Keep the safeguards in California’s ‘End-of-Life’ law

An illustration of a terminally ill patient comforted by a relative. (Image: Lightspring, via Shutterstock)

Assisted suicide is already legal in California through the so-called End-of-Life Option Act, narrowly passed by the California Legislature and signed by then-Gov. Brown in 2015. The bill was opposed by both Democrat and Republican Assembly members and Senators, but passed during a contested Special Legislative Session on Medi-Cal funding.

Despite the bill’s narrow passage, now just a few years into the new law, its proponents want to eliminate some of the very “safeguards” they used as arguments to pass their bill.

The new bill, Senate Bill 380 by Sen. Susan Eggman (D-Stockton), would eliminate the 2026 sunset provision that doctors, patient advocates, and legislators included to undertake a thorough examination of California’s experience with this controversial law. This new bill will also eliminate the 15-day safety period to receive deadly prescription drugs, an important protection because studies such as one from The Lancet show the high percentage of patients who change their minds after deciding to hasten their deaths.

This rush to erode the safeguards included in the 2015 End of Life Option Act is dangerous public policy.

During the 2015 debate on the End of Life Options Act, former State Senator Bill Monning (a bill author) noted in Healthline that, “co-authors on this bill … endeavored to build in protections that are stronger than any of the states where this has been practiced.”

Monning’s statement is untrue because the bill’s minimal  protections and limited data, when compared to other states where assisted suicide is legal, remain central to its problems today.

The Death with Dignity National Center, supporters of the End of Life Option Act, contradict this new effort to eliminate patient protections in their website FAQs, as recently as April 12, 2021. The notation states, “Death with dignity statutes contain a number of safeguards, protecting patients from abuse and coercion … the patient must make two oral requests, at least 15 days apart.” (Source: https://www.deathwithdignity.org/faqs/). But in this new bill, proponents want to eliminate this very “safeguard” they once held up.

This rush to erode the safeguards included in the 2015 End of Life Option Act is dangerous public policy. There is simply no data or science to support removing them so soon.

Annual reports on the End of Life Option Act required by the State of California do not contain any data whatsoever detailing complications or patients’ reasons for requesting the lethal drugs. For the limited data that is provided, too much remains listed as “unknown.” Over the past year, due to the COVID pandemic, we have become sadly familiar with how important medical and scientific data are in making informed public policy decisions; especially those involving life and death.

With the benefit of hindsight, it appears that the protections proponents touted as safeguards were no more than a ruse to get the original law passed.

For example, the latest California annual report on the End of Life Option Act released in July 2020 reports that 10% of those requesting the lethal drugs had an “unknown” insurance coverage, and it was “unknown” whether 7% ever received information about available hospice or palliative care options.

In a March 2021 New York Times interview with Dr. Diane E. Wright, longtime Director of the Center to Advance Palliative Care at Mount Sinai Hospital, Dr. Wright noted, “All the heartfelt adherence to restrictions that are announced when you first get the public to vote in favor of this go up in smoke once the practice is validated.”

Indeed, with the benefit of hindsight, it appears that the protections proponents touted as safeguards were no more than a ruse to get the original law passed.

Given the contentious history of the End of Life Options Act, as well as a patient healthcare infrastructure pushed to the breaking point by the COVID pandemic, it is neither wise nor appropriate to remove any of the law’s protections.

Further, any effort to expand assisted suicide policy in California is in stark contrast to the on-going, unresolved debate on healthcare disparity and inequity within ethnic and minority communities who lack access to palliative, hospice and other care for serious and terminal diseases.

Prioritizing the right to die rather than the basic means needed to live is clueless at best, if not disingenuous.

Enough of the doubletalk, and the double standards, that accompanies the double jeopardy that the repeal of assisted suicide’s protections would no doubt unleash. The minimal protections established in 2015 are just as necessary now, perhaps even more so.

No matter what they say, proponents of assisted suicide can’t have it both ways.

Editor’s Note: Marilyn Golden is senior policy analyst at the Disability Rights Education & Defense Fund.

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