In a press conference held Wednesday in the State Capitol, Senators Bill Monning and Lois Wolk were joined by the family of Brittany Maynard and a diverse array of supporters as they made their announcement of the End of Life Option Act, a bill to authorize the medical practice of aid-in-dying in California. Also joining the two members on stage were co-authors of this legislation, including principal co-authors, Assemblymember Susan Talamantes-Eggman and Senator Mark Leno.
“The time is right for California to advance the conversation about end of life options,” said Senator Monning. “ We are working together to establish a process that honors a terminally ill patient’s right to make informed decisions about dying, including an individual’s option to reduce suffering by taking aid-in-dying medication.”
The legislation, Senate Bill 128, is modeled on legislation in Oregon and other states where aid in dying has been proven to be effective and successful.
The bill includes the following:
· Only qualified, terminally ill adults who are residents of California may request and obtain prescriptions from their physician for medication that the patient has the capability to self-administer. A person may not qualify solely because of age or disability.
· In order to receive the prescription the terminally ill patient is required to have two physicians confirm the patient’s prognosis of six months or less to live and that the patient has the mental competency to make health care decisions for him or herself.
· As in Oregon’s legislation this bill requires two oral requests to be made to a physician, a minimum of 15 days apart, in addition to one written request with two witnesses attesting to the request before the prescription can be written.
· Protections for physicians, pharmacists and healthcare facilities from civil or criminal liability, and from professional disciplinary action, if they fulfill a terminally ill, mentally-competent individual’s request.
· Voluntary participation by doctors, pharmacists and healthcare facilities.
· Safeguards against any coercion of patients by establishing felony penalties for coercing or forging a request.
· A patient’s right to rescind the request.
· The attending physician of the terminally ill patient who wishes to engage in the End of Life Option Act is required to discuss feasible alternatives or additional treatment opportunities, including, but not limited to comfort care, hospice care, palliative care and pain control.
The announcement of this bill comes two months after the death of 29-year-old Brittany Maynard. In the final weeks of her life, Brittany, a Californian, partnered with Compassion & Choices to share her story in hopes that it would help make aid-in-dying an open and accessible medical practice in her home state and throughout the country. Aid-in-dying offers mentally competent, terminally ill adults the option to request a prescription for medication they can use to end their dying process if it becomes unbearable.
“Having aid-in-dying as an end of life option provided great relief to Brittany,” said Dan Diaz, Brittany’s widower. “It enabled my wife to focus on living her last days to the fullest, rather than having to worry about dying in agony from terminal brain cancer. I promised Brittany I would do everything in my power to fulfill her mission to make this end of life option available to all Californians.”
Debbie Ziegler, spoke about her mission to keep her only daughter’s legacy alive.
“Brittany fought to the end for expanded availability of end of life options in California,” she said. “I will make my daughter Brittany proud by standing up and telling her story even if my voice shakes. Even if I choke back tears. I hope that no other Californian has to go through what Brittany did.”
“It’s time for terminally ill patients in California to have the same right to die peacefully in comfort as now allowed in other states,” said Senator Lois Wolk, “In the end, how each of us spend our last days of life, if we are fortunate to have a choice, is a deeply personal decision. That decision should remain with the individual, as a matter of personal freedom and liberty, without criminalizing those who help to honor our wishes. This law will honor that freedom, with appropriate protections to prevent any abuse.
Medical aid-in-dying is authorized in Oregon, Washington, Montana, Vermont and New Mexico. More than half a dozen other states are also considering similar legislation this year including Colorado, Florida, Indiana, Nevada, Iowa, Minnesota, New Hampshire, New Jersey and Pennsylvania.
National and state polls consistently show the vast majority of Americans across the demographic and political spectrum want to maintain their right to choose their medical treatment at the end of their life.
“Support for this law runs across all demographic categories, from every ethnic, religious, and economic background,” said Senator Wolk, “It is not a partisan issue. It is about the most personal freedom there is and guaranteeing terminally ill Californians will have a right to exercise this option if they believe it is right for them.”
Robert Olvera, M.D., recalled the death of his 25-year daughter, Emily Rose, who died in April 2014, after a four-month agony from a rare form of leukemia.
“As a Catholic and as a father, I never lost hope, but as a physician, I knew what was in store,” said the Santa Ana physician. “My daughter, Emily Rose, was confined to a bed, blind, she struggled to breath with excruciating headaches that no medication could alleviate. She suffered horribly as I sat next to her, unable to make it better.”
Jennifer Glass from San Mateo has been living with advanced lung cancer since January 2013.
“We all seek the best quality of life possible, regardless of how much time we have left,” she said. “We expect and demand options across all aspects of life because they influence quality of life. This has to include end of life.”
