“COMPASSIONATE CHOICES ACT” (AB 374)
Update (6/7/07): AB 374 failed to get through the Assembly. The bill is “shelved,” meaning it cannot be brought up again until January 2008.
On 2/15/07, Assemblywoman Patty Berg, Assemblyman Lloyd Levine (D-Van Nuys) and Speaker of the Assembly Fabian Nunez introduced the latest assisted suicide bill, the 2007 “California Compassionate Choices Act” (AB 374). The bill, patterned after Oregon’s assisted-suicide law, contains the same provisions as AB 651 that failed in 2006.
On 3/27/07, the bill passed the Assembly Judiciary Committee in a 7-3 vote and, on 5/31/07, it passed the Assembly Appropriations Committee 10-5. Assisted-suicide advocates scheduled it for a full Assembly vote on 6/6/07, later delaying the vote for a day when they realized they did not have sufficient support. The necessary support to pass the measure did not materialize and the bill was shelved on 6/7/07.
Background:
In 2/05, Berg and Levine (D-Van Nuys) introduced AB 654,also called the California “Compassionate Choices Act” (CCA), patterned after Oregon’s law permitting assisted suicide. On 6/6/05, the number for the assisted-suicide proposal was changed to AB 651 through a process called “gut and amend”.
On 6/15/06, assisted-suicide supporters, in an attempt to make the bill more palatable, amended it, replacing most references to ending life with the soothing language of “comfort.” Furthermore, the bill, as amended, would require all state agencies to refer to assisted suicide as “aid-in-dying.”
The bill was defeated in the Senate Judiciary Committee on Tuesday, 6/27/06.
Text of 2007 “California Compassionate Choices Act” (AB 374)
ANALYSIS
AB 374 would legalize assisted suicide in California. It would make assisted suicide a medical treatment. AB 374 would give doctors the power to prescribe lethal drug overdoses for patients to commit suicide.
AB 374 does not require that family members be notified when a doctor is going to help a loved one commit suicide.
Family notification is not required, only suggested. [Sec. 7196.4] The patient’s family doesn’t need to be notified until after the patient is dead.
AB 374 would give government health programs, managed care programs and HMOs the opportunity to approve prescriptions for suicide to cut costs.
In Oregon (the only state with a law permitting assisted suicide), Medicaid pays for assisted suicide for poor residents under the category of “comfort care,” and spokes-persons for health insurance plans said assisted suicide “…would be no different than any other covered prescription.” [Oregonian, 2/27/98; Statesman Journal, 12/6/94] The drugs for assisted suicide are very inexpensive – far less costly than medications to make patients comfortable.
Sen. Joe Dunn (D-Santa Ana) cast the deciding “No” vote in 2006 because the “power of money” would influence HMOs, health insurers and the state. [SF Chronicle, 6/27/06] To save money, assisted suicide would expand while patient care would be cut back.
AB 374 would give physicians the power to suggest assisted suicide to their patients.
AB 374’s supporters claim that, if the bill passes, physicians would not be able to suggest assisted suicide to their patients. That claim is false.
However, nothing in AB 374 prohibits HMOs, insurance companies, health providers, or others from suggesting assisted suicide to a patient or encouraging a patient to request a lethal prescription
Previous assisted-suicide measures did not allow anyone to “coerce” or use “undue influence” to obtain a request for assisted suicide. [AB 654, Sec. 7198.5 (b)] That is omitted in AB 374. Even if it had remained, it would not have precluded encouraging or suggesting assisted suicide.
AB 374 would permit doctors to help mentally ill or depressed patients commit suicide.
A referral for counseling is only necessary if, in the “opinion” of the attending or consulting physician, the patient requesting death has a “psychiatric or psychological disorder, or depression, causing impaired judgment or if the patient is not a hospice patient.” [Sec. 7196.2] “Counseling” is defined as “a consultation” between a psychiatrist or psychologist and the patient. [Sec. 7195.1(e)]
Even if the counselor determines that the patient is mentally ill or depressed, that patient would still be able to get drugs to commit suicide as long as the counselor determines that the patient’s judgment is not impaired.
According to the 2006 official report on Oregon’s assisted-suicide law, only 5% of patients were referred for a psychological evaluation or counseling before receiving a prescription for assisted suicide. [Oregon, DHS, Eighth Annual Report on Oregon’s Death with Dignity Act, 3/9/06]
AB 374 would allow drugs for suicide to be mailed to the patient.
