February 17, 2005 | Print-friendly version

Physician-assisted suicide advocates predict California this year will become the second state in the union after Oregon to make it legal for doctors to prescribe lethal drug doses to dying patients.

But nothing in life is certain and since the Oregon law took effect in 1997, opposition by state medical associations and activism by disability rights groups have tilted the balance away from passage elsewhere in the U.S. Both factors will be in play in California.

In addition, the U.S. Supreme Court this spring will decide whether to hear Bush Administration arguments that Oregon’s Death With Dignity Act violates federal controlled substances law.

The California Catholic Conference has made derailing physician-assisted suicide its top legislative priority this year. It is joining with the Alliance for Catholic Healthcare and other allies to fight it. The California Medical Association and twelve disability rights groups, including Not Dead Yet, the National Spinal Cord Injury Association, and the National Council on Disability, also oppose physician-assisted suicide.

"Of course it’s cheaper to provide a $35 lethal prescription rather than take care of someone," said Carol Hogan, executive director of the California Catholic Conference, noting millions of Californians don’t have health care insurance and that end of life care or any serious illness can cost $100,000 or more.

Previous California assisted suicide efforts failed in 1992 and in 1999. The 1992 legislation included euthanasia.

Pope John Paul II specifically addressed euthanasia in his Lenten address January 27, 2005, in Rome, urging Catholics to reject "a certain mentality which considers our elderly brothers and sisters practically useless when they find themselves confronted by reduced capacities by the inconveniences of age or illness."

"The life of man is a precious gift, which we must love and defend at all of its stages," the 84-year-old pontiff said.

To combat the ongoing assisted suicide campaign, the Catholic Conference in 2002 created a web-site, "Embracing Our Dying." It states, "We believe that a dying person's request for ‘assisted suicide’ is actually a cry for help coming from a fear of helplessness and a fear of abandonment."

Bill sponsors, Democratic State Assembly Members Patty Berg and Lloyd Levine, held two public hearings in late January and early February. In addition to predicting passage by the Democrat-controlled legislature, Berg expressed hope that California Governor Arnold Schwarzenegger, a Republican and pro-choice Catholic, would sign it. Schwarzenegger has not said what he would do if the bill passed.

While efforts in other states so far have failed since Oregon’s law took effect, assisted suicide legislation is introduced regularly around the country. In Hawaii, lawmakers killed an assisted suicide bill in committee in early February, but legislation modeled on the Oregon law is under consideration in Vermont and Arizona.

In 1994, Oregon's state medical association took a neutral stance and assisted suicide opponents were portrayed as shoving their religious beliefs onto others–which opponents credit with aiding its passage.

The U.S. Supreme Court in 1997 ruled that people do not have a constitutional right to assisted suicide.

"There have to be alternatives to the way some people spend their final days," bill sponsor Berg said.

Further, Berg contends, excessive pain medication and withdrawal of food and water are common: "I want to make clear that hastening a death is not a new concept. It happens every day, and it has for generations. But unlike the patient-controlled choice we are talking about in this bill, the current system can leave the patient out of the final decisions," Berg said.

Berg said the bill will be modeled on Oregon’s law, which does not allow euthanasia. An adult whom a physician has predicted has less than six months to live may receive deadly medication to self-administer. The person must be determined by the physician to be mentally competent to make a decision–but that does not preclude being depressed–see two physicians, make written and oral requests for the medication, and wait two weeks.

"It’s discriminatory. The idea that this is about autonomy is a lie," said Stephen Drake, Not Dead Yet policy analyst, speaking from Illinois. Not Dead Yet was founded by people with disabilities after Dr. Jack Kevorkian assisted in the suicides of two disabled women who were not dying.

"We’re opposed to any legalization of assisted suicide. The people they’re talking about with terminal illness are already by definition people with disabilities," Drake said. "Obviously if people were perfect up until the point they dropped over, there would be no issue about this."

Drake said that in perusing Hemlock Society literature dating back several decades, it is clear that physician-assisted suicide is the first step in an incremental strategy. That strategy could lead to the situation in the Netherlands where in 1997 eight percent of infant deaths were "physician induced," according to The Lancet, a British medical journal. The Lancet estimated that in 2001, physicians euthanized about 3,000 patients, assisted in the suicide of about 140 patients–but ended "life without patient's explicit request" for some 840 patients.

Internationally, the Netherlands has legalized euthanasia and Belgium has legalized physician-assisted suicide. Physician-assisted suicide requires that the patient give himself the lethal dose. With euthanasia, the physician administers death.

The American Medical Association opposes physician-assisted suicide.

While physician-assisted suicide advocates such as Berg say the law will provide safeguards, the Oregon experience proves the opposite, said Wesley J. Smith, consultant to the International Task Force on Euthanasia and Assisted Suicide.

"We really don’t know what has been going on in Oregon. The practice of assisted suicide is conducted in utter secret. The State of Oregon exercises no independent oversight," Smith said. "All the state knows is what the death-describing doctors tell the state when they send in assisted suicide forms."

Newspaper reports of individual cases are disturbing, including a woman with cancer and Alzheimer’s who received assisted suicide despite two mental health professionals stating that there were family pressures, Smith noted.

If assisted-suicide legislation is enacted, the economics of what can be expensive end-of-life care will take over, the Catholic Conference’s Hogan predicted. "Unfortunately, what starts as a choice often ends as an obligation."

"The key question is what should society's response be to suicide desire?" asks Smith. "Surely, we want it to be suicide prevention–not just for some, but for everyone.

"Indeed, when I was a hospice volunteer I was taught that suicidal desire in a patient meant that the patient had an urgent need that was not being fulfilled. Also, that when that issue was addressed, the desire usually disappeared. These important matters should be approached with compassionate, hands on care: Not a jar of poison pills."