“This legislation is long overdue for California residents who have a terminal diagnosis and are concerned with the unknown suffering and physical effects from the disease,” stated Senator Monning. “No patient should have to leave his or her home and family to relocate to another state to exercise this option in order to control the terms of his or her imminent death.”
Article is from a press release from Senator Wolk’s office
Senator Wolk deserves applause for introducing this bill. Oregon’s experience with its death with dignity rules have proved beyond all doubt that this can work well; and the notion that it would result in killing anyone without his approval or helping the depressed commit suicide has been shown to be false.
Most of us and most of our family members will never need aid-in-dying medication. It’s really only those who have a terminal illness and who are withering away in a miserable existence who will be aided by the Wolk bill.
When an animal, including a beloved pet, is in such a state, we help that creature by humanely putting it down. But when a person is dying a painful and undignified death, we are far less humane. At best, we can remove that person’s consciousness by giving him so many pain pills that he is catatonic until his heart finally gives out. Is that what human life is all about? At worst, the person in pain just suffers in a hospital bed, unable to think of anything but his anguish for as long as very expensive machines keep his organs functioning.
I would hope that most Californians would be humane enough to give those with terminal illness the right to choose for themselves how they go out. It’s bad enough that we spend $125 billion a year–enough to give 25 million poor people $5,000 each–to keep the elderly alive for another month or two. But even worse when the recipients of that “compassion” don’t want it.
As currently proposed, I have grave concerns about whether this could be the beginning of a “slippery slope”. I could support it if I was assured that it was a “this far, but no further” proposition. I fear it is not. Witness other social ‘trends’, where we are asked to accept A, and when A is OK, the trend is towards B, which is not acceptable to those who grudgingly accepted A, but would not have done so if B was ‘on the table’.
I, for one, could accept and support the current proposal, if the criteria ‘this far and no farther”, and of two physicians and all other applicable provisions will be applied to other “end of life” decisions (currently made by those whose life is NOT under their control)… i.e., abortion. If a fetus is “terminal”, facing a lifetime of excruciating pain and suffering if brought to term, or their mother is in grave peril if the pregnancy continues, AND if the mother goes thru the same ‘vetting’ that is proposed in this bill, I could morally support that.
Otherwise, why would we not assume that the proposed bill will eventually morph into a “euthanasia on demand”, become a spouse’s/child’s constitutional right? We have precedence. We have gone from abortion being OK when fetus is not ‘viable’ and/or mother’s life is in demonstrable danger, to a ‘constitutional right’ of “choice”. I could easily see where having Dad/Mom/Granny euthanized could, in the future be touted to be a constitutional right regarding the property that would be inherited, but is being diminished by the costs of care.
hpierce raises important concerns when someone other than the patient is making the ending life decision. Allowing second-party venality to creep into such decisions needs to be scrupulously avoided. However, when the decision is being made by the person whose life will be the one that ends, I really don’t see how the “this far, but no further” standard can be violated. In the recent Connecticut case of Cassandra (as she is identified in Connecticut Supreme Court papers) there is discussion about “protecting the life…” Specifically, the Connecticut Department of Children and Families issued the following statement:
I believe that statement takes the concept of “right to live” and replaces it with “obligation to live.” When a patient like Cassandra makes clear and logical statements that “the quality of my life, not the quantity” is important, and that having toxic harmful drugs placed in his/her body, he/she should be a given human right to decide what she/he wants and doesn’t want for his/her own body. That first-hand clear decision has no “slippery slope” associated with it. It honors the right to life, rather than recasting it into an obligation to live.
Both hpierce and Matt Williams have done an excellent job making their individual cases. And Rich Rifkin below with his pet experience and with his uncle hit home with me.
For me, assuming sound mind, a person should absolutely have a right to chose to end his/her life.
The only slippery slope for me is others making the decision. Or if the subject demanding to end his/her life is not of sound mind.
I agree with hpeirce that inheritance, and even the motivation to get rid of a care challenge, are potential problems.
Even if we assume nothing but love motivates the decision as is usually the case with our pets, the emotional turmoil makes it difficult for many people to think objectively. However, I tend to see these decisions made by those that truly love as righteous in the eyes of God (or through the antenna of the benevolent and terrible aliens that placed us here).
Those of us that have experience with hospice dealing with the end of life for a loved one, know that there is already sometimes some nuanced decisions made. Morphine does the trick… it stops much suffering and at higher doses it stops everything. My experience with hospice has always been A+. In fact, I often wondered why healthcare providers could not develop similar bedside manners and skills. Treating patients of terminal illness or age-related decline is as much about caring for the family… and that is what hospice does in my experience. It is a collaborative and consultative effort where the experienced care providers explain and listen and sooth and also carefully advise… at least of the choices available and what to consider in terms of timing for a decision.
