California became the fifth state to legalize assisted suicide after Governor Jerry Brown signed the bill on October 5, 2015. The Golden State joins Oregon, Vermont, Montana, and Washington on allowing those who are diagnosed with a terminal illness to have a choice in ending their life voluntarily.
This is the fourth time that California law makers have attempted to pass such a bill. The first was in 1992 when Proposition 161 was on the ballot. The proposition, according to ballotpedia.com, would allow “mentally competent adults to instruct their physicians in writing to provide aid-in-dying upon their request when they become terminally ill.” Californians voted against the proposition with 54.13% of the vote. There were two other attempts to pass the law in 2005 and 2007, but both failed in the State Legislature.
The bill that was successfully passed, called ABX2-15, was in development since late 2014, and was introduced to the Legislature by one of the authors of the bill ,California Sen. Bill Monning in January of 2015. The beginning of the process, however, started in 2013 according to Kathy Smith, a spokeswoman for Monning.
“One of the members from an organization called the California Senior Legislature had met with me to ask Senator Monning to author that legislation. As a staff, we research our proposals that are brought to us and in my research I met with various people who were involved in the previous legislative attempt in 2007. They recommended that Senator Monning wait until January of 2015 to introduce it because they felt that it could take all two years of the legislative cycle to be succesful,” Smith said.
Monning and his team took that advice and decided to wait until January of 2015 to introduce it. But in 2014, national attention was turned to the story of Brittany Maynard, a California native who moved to Oregon to take advantage of their death with dignity law. Maynard was diagnosed with terminal brain cancer in April of 2014 and was given six months to live. However, Maynard chose to take medication that will aid her in her own death, which she took in November.
With the new publicity to the issue, Smith and the rest of Monning’s staff began to work rigorously during the later part of 2014.
“We started meeting with many individuals like bio- ethicists, physicians, oncologists, staff in the legislator. We talked with people in Vermont who had a success in passing the bill there. We were just trying to line everything up to get a strong introduction, especially knowing that we were going to have major opposition like the California Medical Association and the Catholic Church,” Smith said.
Besides the Catholic Church and the California Medical Association, there was a coalition of organizations called Californians Against Assisted Suicide that consisted of various medical groups and physicians. This group, along with others part of the opposition, were a strong force when past bills came up in California, but after the Brittany Maynard case, those for assisted suicide began to gain more support.
“Before this [Brittany Maynard], most of the time when people thought about assisted suicide it mostly would have been with people who are older, who had long histories of disease, that sort of thing. The proponents never had kind of ‘poster child’ until Brittany Maynard. That captured attention for once and put the issue on the cover of People magazine, Oprah Winfrey, Dr. Oz, and so on,” spokesperson for Californians Against Assisted Suicide Tim Rosales said.
The case of Brittany Maynard was of great interest to California, as Maynard was an original residence of California who had to move to Oregon in order to get the medication that can help her end her life. Oregon’s bill, passed in 1997, requires the patient to get two physicians’ permission among other things, according to the Oregon Health Authority.
“To request a prescription for lethal medications, the DWDA requires that a patient must be:
- An adult (18 years of age or older),
- A resident of Oregon,
- Capable (defined as able to make and communicate health care decisions), and
- Diagnosed with a terminal illness that will lead to death within six months.”
– Oregon Health Authority
California’s own law is similar to that of Oregon’s, with patients having to seek out two physicians for permission to get the medication and that if physicians are wary of the patient’s mental state, they are then referred to a mental health specialist, according to the ABX2-15 bill.
“443.7. Upon referral from the attending or consulting physician pursuant to this part, the mental health specialist shall:
(a) Examine the qualified individual and his or her relevant medical records.
(b) Determined that the individual has the mental capacity to make medical, decisions, act voluntarily, and make an informed decision.
(c) Determine that the individual is not suffering from impaired judgement due to a mental disorder.
(d) Fulfill the record documentation requirements of this part.”
When writing this bill, Smith emphasized the fact that Monning made an effort to reach out to the opposition, specifically the Catholic Church and the California Medical Association, so that the language in the bill can also be inclusive of the interests of those in the opposition.
“CMA wanted their physicians to be protected. They wanted to make sure those protections were included in the legislation that made it completely voluntary and optional and free them from liability, whether they participated [in assisted suicide] or not,” Smith said.
The CMA eventually joined the supporting side of the cause, but Smith said that the Catholic church “did not want to come to the table for any conversation.”
But despite the strong effort on the supporting side, the bill still had a hard time getting through the Legislature smoothly. When it was introduced in January 2015, the bill was able to pass through the state senate, but when it got to the assembly, Rosales said that things got tough.
“I don’t think that they expected it to be as tough as it was because they were spending millions of dollars. They were getting the cover of People magazine. They had these very sympathetic individuals to put forward to make their case. But the opposition was countering with a lot of the real concerns relating to health care cost and the accessibility,” Rosales said.
Rosales went on to explain that after the senate, the bill then had to face the first committee, which was the Assembly Health Committee. The bill failed to garner enough votes for it to move on, basically stalling the vote. But proponents of the bill did not give up.
“Through a procedural trick, they had to introduce a new bill that was able to be heard in what was a special session in the legislation. Under the assembly rules, proponents were able to introduce that bill in that special session and get it on the floor. Once it got to the floor, there were passionate speeches given from both sides, and at the end of the day, the bill narrowly passed the assembly and went on to the governor,” Rosales said.
The bill ended up on the governor’s desk by the end of September, and at the beginning of October the it was signed. In total, the bill took about nine months going through the proper channels to get it done.
“We take great pride in the fact that we were able to do it in that few of months compared to the two years that we were expecting it would take us,” Smith said.
Although the bill was signed, the bill will not go into effect until 90 days after the special Legislature will adjourn, November being the latest. In the meantime, Rosales says that there are health care and medical groups that are developing protocols and instructions for their hospital systems so that they don’t have to participate in the law. As it stands, doctors are not required to give these drugs to patients that ask for it, and the protocol for doing so is now being developed by these groups.
Moving forward, Rosales expects that problems will arise with the law that the government will have to address later on, and unfortunately those problems may be consequential.
“People that are supportive of the new law acknowledge that there are going to be problems with it. And the unfortunate thing with a law like this is that the end results of those problems is somebody possibly ending their life for no reason,” Rosales said.