California End of Life Option Act

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California End of Life Option Act is a law enacted in June 2016 by the California State Legislature which allows terminally ill adult residents in the state of California to access medical aid in dying by self-administering lethal drugs, provided specific circumstances are met. [1] The law was signed in by California governor Jerry Brown in October 2015, making California the fifth state to allow physicians to prescribe drugs to end the life of a terminally ill patient, [2] often referred to as physician-assisted suicide.

Contents

In May 2018, a state trial court ruled that the law was unconstitutionally enacted, [3] but the following month, the law was reinstated by a state appeals court; [4] the law was affirmed by the California Supreme Court. [5]

History

Previous similar bills have been rejected on at least four other occasions in the state of California and residents voted against a proposal in a ballot in 1992, [6] however a report published by Compassion and Choices collating more recent regional and national independent opinion polls on the right to die issue shows that the US public consistently supports or strongly supports medical aid in dying. [7] Criticism has also come from Life Legal Defense Foundation who have stated that there is no way to tell whether the process is voluntary or whether some degree of persuasion may be involved. [8]

In January 2015, Senate Bill 128 was introduced by Democratic Senators Lois Wolk and Bill Monning, eventually becoming PART 1.85. End of Life Option Act added to Division 1 of the California Health and Safety Code. [9] The act includes definitions and procedures which must be fulfilled, a statement of request for aid-in-dying drugs which must be signed and witnessed and a final attestation of intent signed 48 hours before self-administering the drug. [9] The bill was initially revealed by the family of right to die advocate Brittany Maynard, the 29-year-old terminally ill campaigner who had exercised her right to die in the state of Oregon in November of the previous year, and who had partnered with Compassion and Choices to become the public face of the right to die campaign. Maynard had been a resident of California, her family pointing out she would have preferred to die at home. [6]

The bill was modeled on Oregon's Ballot Measure 16 Death with Dignity Act which has been in force since 1994, after the California Medical Association, which represents physicians in the state, withdrew its longstanding opposition on May 20, 2015, by the recommendation of its Council of Ethical Affairs. [10]

In the run up to its enactment the bill received considerable opposition from religious organizations including the Catholic archdiocese and in July 2015 the bill was held up as it did not receive the required number of votes to proceed to the assembly health committee. [11]

The California End of Life Option Act was signed into law by Governor Jerry Brown on October 5, 2015, with Brown taking the unusual step of releasing a personal statement in which he indicated his dilemma regarding the consideration of the ethical issues involved and that he felt unable to deny the right of choice to others. [2] [12]

The law went into effect on June 9, 2016, making California the fifth state to have a law enabling some of its residents to die of their own volition at a time of their choosing, after Oregon, Washington, Montana, and Vermont. [13] Because the bill was passed during a special session, it did not take effect until June 2016. [14] [15] By the end of 2016, 250 people had exercised the right to begin the process, 191 received a prescription for the medication, of whom it is known 111 took their own lives, 21 dying of natural causes. [16]

Procedure

The law requires that an individual must be over the age of 18 and possessing full capacity to make an independent decision to end their own life, as well as be able to administer the drugs themself. Participation in all aspects of the bill is voluntary for all involved and the application must be made to both an attending and consulting physician with a gap of no fewer than 48 hours. [1] The patient must also be certified by the physician as having a life limiting illness with estimated less than 6 months to live and other palliative care options must have been previously discussed and considered. [6] The law does not specify which drugs must be prescribed. [17]

Under the provisions of the law, if a person chooses to die in this manner, their death certificate only lists their underlying illness as the cause of death; no mention is made of the act or of suicide. According to CNN, this is done to protect patient confidentiality, in addition to avoiding potential legal complications regarding the decedent's estate and life insurance that may arise when a death is registered as a suicide. [18]

