First, Life With Dignity

This spring has seen several wrenching debates in Sacramento over a bill by Assemblywoman Dion Aroner (D-Berkeley) that would allow physicians to give terminally ill patients drugs they could then use to take their own lives. The debates have highlighted problems with end-of-life care that California cannot afford to ignore.

The Aroner bill, far from solving these problems, could lead California down a slippery slope toward sanctioning or even encouraging assisted suicide. That’s why legislators should clearly reject it in a key vote scheduled for today.

Modeled after an assisted-suicide law that Oregon voters narrowly passed in 1994, Aroner’s “death with dignity” bill would allow lethal drugs to be given to patients found to have less than six months to live and deemed mentally competent by two physicians.

The bill fails to require that either of those physicians be an expert in pain management, even though it is aimed at helping those in intractable pain. Nor does it require a mental health evaluation, even though studies of the 15 Oregon individuals who committed suicide in 1998 found that most were looking for relief from depression, not intractable pain.

The bill’s ambiguity about which doctors can approve assisted suicide is especially troubling given recent studies of the Netherlands, where doctors have long practiced assisted suicide with immunity from prosecution. The studies show that doctors who agree to see patients requesting suicide tend to be converts to the cause: advocates who regard euthanasia as “the ultimate civil right,” rather than everyday medical professionals.

The preamble to Aroner’s bill declares that by legalizing assisted suicide, Oregon was able to persuade its doctors to “significantly increase the use of morphine and other strong pain medications . . . for more dying patients.” But surely there are other, better ways of improving palliative care. Legislators could, for instance, draft a state version of a congressional bill introduced earlier this month that would create regional hotlines to help Americans in chronic pain and fund studies of how to address liability concerns that lead some physicians to undermedicate for pain. More attention also should be given to mental health.

Legislators need to improve the state’s historically lax oversight of nursing homes for the elderly, which were excoriated in a recent federal report for violations like failing to provide promised basic medical care and suddenly and inexplicably evicting residents whose health had deteriorated.

Aroner’s bill does far too little to ensure that patients have an essential right: to get quality end-of-life care. Ensuring that right is a task state legislators must face first. Sacramento Rabbi Reuven Toff put it best in a recent hearing on the bill: “We need a different kind of law. We need a Life With Dignity Act.”