News Flash: On October 5, 2015, Governor Brown signed the End of Life Option Act. It authorizes “an adult who meets certain qualifications, and who has been determined by his or her attending physician to be suffering from a terminal disease, as defined, to make a request for a drug prescribed …. for the purpose of ending his or her life.” The law sunsets (i.e., it ends) in 2026, unless the Legislature votes to extend it. Meanwhile and before that sunset date, the California Law Revision Commission will study its operation and make a formal recommendation to the Legislature. The Legislature may then vote to extend, modify and/or terminate the law. Alert: It was just announced that the new law will go into effect June 9, 2016, which is 90 days after the end of the Special Session of the Legislature which ended March 10, 2016.
The full text can be found here:
Governor’s signing message can be found here:
What follows is a discussion that was relevant BEFORE Governor Brown signed the new law.
Q. I recently read about a young lady from California, who had been diagnosed with terminal brain cancer and had to relocate to Oregon to arrange her own death with dignity. Why did she have to move? I thought each of us had the right to control our own end-of-life decisions?
A. I believe you refer to Brittany Maynard, who was diagnosed with an aggressive brain cancer which began to rob her of cognitive function and subjected her to progressively painful seizures. Her doctors had given her six months to live. In coming to terms with her decision to die with dignity before the pain became too great to bear, she made a YouTube video and uploaded it to the internet. It quickly went viral, renewing the debate over right-to-die laws.
The reason she had to relocate was to take advantage of Oregon’s “Death with Dignity Act”, which allowed her to obtain physician-prescribed drugs to peacefully end her life at the time and in the manner of her choosing.
By contrast, in California physicians are currently prohibited from prescribing death inducing medications, as doing so is viewed as assisting suicide, which is a crime in this state. So, in California there are limits on our right to control our end-of-life, and I understand your confusion. True, as counselors we do encourage clients to complete an Advanced Health Care Directive and/or a Physician’s Order for Life-Sustaining Treatment (POLST), both of which express the client’s wishes regarding end-of-life care. But California draws a distinction between our right to accept or reject life sustaining medical treatment, on the one hand, and our right to self-administer physician-prescribed lethal drugs, on the other. We have the right to the former, but not to the latter.
So the question really becomes what is considered to be “medical treatment”. Under California law, this includes medical procedures and medications, but also includes artificial nutrition and hydration (food and water) as well as palliative, hospice and comfort care including medication for pain. Thus, for example, we can direct the removal of a feeding tube, and instead opt for pain medication and hospice care and thereby allow “nature to take its course”, even if doing so hastens the moment of death. But we cannot go so far as to ask our doctor to prescribe death inducing drugs.
For most of us, knowing that in California we retain the right to control our end-of-life care by directing the extent to which we want life-sustaining medical treatment (including nutrition, hydration and comfort care), is reason enough for each of us to sign an Advance Healthcare Directive.
Yet, we fall short of the law in states like Oregon, which extends this right further by allowing terminally ill, but mentally competent, patients to actively end their life with physician prescribed drugs. But even in Oregon, the patient — and not the doctor — must self-administer the lethal dose of medication. Ironically, a Gallup Poll has found that about 70% of Americans support allowing physicians to help terminally ill patients end their lives by some “painless means”. A Field Poll in California found similar approval. Yet, attempts to pass legislation in California to offer this option to dying patients has thus far been defeated by outcries from vocal interest groups. So, for those exceptional patients like Brittany Maynard, states like Oregon may be a refuge of last resort.
ALERT: In January, 2015, inspired by the plight of Brittany Maynard, two California lawmakers introduced right-to-die legislation. It is called the End of Life Options Act and is patterned after Oregon’s Death With Dignity Act. And in February, 2015, a California woman — joined by physicians — filed a lawsuit against the State of California seeking to establish, through the courts, her right to die at home. Stay tuned.