San Francisco Chronicle - (Sunday)
Bill would expand state’s aid-in-dying law
As California’s aid-indying law survives a legal challenge, its use to allow terminally ill patients to end their lives has increased substantially since the mandatory waiting period was shortened, according to the latest state report. And newly introduced legislation would expand the law to cover patients whose illnesses, although not terminal, are incurable and cause them severe suffering.
The law, which took effect in 2016, allows a patient to receive life-ending drugs if two doctors certify that the patient has six months or less to live and is mentally competent to choose death, and if the patient has made two spoken requests, at least 48 hours apart, and one written request for the drugs.
Four disability-rights organizations filed suit last year, claiming the law discriminates against the disabled. They argued that people with disabilities lack access to adequate health care and to life-saving resources, are disproportionately affected by the law and may lack the freedom to make completely voluntary choices.
But U.S. District Judge Fernando Aenlle-Rocha of Los Angeles, who had previously struck down another part of the aid-in-dying law, ruled Wednesday that the overall law was constitutional and nondiscriminatory.
“The statute provides an entirely optional alternative for terminally ill patients when deciding how to manage their diagnoses, and contains a number of safeguards designed to ensure that a requesting patient’s decision is voluntary and intentional,” Aenlle-Rocha wrote in a ruling dismissing the lawsuit.
California’s law, he said,
“does not preclude … disabled individuals from availing themselves of the benefits of any behavioral health services and suicide prevention programs, nor does it contain any provisions encouraging or steering patients toward physician-assisted suicide.”
Last September, AenlleRocha, an appointee of former President Donald Trump, blocked enforcement of the law’s requirement that doctors with religious or moral objections to aid-in-dying record a patient’s request for life-ending drugs and refer it to a physician who would supply the medication.
The judge said forcing opponents to take part in the law’s application appears to violate their freedom of speech. The state settled the case with a $300,000 payment to the Christian Medical & Dental Association, which had filed the suit.
State officials are also reporting a significant impact of legislative amendments in 2022 that allowed patients to make the requests for life-ending drugs within 48 hours instead of 15 days, as previously required. Supporters of the change said the longer waiting period had prevented thousands of terminally ill Californians from requesting the medication because they were too ill, or had already died, within 15 days of their initial request.
In its most recent report, the state Department of Public Health said 1,270 prescriptions for life-ending drugs had been issued by California physicians in 2022 compared with 863 prescriptions in 2021, a 47% increase.
The numbers reflect “the urgency of timely access to physician-assisted dying” and the easing of “unnecessary and prolonged suffering” by the amended law, according to
Death With Dignity, an advocate of the legislation.
But Michael Bien, attorney for the disability groups who challenged the law, said the longer waiting period was intended to “make sure that people were not acting impulsively” and that the increased numbers were disturbing. He said the judge’s ruling “leaves people with disabilities vulnerable to the problems” posed by the law and may be appealed.
Meanwhile, a new bill in the state Legislature would extend the aid-in-dying law to another group of patients, those in agony from illnesses that have been diagnosed as incurable but not necessarily fatal.
SB1196 by state Sen. Catherine Blakespear, DEncinitas, would allow doctors to provide life-ending medication to a patient who is suffering severe physical or psychological pain from a condition that is causing an irreversible decline in the person’s capacities, cannot be cured, and is likely to eventually cause death. The bill would also allow patients from other states to receive the medication from a California physician.
“People with a terminal, incurable illness or disease have the right to determine what is best for their health and how they leave this existence,” Blakespear said in a statement announcing the legislation, which is awaiting its first committee hearing. “No person should have to suffer as they near end of life, and they should have the right to leave peacefully, on their terms.”
But Compassion & Choices, a sponsor of the 2016 aid-in-dying law, opposes its expansion to people who are seriously but not terminally ill. Limiting eligibility to patients with no more than six months to live was intended to “ensure that people don’t feel compelled to access medical aid in dying because they lack availability to adequate pain management and symptom relief,” Sean Crowley, a spokesperson for the group, said in a statement.