Assisted-Suicide Debate Shifts to State

With Jack Kevorkian sentenced to spend up to 25 years in a Michigan prison for helping a terminally ill man die, the spotlight of the national debate over physician-assisted death is about to turn on California.

For years, Kevorkian, a controversial former pathologist, has driven the debate over assisted suicide, but now California lawmakers are poised to tackle the emotional question of how to make the end of life as comfortable and pain-free as possible.

At stake is whether the country’s largest state will enact a measure modeled after Oregon’s first-in-the nation law that allows a physician to prescribe a lethal dose of medication to a terminally ill patient.

“This law will provide people suffering from terminal illness the peace of mind to know that if their symptoms become so severe and debilitating or their pain so great they have the choice to end their suffering. And ‘choice’ should be underlined,” said Assemblywoman Dion Aroner (D-Berkeley), who is carrying the measure on behalf of Americans for Death With Dignity.

But opponents, including the Roman Catholic Church and the California Medical Assn., worry that the proposal would make it easier for the disabled and others who aren’t terminally ill to take their own lives.

“Curing suffering by eliminating the sufferer is not the way we need to go. We need to embrace our dying,” said Carol Hogan, a lobbyist with the California Catholic Conference.

Hogan expects that Aroner’s bill (AB 1592) will win approval today from the Assembly Judiciary Committee. Others say it is difficult to predict the outcome of the hearing--the first of several--and it is unclear how Gov. Gray Davis will react if the measure reaches his desk.

Whatever happens at the hearing, the bill is expected to kindle a lively debate over the larger issue of the way Californians, especially the elderly, die. Should more effort be made to comfort the dying and relieve their pain? Should more emphasis be placed on hospice care? What’s the appropriate state role?

Almost every legislator’s thinking on physician-assisted suicide, unlike most of the hundreds of other issues and bills they scrutinize, is influenced by a heart-wrenching personal story about a dying relative or friend. As a consequence, the Assembly deliberations are expected to transcend party lines and the normal liberal-conservative divide.

Aroner, a former social worker and legislative aide who was elected in 1996, said her family has faced an ordeal with a dying relative she described only as “not a happy one.” She said her 86-year-old mother is beginning the end of her life and recently moved into an assisted-living facility in Los Angeles.

“I want to have the option [of physician-assisted death]. I want my mother to have the option and I want my children to have the option. . . . [I] want to make sure it can be legal,” Aroner said.

In advancing her measure, Aroner, 53, had in mind the terminally ill who have the strength to self-administer a medication. Its supporters say the bill is full of safeguards.

“This isn’t like someone saying, ‘I’m having a really bad day and want to check out,’ ” said Donne Brownsey, a lobbyist for Americans for Death With Dignity.

To qualify under the proposed measure, a sick person must have a medical diagnosis that he or she is within six months of death, must voluntarily request assistance in dying and must enlist two doctors to review the case.

In addition, the bill requires that a request for assistance be made twice, at least once in writing. If doctors question the competence of a patient, they can seek a mental examination.

Aroner’s legislation revives a public debate in California among religious leaders, politicians and ethicists over the morality of euthanasia. Now, it is a felony for anyone to assist in a suicide.

In 1992, California voters rejected Proposition 161, a more broadly worded ballot initiative that would have allowed dying patients the choice to end their lives by asking their doctors to administer fatal injections or by providing other means for suicide.

Two years later, Oregon voters passed an assisted-suicide law, but it was ruled unconstitutional--a decision that was overturned on appeal. In 1997, Oregon’s electorate decided to keep the law on the books.

The New England Journal of Medicine recently reported that in 1998, the first year Oregon’s Death With Dignity Act has been in place, only 15 people used it and had their physicians prescribe lethal drugs.

Even as the Oregon experiment began last year, a similar proposal was rejected by voters in Michigan, where Kevorkian’s highly publicized campaign has played out.

Over the past decade Kevorkian, who says he has helped more than 130 people commit suicide, has become the central player in the assisted-death drama.

Last month, a jury convicted Kevorkian of second-degree murder in the death of a man who suffered from amyotrophic lateral sclerosis, or Lou Gehrig’s disease, and whose death was broadcast on “60 Minutes.” Last week in Pontiac, Mich., Kevorkian was sentenced to 10 to 25 years in prison.

Aroner said that what Kevorkian did--administer a lethal injection--would be prohibited under her measure.

“He was a physician who certainly heightened the level of debate in this country around how we treat our most treasured citizens, meaning our seniors or other individuals in their last days,” Aroner said. “I’m sorry he chose to highlight it the way he did, going on TV.”

Dr. Rex Greene, president of the Los Angeles County Medical Assn. and a critic of Aroner’s measure, described her bill as almost a carbon copy of Oregon’s. “It’s the same stuff, the attempt to define physician-assisted suicide as not being suicide in order to legalize physicians prescribing lethal overdoses for terminal patients.”

Opponents describe the bill as being fueled by an elitist social movement that ignores pressing health care issues such as universal access to medicine and reforms to the managed care system.

Greene described it “as a way of opening the door for expanding this for people who aren’t terminal, who aren’t adults, who aren’t competent mentally.”

Other critics say it is too soon for California to follow Oregon’s lead and that not enough is known about Oregon’s experience.

“It’s not in the interest of good public policy in California to copy Oregon before we find out if it’s worth copying,” said Alexander Capron, co-director of the Pacific Center for Health Policy and Ethics at USC.

Capron, who has not read Aroner’s bill in detail, said that in general such proposals “take away” from the bigger issue of how best to care for dying patients.

The focus of the public debate, he said, should be on how to make the dying “as comfortable as possible and relieve as many symptoms and pain as possible.”