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  • BIOETHICS FORUM ESSAY

Assisted-Dying Provisions: California Legislature Says Yes, the U.K. Says No

A new chapter in efforts to secure legal provisions for physician-assisted dying began last week when the California State Legislature voted to approve the End of Life Option Act. If Governor Jerry Brown signs the bill, California will become the fifth state to permit physician-assisted dying through statute (as in Oregon, Washington, and Vermont) or case law, as in Montana; a lower court decision permitting the practice in New Mexico was overturned last month. For advocates, it is a huge victory to have an assisted dying provision available in the nation’s most populous state.

Factors influencing the debate in California have included the recent Brittany Maynard case; in 2014, Maynard moved from California to Oregon to make use of that state’s longstanding assisted dying provision. Before her death last November, she recorded a series of videos urging California lawmakers to adopt a similar provision; the most recent video was released by her family four months after her death and was viewed by a committee of California’s State Senate during their deliberations on the bill. The rebranding of the Oregon-style provision reflected in California’s legislation as “end of life choice” rather than “death with dignity” may also turn out to be relevant to securing political and public support for the measure.

California’s population of 38.8 million is 10 times that of Oregon, and implementing this provision will be more complicated than in the much smaller states that have similar laws, protocols, and reporting requirements for voluntary self-administration of a lethal medication proscribed by a physician for that purpose. For example, Oregon’s and Washington’s admirably accessible data show that nearly everyone who uses these states’ assisted-dying provisions is enrolled in hospice; the assisted-dying provisions are designed for a hospice-eligible person who is able to make a voluntary decision and to self-administer medication. California’s hundreds of hospice programs, and other programs serving people nearing the end of life, will now need to consider the organizational ethics of how to provide patients with information about this new right, and how the provision will work in practice, as well as the rights of professionals and institutions to participate or refuse to participate. Examples from Oregon’s health care community suggest that professional reflection and discussion continue long after an assisted dying bill becomes law.

On the same day as California lawmakers voted in favor of legalizing assisted dying, the British House of Commons overwhelmingly rejected similar legislation. The Labor Party’s losses in the recent general election may have doomed the current prospects for this bill, which was not supported by the Conservative leadership. However, some British health care professionals are calling attention to the reality that some terminally U.K. residents travel to other jurisdictions (typically, Switzerland) to make use of assisted-dying provisions there, making arguments similar to those of Brittany Maynard. In the U.K. as in the 50 different state-level jurisdictions in the U.S., the local politics of assisted dying matter.

Nancy Berlinger is a research scholar at The Hastings Center and lead author of The Hastings Center Guidelines for Decisions of Life-Sustaining Treatment and Care Near the End of Life.

Posted by Susan Gilbert at 09/14/2015 11:04:14 AM |

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Published on: September 14, 2015
Published in: Chronic Conditions and End of Life Care, End of Life

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