Funny, but at one point I would rail that we could make these decisions out of love for our pets but not human loved ones. Then I had experience with professional hospice and I complained that there was nobody that would similarly advise me on my old or sick pets at end of life.
I made the decision to euthanize one of our two cats that was clearly suffering… both were 17 years old. Even though we did this at home, the experience caused me to consider that it was wrong and we should support natural death. Then the second cat died in my wife’s arms six months later, and that experience sucked too.
So I came to an understanding that death of loved ones just generally sucks. So we can only just work on supporting it with as much thoughtfulness and grace as we can muster.
And having professional medical advise and hospice services to help steer a family through this tough decision process, assuming no other conflicts of interest, I would support others making the decision in many cases where the patient cannot.
I might add that I don’t have any personal experience with a loved one who wanted the pain to end in this way. However, I did witness the final breath of an uncle of mine, who happened to live in Salem, Oregon; and I also had a dog who was dying of cancer humanely put down here in Davis. Both of those events gave me a little insight into the topic.
With Moxie, my dog, it was very traumatic for me to see her draw her last breath in Dr. Gravem’s clinic. But her cancer, which was in her mouth, was causing her to bleed more and more. Her lower jaw was just about gone. Her teeth were falling out. She could no longer chew food. I wanted her to go on living. But her ability to do so was receding very fast. Having her put down, painful as it was for me, was the only humane choice. It’s not the same as with a person. But it does bring up some of the same sorts of issues. …
My uncle, who was 89 years old, also had cancer. He had “beat” cancer once before, but his last time it had spread and he had accepted that he would not defeat it a second time. When my family and I travelled up to Oregon to see Uncle Ted one last time, we did not know how far along he was. He had moved from his house into hospice care, which was run by two women (both RNs) in their home. He was still alive and conscious, though no longer talking, when we got there. I don’t think he was in inordinate pain.
A funny incident which happened during our visit took place when my brother, Barry, and I were in Ted’s bedroom. We thought he was asleep. We were talking about baseball games we had gone to with Ted. Ted was a Giants fan, but he had grown up in Chicago with the Cubs. My brother mentioned that in 1932 our dad, Uncle Ted and Uncle Bob all went to Game 3 of the World Series at Wrigley Field in Chicago. That was a game made famous because Babe Ruth allegedly pointed to centerfield after a pitch and on the next pitch hit a home run right to where he had pointed. It has ever since been known as “the called shot.” Barry believes Ruth really called his home run in advance. My dad, who was 13 in 1932 but died when I was 7 years old in 1971, had convinced him of that. I am less sure. I have read compelling stories that Ruth was pointing at the pitcher, upset that the previous pitch was high and inside. But as I said I had my doubts, Uncle Ted raised his hand, still not speaking, and pointed toward a hypothetical center field. Barry said, “See. Ruth called his shot.” Not too much later, Ted started having trouble breathing. The hospice nurse called in Ted’s rabbi, who recited some prayers in Hebrew. And in a quiet way, with dignity, Ted passed away that afternoon.
Game 3 of the 1932 World Series, held on October 1, 1932, at Wrigley Field in Chicago.
Have never been present at “moment of passing”, but had a dear relative who was dying of a particularly painful (normally) cancer. They were identified as “hospice”, and were given an IV where they could control how much morphine dripped into their system. 13 years ago… California. They probably could have given themself a lethal dose… could this be considered as a case where ‘physician-assisted suicide’ already exists? My relative “lucked out”. They were atypical. The relative was no martyr, but only needed a couple of aspirin a couple of times to deal with the pain. The IV was unused. Had the pain been as severe as others diagnosed with that particular cancer, I wouldn’t have thought twice if they had decided to use the morphine, even to the extent that it ended their life.
See my earlier post. Hospice absolutely does assist with morphine… in a very legal and careful way.
Not sure how I feel about this idea. Like hpierce I have reservations, but understand why this concept is being proposed. I will have to think long and hard about it. And yes, I have had terminally ill relatives die, and I have put a dog down for humane reasons.
David wrote:
> Also joining the two members on stage were co-authors of this legislation,
> including principal co-authors, Assemblymember Susan Talamantes-Eggman
> and Senator Mark Leno.
