Terminally ill patients should absolutely have the option for physician-assisted suicide, though the passage of California’s End of Life Option Act is not the issue’s finish line.
If anything, the passage of the right-to-die legislation is only the beginning, and future procedures must be scrutinized, not only to prevent malpractice, but to improve palliative care moving forward.
California’s End of Life Option Act allows patients to request aid-in-dying drugs from their physicians, provided they are suffering from “an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, result in death within six months,” according to the legislation.
The law was passed by Gov. Jerry Brown last October and is scheduled to go into effect June 9 after its “special session” concluded Thursday.
The bill itself is fairly sound and institutes several checks in place to prevent wanton distribution of life-ending medication.
The End of Life Option Act will provide terminal patients their requested lethal medication if two separate doctor consultations determine that the patients have six months or less to live.
Moreover, the bill requires the patient to self-administer the medication and, 48 hours prior, confirm in writing that he will take the drugs himself.
Opponents of the right-to-die legislation, such as Marilyn Golden, a senior policy analyst for the Disability Rights Education and Defense Fund, argued that legislation opens doors to abuse.
“There are hundreds — or thousands — more people who could be significantly harmed if assisted suicide is legal,” Golden wrote in an op-ed for CNN, responding to Brittany Maynard, a right-to-die advocate and brain cancer patient who died in 2014.
Golden is correct in her concern that, even with safeguards and narrowly defined legislation, there is nothing truly preventing patients from finding doctors who will circumvent the rules and provide medication, nor are there any safeguards against coercion.
In the bill itself, coercion is only addressed a handful of times, with no concrete definition. The only provision is for the patient to agree that he or she is not being coerced and that coercion is a felony.
But just as there is no guarantee people will adhere to laws, closing the option of physician-assisted-suicides will not prevent suicide.
In 2013, intentional self-harm, or suicide, was the 10th leading cause of death in the United States with 41,149 Americans who committed suicide, and over 50 percent of which were inflicted via firearm, according to the Centers for Disease Control and Prevention. If a terminally ill patient truly wanted to end his or her life, approval by a physician certainly wouldn’t be the deciding factor.
A further consequence of staunch opposition of physician-assisted suicide is the closure of discussion on improving end-of-life care. There is a national shortage of specialists focused on palliative care, and “medical schools have traditionally given short shrift to palliative and end-of-life issues,” according to Harvard Magazine.
To force terminal patients to live out the end of their illness is to deny that there are things that modern medicine does not have a cure for, and focusing on intensive treatment without consideration for patient relief and pain management can do more harm than good.
“We’ve now got very good research to show that just doing more procedures and tests on people in their final months of life isn’t better,” said Dr. Porter Storey, executive vice president of the American Academy of Hospice and Palliative Medicine, to NPR. “They don’t live longer. They’re not more comfortable and often the opposite is true.”
Opponents of the End of Life Option Act have every right to be skeptical of the bill. Like many pieces of legislation, the act is not perfect and should be closely scrutinized. But to oppose the right-to-die legislation outright is to deny those who are dying to live life on their own terms and receive care focused not on miraculous treatments, but merciful relief. It also means the denial of a universal truth: everyone dies.