Reception

California residents who have spoken to the media to publicize the law and are known to have exercised their right to die include: ex-Peace Corps and homeless charity worker Robert Stone, [13] former Marine and insurance broker Tom House, [16] right-to-die campaigner Brittany Maynard who moved to Oregon to be able to fulfill her right to die, [16] retired psychologist Tom Minor who initially failed to find a doctor to support him, [8] Democratic politician Warren Church. [19] and folksinger and political activist Barbara Dane. [20]

It has been suggested that the bill may exclude Californians based on income and medical care coverage, with Medicare and other insurers not covering the cost of barbiturates to end life. Death With Dignity estimates the cost can reach $5,000 as of 2017. [21]

Given that the cost for such drugs per individual runs between $1.50 and $50 compared to the inordinate cost of treatment for complex, life-threatening diseases like cancer, other critics express concern about disenfranchised Californians choosing assisted death because other options are too expensive. The law nevertheless makes overt coercion or deception of patients a felony. [22]

In 2023, a coalition of disability Rights groups began a lawsuit to have the Act repealed. [23]

See also

Related Research Articles

<span class="mw-page-title-main">Assisted suicide</span> Suicide undertaken with aid from another person

Assisted suicide describes the process by which a person, with the help of others, takes medications to die by suicide.

The right to die is a concept based on the opinion that human beings are entitled to end their lives or undergo voluntary euthanasia. Possession of this right is often bestowed with the understanding that a person with a terminal illness, incurable pain, or without the will to continue living should be allowed to end their own life, use assisted suicide, or decline life-prolonging treatment. The question of who, if anyone, may be empowered to make this decision is often the subject of debate.

Measure 16 of 1994 established the U.S. state of Oregon's Death with Dignity Act, which legalizes medical aid in dying with certain restrictions. Passage of this initiative made Oregon the first U.S. state and one of the first jurisdictions in the world to permit some terminally ill patients to determine the time of their own death.

Compassion & Choices is a nonprofit organization in the United States working to promote what the organization views as patient autonomy and individual choice at the end of life, including access to physician assisted suicide or what the organization refers to as “aid in dying,” which in the USA is generally limited to people with terminal illnesses. The organization’s primary function is advocating for and ensuring access to “aid in dying.”

Voluntary euthanasia is the purposeful ending of another person's life at their request, in order to relieve them of suffering. Voluntary euthanasia and physician-assisted suicide (PAS) have been the focus of intense debate in the 21st century, surrounding the idea of a right to die. Some forms of voluntary euthanasia are legal in Australia, Belgium, Canada, Colombia, Luxembourg, the Netherlands, New Zealand, and Spain.

The Hemlock Society was an American right-to-die and assisted suicide advocacy organization which existed from 1980 to 2003, which took its name from the hemlock plant Conium maculatum, a highly poisonous herb in the carrot family, as a direct reference to the method by which the Athenian philosopher Socrates took his life in 399 BC, as described in Plato's Phaedo.

Involuntary euthanasia is illegal in all 50 states of the United States. Assisted suicide is legal in 10 jurisdictions in the US: Washington, D.C. and the states of California, Colorado, Oregon, Vermont, New Mexico, Maine, New Jersey, Hawaii, and Washington. The status of assisted suicide is disputed in Montana, though currently authorized per the Montana Supreme Court's ruling in Baxter v. Montana that "nothing in Montana Supreme Court precedent or Montana statutes [indicates] that physician aid in dying is against public policy."

<span class="mw-page-title-main">Dignity in Dying</span> UK pro-euthanasia organisation

Dignity in Dying is a United Kingdom nationwide campaigning organisation. It is funded by voluntary contributions from members of the public, and as of December 2010, it claimed to have 25,000 actively subscribing supporters. The organisation declares it is independent of any political, religious or other affiliations, and has the stated primary aim of campaigning for individuals to have greater choice and more control over end-of-life decisions, so as to alleviate any suffering they may be undergoing as they near the end of their life.

