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The National Catholic Bioethics Center
Physician-Assisted Suicide Advances in California
Wednesday, October 07, 2015 9:00:00 AM
© 2017 by The National Catholic Bioethics Center


Physician-Assisted Suicide Advances in California

October 7, 2015


The National Catholic Bioethics Center Profoundly Regrets Governor Brown’s Signing into Law of ABX2-15, End of Life Option (Physician –Assisted Suicide). 

On October 5, 2015, Gov. Edmund Brown made California the 5th state legalizing physician– assisted suicide, as an “End of Life Option.” In some states such legislation has been entitled “Death with Dignity.” Such labels are clearly misnomers. The harsh reality is that the “options” create victims of physician– assisted suicide (PAS) through social coercion, and have nothing to do with the “dignity” innate in every human being.

A growing body of sociological data demonstrates that when vulnerable persons see suicide as a “good” from which the state no longer provides protection, suicide rates in general rise. For example, in Oregon, the first state to legalize PAS, suicide rates overall (excluding those from PAS) have skyrocketed. Oregon has the second highest suicide rate in the country, again, excluding PAS. Evidence shows that despite supposed restrictions of PAS to those with “terminal illness,” those with disabilities are routinely viewed by social policymakers as less worthy than others of the legal protection against suicide. PAS becomes an open invitation to patient abuse.

Americans hold as self-evident that all men are “endowed by their Creator with certain unalienable rights; that among these [is the right to] life …; [and] that, to secure these rights, governments are instituted among men” [Declaration of Independence, para. 2 (U.S. 1776)]. When government secures such rights for some but not others, when it relaxes laws against aiding the suicide of terminal patients but not the able-bodied, it is saying this class deserves less protection of their lives, its members deserve less safeguards of their unalienable rights —in other words, they deserve less respect because in some way they are less human. In discounting such rights entrusted to its care, government denies, not enhances, human dignity, and thus compromises the very grounds on which government is instituted.

Persons with disabilities have grave concerns for such lack of protection by government. As physical impairments that substantially limit life activities, terminal conditions are disabilities. Those with disabling conditions which can cause death within six months, but only if treatment were removed, are terminal for purposes of ABX2-15 . The high cost of keeping such people alive could provide insurance carriers a powerful incentive to develop reimbursement policies for those with disabilities and terminal illness that become a coercive factor in a patient’s decision to seek the less costly barbiturate prescription to end one’s life.

Governor Brown has stated that the reason he signed ABX2-15 into law was that if persons were “suffering prolonged and excruciating pain … it would be a comfort to be able to consider the options afforded by this bill.” This is a completely fallacious reason for this dangerous change in public policy. The Oregon Public Health Division has been collecting data, annually since 1998, on the reasons persons have availed themselves of PAS. Consistently, the least frequent reasons for such a request are pain and finances. The primary reasons terminal patients give for requesting PAS are loss of autonomy, loss of dignity, and inability to participate in activities that make life enjoyable. Clearly, these reasons speak to why PAS is being sought: fear of social abandonment, now enabled by a government that has removed protections from such abandonment.

There is no mandate in ABX2-15 to assess for the presence of depression or other psychological condition that may trigger a request for PAS. Though either the attending or consulting physician may refer patients for psychological or psychiatric evaluation if they suspect clinical depression or other mental disorders that can impair judgment, many physicians lack training to recognize depression; and nothing in ABX2-15 or its exemplars requires that they have it. Not surprisingly, referrals almost never have been made in the seventeen-year history of the Oregon Act (47 out of 859 deaths) and, thus far, Washington is following suit. Given that the U.S. Supreme Court [Washington v. Glucksberg, 521 U.S. at 730-31] has reported that many people, terminal or not, seeking suicide suffer from clinical depression and often lose the urge when the condition is treated, the absence of reported referrals in these states is most troubling for the future of PAS in California. Furthermore, the law prohibits the physician from informing the patient’s next of kin of the request for PAS without the patient’s consent. Equally troubling is how, in European jurisdictions where PAS has been legalized, non-terminally ill persons with psychological disorders have been allowed to access PAS. 

The potential for abuse is enhanced by the fact that the law allows persons with a financial interest in the patient’s death to be one of the two witnesses to the written request, attesting to the patient’s competence and the lack of coercion. That same person can be the only witness present when the lethal drug is taken since ABX2-15 fails to require an objective observer to the act. Once the prescription is written and the lethal drug dispensed, the attending physician’s duty to the patient ends. He is not obliged to re-evaluate the patient’s competence before the drug is taken, even though weeks or months have passed. This is an open invitation to patient abuse since no one will know if the patient resisted. Astonishingly, under ABX2-15 , information the attending physician must provide the Department of Public Health, including the circumstances and cause of the patient’s death, “shall not be disclosed, discoverable, or compelled to be produced in any civil, criminal, administrative, or other proceeding” [§443.19(a)]. This provision will impede investigations by coroners and prosecutors into whether patients’ deaths involved foul-play, thus supplying a shield to a potential crime.

By purportedly offering safeguards that serve instead to place patients at risk of abuse, this law employs a legal sleight-of-hand. Despite Governor Brown’s statement, rather than providing comfort to those suffering with terminal illness, this law provides a mechanism for the ultimate abandonment of the terminally ill patient to death. True compassion, “leads to sharing another’s pain; it does not kill the person whose pain we cannot bear” [St. John Paul II, Evangelium vitae [Encyclical Letter on the Gospel of Life] ¶ 66 (1995)].