laws. The California Medical Assn. and the Los Angeles County Medical Assn. have worked very hard over the last few years to make physicians aware of patient rights under the law. Adding another law is not going to make scofflaw physicians, who are few in number, more compliant.
It is true that healthcare providers cannot be required to provide treatment they find contrary to their beliefs. In that case, however, the physician must refer the patient to another physician who will provide the treatment and cannot abandon the patient until the new physician takes over.
Not only is AB 2747 unnecessary, it brings serious confusion to the law regarding end-of-life care. The bill is such a legal mess that only a few of its problems can be discussed here. The bill refers to "terminally ill" patients and "terminal illness," and requires a physician to provide information about palliative care to patients in those categories. "Terminal illness," though, is a term that is vague to the point of being meaningless. Breast cancer, prostate cancer, diabetes and many other conditions are terminal unless treated. But with proper treatment, they may not be terminal at all. Requiring an oncologist to tell a woman who has just been diagnosed with breast cancer all about end-of-life palliative care would only frighten and be extremely inappropriate. It is far better to leave it up to the discretion of the doctor and patient to determine when information about end-of-life care is given.
"Palliative care" is much too broad a term to be used in legislation. Contrary to what The Times says, it can well encompass assisted suicide. It is not used in any existing legislation. It is also unnecessary, as California legislation already refers to pain management and hospice care, and there is no reason to add a third term that is very uncertain and may be too broad.
There are many other existing laws AB 2747 ignores. If this bill is passed, it will confuse the law and open the way to assisted suicide. It should be defeated in the state Senate or vetoed by the governor.
Stanton J. Price is a health lawyer and member of the Los Angeles County Bar Assn.'s Bioethics Committee, which he recently co-chaired, and the Los Angeles County Medical Assn.'s Biomedical Ethics Committee.