<span class="mw-page-title-main">Legality of euthanasia</span>

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Kathryn Tucker is an American attorney and the executive director of the End of Life Liberty Project, which she founded during her tenure as executive director of the Disability Rights Legal Center. This appointment to the DRLC was opposed by every other major disability rights group and has since been terminated. She graduated from Georgetown University Law Center in 1985 and Hampshire College in 1981. Tucker has been an adjunct law professor at Lewis and Clark School of Law, Seattle University the University of Washington, Loyola/LA and Hastings. Beginning in 1990, while an attorney at the Seattle firm of Perkins Coie, she did pro bono work for Washington Citizens for Death with Dignity, which led her into the movement to legalize physician assisted suicide.

Barbara Coombs Lee is an American activist, author, former family nurse practitioner and physician assistant, and president emerita/senior adviser of Compassion & Choices, a national non-profit organization dedicated to expanding and protecting the rights of the terminally ill.

<span class="mw-page-title-main">Washington Death with Dignity Act</span> Referendum legalizing some assisted suicide

Initiative 1000 (I-1000) of 2008 established the U.S. state of Washington's Death with Dignity Act, which legalizes medical aid in dying with certain restrictions. Passage of this initiative made Washington the second U.S. state to permit some terminally ill patients to determine the time of their own death. The effort was headed by former Governor Booth Gardner.

<span class="mw-page-title-main">Assisted suicide in the United States</span> Medically-induced suicide with help from another person

In the United States, the term "assisted suicide" is typically used to describe what proponents refer to as medical aid in dying, in which a terminally ill adult is prescribed and self-administers barbiturates if they feel that they are suffering significantly. The term is often used interchangeably with physician-assisted suicide (PAS), "physician-assisted dying", "physician-assisted death", "assisted death" and "medical aid in dying" (MAiD).

<i>Baxter v. Montana</i> Montana Supreme Court decision ruling physician-assisted dying is not illegal

Baxter v. Montana, is a Montana Supreme Court case, argued on September 2, 2009, and decided on December 31, 2009, that addressed the question of whether the state's constitution guaranteed terminally ill patients a right to lethal prescription medication from their physicians. The Montana Supreme Court sidestepped the question of if medical aid in dying is guaranteed under Montana State Constitution, but it instead ruled, on narrower grounds, that neither legal precedent nor the state's statute deem such assistance to be against public policy or illegal. Montana is one of ten states in which aid in dying is authorized. The others are California, Colorado, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington; it is authorized in the District of Columbia as well.

<span class="mw-page-title-main">2012 Massachusetts Question 2</span> "Death with dignity" ballot initiative

The Massachusetts "Death with Dignity" Initiative, also known as Question 2, appeared on the November 6, 2012 general election ballot in the state of Massachusetts as an indirect initiated state statute to allow physician-assisted suicide. The measure was filed with the Massachusetts Attorney General and would establish, according to those who filed the measure, an "Act Relative to Death with Dignity". The petition number for the initiative was 11-12, and was filed by Michael Clarke as "An Initiative Petition for an Act Relative to Death with Dignity".

<span class="mw-page-title-main">Brittany Maynard</span> American activist

Brittany Lauren Maynard was an American activist with terminal cancer who decided that she would end her own life "when the time seemed right." She was an advocate for the legalization of assisted suicide for the terminally ill.

Act 39 of 2013 established the U.S. state of Vermont's Patient Choice and Control at End of Life Act, which legalizes medical aid in dying with certain restrictions. Vermont was the first state to enact this Law through legislative action; it permits some terminally ill patients to determine the time of their own death.

<span class="mw-page-title-main">End of Life Choice Act 2019</span> Act of Parliament in New Zealand

The End of Life Choice Act 2019 is an Act of Parliament in New Zealand that gives people with a terminal illness the option of receiving assisted suicide or euthanasia. The act came into force on 7 November 2021, twelve months after the 2020 euthanasia referendum was declared in favour of the legislation.

Assisted suicide is the ending of one's own life with the assistance of another. Physician-assisted suicide is medical assistance in helping another person end their own life for the purpose of relieving their suffering, and voluntary euthanasia is the act of ending the life of another, also for the purpose of relieving their suffering. The phrase "assisted dying" is often used instead of physician-assisted suicide by proponents of legalisation and the media when used in the context of a medically assisted suicide for the purpose of relieving suffering. "Assisted dying" is also the phrase used by politicians when bills are proposed in parliament. Assisted suicide is illegal under English law.

