ORANGE COUNTY VOICES / TREACY COLBERT : Prop. 161: a ‘Rationing’ of Individual Health Care : ‘Aid in dying’ issue does not belong on an initiative. Solving questions of basic health care for all should be a priority.

On November 3, Californians will be asked to make a decision on Proposition 161 which, if passed, would permit physicians to provide “aid in dying” under certain circumstances.

The debate on this highly charged, emotional issue lacks focus and is, for the most part, irrelevant. The question voters must pose to themselves about Proposition 161 has nothing to do with whether it is ethically or morally justified, has adequate safeguards to prevent abuse or provides a humane way to end suffering. The real question is whether the issue of care for dying patients belongs on an initiative. It does not. The initiative process has led to a premature step in placing this issue before voters.

The initiative’s proponents argue that animals are treated more humanely than people and tell heart-wrenching stories about spouses or friends in intractable pain who suffered without relief and begged to die. Its detractors issue grim warnings about physicians who “kill,” and dire predictions about “aid in dying” clinics. I am convinced that it is in many ways a fruitless exercise to ask people to accept or reject a law governing private, deeply personal choices before we settle larger social questions.

In the last several years in Orange County and throughout the state, California Health Decisions (CHD) has engaged the public in community discussions on legal, ethical and economic issues in health care. Is health care a right? If so, how much? What is appropriate care for terminally ill patients? For chronically ill newborns? Who should pay for care for the medically indigent?

In the fray about the physician-assisted death initiative, CHD sponsored a series of community forums on Proposition 161 in Costa Mesa, Los Angeles and Sacramento to address an immediate, short-term need for unbiased public education on an issue that has come to a vote.

However, we assumed this responsibility while remaining firm in our conviction that we must collectively as a society identify and articulate the values that are important to us in shaping the future of health care. Our long-term vision is one where voters will not be asked, prematurely, to indicate yes or no on single initiatives before they have had the chance to participate in developing guidelines for allocating finite health care resources.

In a sense, the basic tenet of Proposition 161 could be described as one where the patient is given the power to “ration” his or her own health care by requesting to be put to death. It seems both an irony and a social failure that we find ourselves in the midst of a discussion on whether physicians should assist patients in dying without having achieved consensus on fundamental questions concerning the right to basic health care for all. Until we have done so, our attempts to codify or legislate these complex questions will continue to raise more questions than they answer.