Interesting that Mark Leno was on the stage since this summer he was on a stage talking about how his work was key in getting the funding for the new suicide barrier on the Golden Gate Bridge that will be built to prevent suicides. Now just a few months later Leno is on a stage talking about how he is co-author of a bill making it easier to commit suicide with the help of a doctor (joined by the family of Brittany Maynard who could have saved the ~$75 cost of a one way Greyhound bus ride to Oregon if she took a cab to the Golden Gate Bridge)…
not interesting at all, two completely separate issues.
SOD, I think it’s interesting…….
Perhaps Leno didn’t want the bridge authority sued (in his district?), but since the new legislation has a hold-harmless clause, he’s not so concerned. Just a wild-assed speculation.
two very different circumstances. one is a carefully planned end of life based on terminal illness and ending suffering, the other is preventing largely temporarily depressed or mentally ill people from making an uninformed decision to end their life. i’m not saying i’m for this legislation, but to act like there’s some tension in leno’s actions is to misunderstand the issue.
DP wrote:
> one is a carefully planned end of life based on
> terminal illness and ending suffering
Any idea if Leno plans a space on the bridge without the suicide barrier for people who have “carefully planned”, have a “terminal illness” and want to “end suffering”?
What’s your point?
obviously you are either not making a serious point or didn’t read the legislation.
Perhaps South of Davis is saying, “je suis levity”. Sure, It’s a serious subject, particularly since Frankly, Rifkin, and I seem to be basically on the same page, some nuances notwithstanding. Sure sign that the world will end at 11:59:59. Tonight.
Hard subject. A little humor actually might help deal with it. My relative, knowing they had a very short time on this mortal sphere, was actually quite quick of wit at the end. The irony/humor is I remember the last words spoken – in retrospect, prophetic and typical of a wry sense of humor… (Me) “is there anything you need before I leave tonight?” (Them) “No, I’m good to go”, Last words.
Having witnessed a number of deaths, some painful, some peaceful, and having a clear belief in the principle of patient autonomy, I can say that with the safeguards that are being incorporated, I am strongly in favor of this proposal.
I am too. I hope this becomes law in California.
I hope one of the “safeguards” you support, Tia, is the provision that the physicians MAY prescribe the drugs, but MAY instead CHOOSE to decline to issue such a prescription.
Pierce, the Wolk bill mirrors what they have in Oregon. In this realm, as this press release notes, “Voluntary participation by doctors, pharmacists and healthcare facilities.” Any doctor who opposes prescribing the drugs needed can do so, and many do. Also, Catholic hospitals do not participate. Same with the V.A.
The bill also mandates, “Protections for physicians, pharmacists and healthcare facilities from civil or criminal liability, and from professional disciplinary action, if they fulfill a terminally ill, mentally-competent individual’s request.”
If you carefully read my words, Rich, I believe it is obvious that I know that the currently proposed language mirrors the Oregon statutes. My concern is what happens to the bill as it goes thru the California legislative process. I’d be dumb-founded if the bill, if passed, will be identical to what is proposed. Too many folk will want to be “innovative”, and not want to copy Oregon. “On principle”. My intended point, is that the “voluntary” participation by health professionals is ‘sacrosanct’, in my view.
hpierce
“physicians MAY prescribe the drugs”
Of course. I am unaware of any situation in which a physician is “forced” to prescribe a given medication. Two real world examples:
1. We had in our group a physician who because of personal religious beliefs would not prescribe birth control pills. Unfortunately he was just turning women away with no prescription and no alternative. The compromise for our group was that of course he did not have to prescribe himself, but he did have to make a same day referral so that a gynecologist would prescribe for the patient in real time.
2. My own case. I am personally opposed to abortion for other than maternal medical indications. I am equally aware that this is my personal perspective and I have no right whatsoever to make this determination for another individual. My solution has always been to inform the patient that I do not do the procedure myself and that I will immediately refer her to physicians providing this service. This is done completely non judgmentally in exactly the same way that I would inform a patient that I do not perform breast surgery and will refer her immediately to a breast surgeon if that is the procedure she needs.
Thank you. I believe I understand your position more fully, and do not disagree with it.
The only alternatives are to go to Syria and wave a Bible at the locals, or go to the forest and slap a bear in the kisser. Lunch!
Whatever you would decide for yourself, it is allowing people to do what they want in their last days. That gives people a lot of peace.
You don’t need to do that near the North Pole.
hpierce
“I believe I understand your position more fully”
I want to thank you for taking the time to reply. On this blog it is very common when faced with a position that is different from our own, to just stop communicating. Frankly has called this “crickets”. Others have criticized ongoing communication as “too much posting” ( paraphrased ). I consider the willingness to share our ideas, and our individual stories to the extent that we are comfortable doing so, one thing that makes the Vanguard unique and a valuable venue for the exchange of ideas. Thus, my appreciation for your comment.