References

  1. 1 2 "End of Life Option Act". Coalition for Compassionate Care of California. Retrieved December 28, 2023.
  2. 1 2 Lovett, Ian; Perez-Pena, Richard (October 5, 2015). "California Governor Signs Assisted Suicide Bill Into Law". New York Times. Retrieved September 6, 2017.
  3. ↑ Smith, Wesley J. (May 16, 2018). "California Assisted-Suicide Law Unconstitutionally Enacted". National Review. Retrieved May 16, 2018.
  4. ↑ "State Appeals Court Reinstates California's Right-To-Die Law". The New York Times. June 15, 2018. Retrieved June 17, 2018.
  5. ↑ "California".
  6. 1 2 3 Gambino, Lauren (January 22, 2015). "California lawmakers introduce right-to-die bill inspired by Brittany Maynard". The Guardian. Retrieved September 7, 2017.
  7. ↑ "Polling on Voter Support for Medical Aid in Dying for Terminally Ill Adults" (PDF). Compassion and Choices. Archived from the original (PDF) on February 2, 2017. Retrieved September 7, 2017.
  8. 1 2 Karlamanga, Soulya. "111 terminally ill patients took their own lives in first 6 months of California right-to-die law". Los Angeles Times. Retrieved September 7, 2017.
  9. 1 2 "SB-128 End of life.(2015-2016)". California Legislative Information. Legislative Counsel Bureau. Retrieved September 7, 2017.
  10. ↑ "Medical group drops opposition to aid-in-dying bill". May 20, 2015. Retrieved September 23, 2019.
  11. ↑ "California right-to-die bill stalls amid opposition from religious groups". The Guardian. July 7, 2015. Retrieved September 6, 2017.
  12. ↑ Brown, Edmund G. "Letter to the members of the California State Assembly" (PDF). Office of Governor Edmund G. Brown. State of California. Retrieved September 7, 2017.
  13. 1 2 Karlamangla, Soumya (August 3, 2016). "This terminally ill man says California's aid-in-dying law means he can end his life 'fully, thankfully and joyfully'". Los Angeles Times. Retrieved September 6, 2017.
  14. ↑ Karlamangla, Soumya (May 12, 2016). "Q&A How California's aid-in-dying law will work". Los Angeles Times. Retrieved September 9, 2017.
  15. ↑ Siders, David; Koseff, Alexei. "Jerry Brown signs doctor-assisted death bill". Sacramento Bee. Retrieved September 9, 2017.
  16. 1 2 3 Hawkins, Derek. "111 people have killed themselves under California's new right-to-die law". Washington Post. Retrieved September 6, 2017.
  17. ↑ "End of Life Option Act". The Coalition for Compassionate Care of California. Retrieved September 6, 2017.
  18. ↑ Tinker, Ben. "111 people died under California's new right-to-die law". CNN. Retrieved September 7, 2017.
  19. ↑ McKenzie, Kathryn. "Warren Church, Monterey County supervisor from 1965 to 1977, uses end of life option, dies at age 87". Monterey Bay Partisan. Archived from the original on September 9, 2017. Retrieved September 8, 2017.
  20. ↑ Williams, Alex (October 25, 2024). "Barbara Dane, Who Fought Injustice Through Song, Dies at 97: She was highly regarded as a folk, blues and jazz singer. She was also ardently left-wing and prioritized social change over commercial success". New York Times . Retrieved October 25, 2024.
  21. ↑ McKenzie, Kathryn. "A Good Day to Die". VOMB. Retrieved October 16, 2017.
  22. ↑ "Assisted suicide bill passed in California". The Telegraph. Retrieved September 7, 2017.
  23. ↑ "Disability groups claim California's assisted suicide law discriminates against them". NPR. April 27, 2023. Retrieved July 24, 2023.
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