Legislators to Take Up End-of-Life Measure

On the heels of a national debate over the Terri Schiavo case, a bill that would allow doctor-assisted suicide in California faces its first vote in a legislative committee Tuesday.

The bill is modeled after a 1997 Oregon law, the only one of its kind in the nation. The bill would allow terminally ill adults who have been declared mentally competent to obtain a lethal prescription of drugs that they could administer themselves.

Backers of the bill, primarily nonprofit groups devoted to giving people control and choices in their end-of-life decisions, say people should have the right to die in a dignified, controlled manner when they choose.

“Dying people can be trusted to live until the very last minute that their life is still good,” said Barbara Coombs Lee, co-executive officer of Compassion & Choices, the Denver nonprofit group sponsoring the California bill. “My own personal bias is that they are free to enjoy life more because they are free of the burden of worry about whether they are going to suffer at the end of life.”

The California bill was introduced months before Schiavo became a household name, spurring millions of Americans to think about how best to control their own deaths and those of their loved ones. Schiavo had been in what doctors described as a persistent vegetative state after slipping into a coma 15 years ago.

A public fight between her husband and parents dominated headlines and drew the attention of Congress and President Bush. Courts ultimately agreed with Schiavo’s husband, that she would not have wanted to be kept alive by artificial means, and her feeding tube was withdrawn. She died March 31.

Prospects for the California bill, AB 654 by Democratic Assembly members Patty Berg of Eureka and Lloyd Levine of Van Nuys, are considered dicey.

Fifteen years ago, Californians rejected a ballot measure that would have allowed the terminally ill to end their lives with a lethal prescription.

The bill that would allow doctor-assisted suicide in California faces moral opposition from the Catholic Church, which teaches that suicide should never be an alternative.

Disabled activists argue that it will encourage suicide among the depressed, the poor and the newly disabled who have not adjusted to their situation. The California Medical Assn., which represents the state’s doctors, and a state association of workers who provide end-of-life care also oppose the bill.

“The opposition doesn’t come from the right or the left. It’s coming from both and the middle,” said Tim Rosales, spokesman for Californians Against Assisted Suicide, a coalition organized to fight the bill. “Everybody has concerns on this bill.”

The opposition has lobbied every member of the Assembly Judiciary Committee, which will consider the bill.

A large majority of Californians support physician-assisted suicide and have done so consistently for decades, regardless of religious or political affiliation, according to the Field Poll, which has polled hundreds of Californians on the issue six times since 1979.

A February survey found that 70% of Californians supported physician-assisted suicide for the terminally ill. The same poll found that 64% disagreed with the argument that such suicide devalues life.

But such support hasn’t led to policy changes.

When California voters were asked in 1992 to pass an initiative that would allow “aid in dying” to people diagnosed with six months or less to live, they rejected it 54% to 46%. Backers of that initiative blamed a last-minute advertising blitz paid for by Catholic groups.

A similar bill in 1999 passed one Assembly committee but was tabled by its author for lack of votes.

“Public sentiment supports it absolutely,” said Lee. “Public sentiment doesn’t translate into political power. That’s kind of the sad truth of life in the United States in 2005.”

She noted that the Bush administration was attempting to overturn Oregon’s Death with Dignity Act, even though Oregonians refused to repeal it by a 60% to 40% margin in 1997. The Supreme Court is expected to take up the issue next fall.

Wayne Johnson, a Sacramento political consultant who worked to oppose the 1992 initiative in California, said people often confuse physician-assisted suicide with the “pull the plug” issue of whether to artificially extend someone’s life, as in the case of Schiavo. Once they understand the difference, Johnson said, they generally “recoil” from doctor-assisted suicide.

“What we’re talking about here is whether or not the government ought to be in the business of sanctioning suicide,” Johnson said.

In the eight years since Oregon’s law took effect, attempts to enact similar laws in Hawaii and Maine have failed, although a bill also is pending in Vermont.

According to the Oregon Department of Human Services, which publishes an annual report on doctor-assisted suicide, 326 prescriptions for lethal doses were written from 1998 through 2004, leading to 208 deaths. The 37 Oregonians who took the lethal medication last year died anywhere from five minutes to 31 hours after the time of ingestion.

The people who sought suicide prescriptions most commonly mentioned as reasons a declining ability to enjoy life, loss of autonomy and loss of dignity.

The Oregon law includes a 15-day waiting period under which a person must request the lethal prescription three separate times -- twice verbally and once in writing.

To get such a prescription, a person must be at least 18 years old, diagnosed with six months or less to live and deemed mentally competent. If a doctor believes the patient is depressed or otherwise mentally impaired, a psychological examination must be conducted.

“People who want lethal prescriptions are, in my experience, very determined to get them,” said Linda Ganzini, a professor of psychiatry and medicine at Oregon Health and Science University in Portland, who has studied the effect of the law. Those who choose suicide, she said, tend to be strong-willed, autonomous people.

Ganzini has found that roughly one-third of doctors and nurses are morally opposed to the law but are nevertheless willing to follow it. “They think it would be worse to abandon the patient than to impose their own morality,” she said.

Ganzini suggested that if Oregon’s law were replicated elsewhere, it should be tied to universal hospice -- the end-of-life care that attempts to make a person’s final days as comfortable as possible. In Oregon, 90% of those who choose doctor-assisted suicide are getting hospice care.

Without a strong safety net, Ganzini said, it’s possible that a terminally ill patient could end up choosing suicide in order to avoid a family bankruptcy, ease the burden on caregivers or stop suffering that could be relieved by better pain management.

“If you were to have a law like this in a state that didn’t have good end-of-life care, I don’t know what it would look like,” Ganzini said.

Many disabled activists fear the worst. They worry that health management organizations, striving constantly to cut costs, would subtly or explicitly encourage suicide, given that end-of-life medical treatment can cost hundreds of thousands of dollars, compared with a lethal prescription of $50 or less.

“We know how the profit motive intrudes into all areas that the healthcare system touches,” said Marilyn Golden, policy analyst with the Disability Rights, Education and Defense Fund in Berkeley.

She also noted that many people live years after they’ve been told they have only months to live, and that it can take longer than a 15-day waiting period to get over the depression that news of chronic illness or disability can bring.

“Anybody who is misdiagnosed as terminal could make use of assisted suicide if the bill is passed,” Golden said.

She questioned the safeguards in the Berg-Levine bill, noting that people can shop for doctors until they find one willing to deem them mentally competent or give them a lethal prescription.

More fundamentally, Golden said, she feared doctor-assisted suicide would lead to doctors actually administering lethal drugs or committing euthanasia, as is legal in the Netherlands.

“The last bright line in law we have is the one we have right now, which it is illegal for a doctor or anyone to take an action with the intent to kill,” said Golden. “If we transgress that line, there’s no more bright line.”

Others say doctor-assisted suicide simply offers comfort to the dying.

Lauren Friedman, an architect for the city of Santa Monica, watched her vivacious, fiercely independent mother wither to 80 pounds and forget her daughter’s name. When Friedman’s mother told a social worker that she wanted to die, the social worker called adult protective services.

“I was laughing,” said Friedman. “It was like, who are you protecting? What are you protecting? This is the Terri Schiavo mentality. It’s not a life; it’s a body. In my mother’s case, it was worse, because it was a body being tortured.

“She had to become the person that she really didn’t want to become,” said Friedman, whose mother died two years ago.

“I’d like to know that if and when I’m in that situation, I don’t have to be the shell of a person, suffering.”