California Ė Physician Assisted Suicide - AB 374
April 2007

  Sacramento - Having failed twice in as many years to legalize physician assisted suicide in California, Denver-based Compassion and Choices (a union of Compassion in Dying and the Hemlock Society) has again sponsored such bill and induced Assembly Members Patty Berg (D - Santa Rosa) and Lloyd Levine (D - Van Nuys) to author and promote it, at taxpayer expense. Compassion and Choicesí primary objective is to legalize assisted suicide across America.

  The new bill, AB 374 California Compassionate Choices Act (1), is virtually identical to its immediate predecessors AB 654, which died in the Assembly for lack of votes, and AB 651, which failed to pass the Democrat-chaired Senate Judiciary Committee last year. Assembly Members Berg and Levine have now secured the support of Assembly Speaker Fabian Nunez, who credits their persuasiveness in bringing him to support their bill and ďbuck his church. . . the cardinal. . . and his Catholic mother.Ē All 7 past attempts to legalize physician assisted suicide in California failed.

  Background: AB 374 is 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 60% to 40% by voters in 1997 and Oregon became the first jurisdiction in the world to legalize physician assisted suicide (PAS).

  What does AB 374 do? It allows 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 intended 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 the patientís written request and physician 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 disaggregated 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 personís 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 
        personís  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 personís 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
   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 not a felony to alter, forge, or coerce a request for or rescission of a lethal drug. This penalty was removed from AB
       654 by amendment on 4/19/05 and never replaced in either AB 651 or AB 374.

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 9 years that PAS has been legal in Oregon, 292 patients committed physician assisted suicide compared with  
         85,755 Oregonians who chose to die naturally from the same underlying diseases.
   l        60% of Oregon voters favored physician assisted suicide, but 99.7% of terminally ill Oregonians reject it.    
   l        34% of Oregon doctors are willing to prescribe lethal drugs.
   l        27% of doctors willing to prescribe lethal drugs admit they cannot confidently predict a 6-month terminal prognosis.
   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   
         the Death With Dignity Act."

Some Observations on the Oregon experience with physician assisted suicide.
   1)    The overwhelming majority of terminal patients (99.7%) opt for medical care, not physician assisted suicide. 
  Most doctors want to practice medicine, not physician assisted suicide.
   3)  There is no real safeguard against an incorrect 6-month terminal prognosis.
  There is no real safeguard against a depression-driven request by the patient; doctor-shopping occurs.
   5)  Un-enforced and unregulated reporting protects PAS practitioners, not patients.

Some Observations on 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.
  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.
In 2005 AB 654, The Compassionate Choices Act failed to receive sufficient support to be brought to a vote. 
   6)  In 2006 AB 651, The Compassionate Choices Act failed in the state Senate Judiciary Committee.
Despite favorable polling, when put to a vote physician assisted suicide has consistently been rejected.
   8)  Jack Kevorkian got a 10-25 year prison sentence for what AB 374 cannot safeguard against.
  AB 374 puts 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.
  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.
  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.
  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