California – Physician Assisted Suicide - AB 654 and AB 651

February 2006

  Update: After being unable to solicit sufficient votes to pass their physician assisted suicide bill AB 654 out of the Assembly in 2005, bill authors Patty Berg (D – Santa Rosa) and Lloyd Levine (D – Van Nuys) gutted and amended AB 651 into an almost identical version of AB 654. At this time, AB 654 has officially died in the Assembly for lack of votes, but authors Berg and Levine intend to move AB 651 forward in the state Senate. Meanwhile, they are pressuring legislators to commit to voting for physician assisted suicide.

  Sacramento - Physician assisted suicide is back. Notwithstanding failed attempts in 1988, 1992, 1995 and 1999, physician assisted suicide is again being proposed in California. Assembly Members Patty Berg and Lloyd Levine have introduced physician assisted suicide (PAS) in the State Assembly as AB 654 and AB 651, the “California Compassionate Choice Act.”(1)   These bills are sponsored by Denver-based Compassion and Choices (a union of Compassion in Dying and the Hemlock Society) whose primary objective is to legalize assisted suicide across America.

  Background: AB 651 and AB 654 are modeled after the Oregon Death With Dignity Act.(2)  That law, passed in 1994, was initially ruled unconstitutional by a federal judge on grounds of unequal protection. His ruling was overturned in 1997 by the 9th Circuit Court, which claimed that the plaintiffs had no legal standing in court. The U.S Supreme Court ruled in 1997 in a separate case that physician assisted suicide was beyond their purview and is to be decided by each state for itself. An initiative to repeal the Oregon Act was rejected by voters in 1997 and Oregon became the first jurisdiction in the world to legalize physician assisted suicide.

  What do AB 651 and AB 654 do? They allow terminally ill patients to legally obtain a physician's lethal drug prescription to be self-administered.
To qualify, the patient must
l     be an adult of 18 years age or older
    l     be capable of making and communicating health care decisions
    l     have a terminal illness with less than 6 months to live
    l     be a California resident
    l     voluntarily request the prescription for lethal drugs

Provisions to prevent abuse of PAS include:
    l     2 physicians must verify the patient is terminal, capable, and voluntarily requesting lethal drugs
    l     if depression or mental disorder is suspected, either physician shall require the patient to undergo counseling
    l     at least 48 hours shall elapse between written request and writing the lethal prescription
    l     a patient may rescind his or her request at any time
Reporting requirements for prescribing and dispensing lethal drugs include:
    l     the physician must document compliance with this Act in the patient's medical record
    l     the California State Department of Health Services shall adopt regulations for collecting information to determine use of          and compliance with this Act
    l     such collected information shall not be public record nor available to the public
    l     the department shall make public a statistical report on collected information
    l     there is no requirement for a dispensing provider to file a dispensing record, as required in Oregon law
Safeguards and Effects for participating in PAS include:
    l     no provision in a contract, will, or agreement shall affect a person’s request or rescission of PAS
    l     no health care service plan, disability insurance or health benefit plan contract, as defined, shall be conditioned on a 
         person’s decision regarding PAS
    l     no sale, procurement, or issuance of life, health or accident insurance or annuity or rate charged for such policies shall be
         conditioned on a person’s decision regarding PAS
    l     actions taken in accordance with this Act shall not, for any purpose, constitute suicide, assisted suicide, mercy killing, or
         homicide, under the law.   
Immunities, liabilities, and penalties include: 
l     acting in good faith precludes criminal, civil or professional disciplinary action against PAS participants
    l     acting in good faith precludes professional organizations or health care providers from penalizing their members for
         participating or not participating in PAS
    l     acting in good faith while fulfilling a request for PAS shall not constitute neglect
    l     no health care provider shall be under any duty to participate in PAS
    l        it is a felony to alter, forge, or coerce a request for or rescission of a lethal drug  This “safeguard” was removed from AB 
        654 by amendment on 4/19/05.

What are the results of the Oregon Death With Dignity Act?  Statistics from the Oregon Health Service(3) and data prepared by Dr. Robert D. Orr, President of the Vermont Alliance for Ethical Health Care(4) show
   l        In the 7 years that PAS has been legal in Oregon, 208 patients committed physician assisted suicide compared with 64,706
         Oregonians who chose to die naturally from the same underlying diseases.
   l        34% of Oregon doctors are willing to prescribe lethal drugs.
   l        27% of Oregon doctors willing to prescribe lethal drugs admit they are not confident they can predict a 6-month terminal 
   l        Several patients lived up to 2 years after qualifying for lethal drugs (6 month prognosis required).
   l        Only 6% of Oregon psychiatrists are confident they can diagnose depression after one visit.
   l        75% of patients who committed physician assisted suicide received assistance from Compassion In Dying, a suicide
         advocacy group; legalizing assisted suicide is on their agenda.
   l        The first patient to die under the Act was refused prescription by her own and another doctor because she was depressed.
         The prescription was written by a Compassion in Dying doctor.
   l        The Act has no penalty for failure of doctors to submit reports.
   l        Reports to Oregon Health Service (OHS) have not included several cases of abuse, expansion, and complications reported
         by families to newspapers, which have not been contested by PAS proponents.
   l        The OHS has no regulatory authority or resources to detect under-reporting or non-compliance.
   l        The OHS admits they "cannot determine whether physician assisted suicide is being practiced outside the framework of t
         he Death With Dignity Act."

Some Observations on the Oregon experience with physician assisted suicide.
  The vast majority of terminal patients opt for medical care, not physician assisted suicide.   
2)  Most doctors want to practice medicine, not physician assisted suicide.
3)  There is no real safeguard against an incorrect 6-month terminal prognosis.
4)  There is no real safeguard against a depression-driven request by the patient.
5)  Un-enforced and unregulated reporting protects PAS practitioners, not patients.
6)  There is nothing in the Oregon experience to suggest substantial patient need or desire for PAS.

Some Observations on the proposed California physician assisted suicide bills.
  In 1988 a physician assisted suicide proposition failed to qualify for ballot in California.
2)  In 1992 California voters rejected physician assisted suicide Proposition 161.
3)  In 1995 two Oregon-style PAS bills were introduced but never heard in the State Legislature.
4)  In 1999 there were insufficient votes in the State Legislature to pass AB 1592, The Death With  
     Dignity Act, (Aroner) which was modeled after the Oregon Death With Dignity Act.
5)  Despite favorable polling, when put to a vote physician assisted suicide has consistently been rejected.
6)  Jack Kevorkian got a 10-25 year prison sentence for what AB 654 and AB 651 cannot safeguard against.
7)  AB 654 and AB 651 put the elderly, disabled, and uninsured at risk of coercion to commit suicide instead of 
     providing the compassionate care they need. It is virtually impossible to disprove acting in good faith.
8)  Once legalized, suicide could be encouraged to preserve an inheritance, hide medical malpractice, or assure HMO   
     profitability. It is impossible to safeguard against such misuse of legalized suicide.
9)  In the Netherlands, de facto physician assisted suicide moved quickly from being voluntary to involuntary, with patients
     being given lethal doses of drugs without their consent. Today, some of the vulnerable in the Netherlands forgo needed
     hospitalization out of fear of being killed by the physician. Children in the Netherlands can request and receive euthanasia
     with parental consent at age 12 and with parental notification at age 16.
10)  Physician assisted suicide is contrary to over 2000 years of medical ethics and jeopardizes patient trust in the medical
     profession. Neither patient nor physician should be subjected to this medical perversion being promoted by special interest
     groups and individuals.

Primary Sources of Information

Prepared by Life Priority Network