Nothing in AB 374 requires the patient to obtain the drugs in person. In one reported death under Oregon’s assisted-suicide law, the patient received the lethal overdose by Federal Express. [Oregonian, 1/17/99]
AB 374 does not require that requests for assisted suicide be made in person.
Under AB 374, a patient must make two oral requests and one written and witnessed request for assisted suicide. [Sec. 7196.5] The two oral requests (which do not need to be witnessed) could be made by phone and the witnessed written request could be sent by mail to the doctor, who could then prescribe the drugs for assisted suicide.
AB 374 has no safeguards for the patient at the time the drug overdose is taken.
AB 374 covers only the time until the prescription for suicide is written. The lethal drugs could be stored over time, with no concern for public safety or patient protection. There are no provisions to insure that the patient is competent at the time the overdose is taken.
According to Dr. Katrina Hedberg, lead author of most of Oregon’s official reports, the state’s job “is to make sure that all the steps happened up to the point the prescription was written” and the “law itself only provides for writing the prescription, not for what happens afterwards.” [Hedberg, 12/9/04] (For more on Hedberg’s comments, see: Oregon.)
AB 374 has no provisions to track abuse or the number of deaths from assisted suicide.
As with the Oregon assisted-suicide law, AB 374 requires that assisted suicide be reported [Sec. 7197.1], but there are no penalties for not reporting. Following the first year after the Oregon law went into effect the Oregon Health Division (OHD) – now called the Department of Human Services (DHS) – which is responsible for collecting the required information, issued a report stating that “it is difficult, if not impossible, to detect accurately and comment on underreporting.” [NEJM 2/18/99, 583]
And since whatever is reported comes from the very doctors who prescribe the lethal doses, the information may be fabricated. According to the OHD, “For that matter, the entire account could have been a cock and bull story. We assume, however, that physicians were their usual careful and accurate selves.” [OHD, CD Summary, vol. 48, no. 6, 3/16/99; emphasis added.]
From the time Oregon’s assisted-suicide law went into effect, state officials in charge of formulating annual reports have conceded “there’s no way to know if additional deaths went unreported” because DHS “has no regulatory authority or resources to ensure compliance with the law.” [American Medical News, 9/7/98]
AB 374 would require all state agencies to refer to assisted suicide as “aid-in-dying.”
AB 374 is an assisted-suicide bill but, if passed, it would require every state agency, department, or office to call it “aid-in-dying” rather than assisted suicide. [7197.7]. Assisted suicide by any other name is still assisted suicide.
The new label for assisted suicide is the result of polling done by Compassion & Choices (formerly known as the Hemlock Society) which is spearheading the California effort to legalize assisted suicide. Polls indicated that the public was far more likely to favor activities called “physician-assisted dying” or “aid-in-dying” than the same activity if it is called “assisted suicide.” [Gallup New Service, 5/17/05 and Californians for Compassionate Choices Act Press Kit, 9/28/05]
AB 374 would give power to provide assisted suicide to the very same health care providers who are “dumping” patients on the street.
A string of reports have described patient dumping in California. (“Dumping” is the practice of transporting discharged patients, whose insurance has run out or who have no insurance, and leaving them on the street.) One such report described a paraplegic man being dumped on a Los Angeles street. The man was still in his hospital gown, without his wheelchair or walker. He was left alone, to drag himself along, clenching a plastic bag with his possessions in his teeth. [Los Angeles Times, 2/9/07] If AB 374 passes, the same health care providers who authorized dumping a paraplegic patient on the street would have the power to suggest and provide assisted suicide.
AB 374 supporters claim it would offer a choice to people who want it. But it would actually victimize minorities, people with disabilities, and poor people.
Advocates of AB 374 say that – since “currently only the very wealthy can travel to Switzerland or Holland, where aid in ding is legal” – legalizing assisted suicide in California would give poor Californians the same opportunities as those who are rich. [compassionatechoices.org, 2/25/06]
There are nearly twice as many people without health insurance in California (6.5 million) [NY Times, 1/8/07] as there are total people in Oregon (3.5 million). Oregon’s official reports indicate that many people die from assisted suicide so they won’t be a burden on their families. How many poor and uninsured Californians would feel that they should choose the “option” of assisted suicide?
“Compassion and choice” are appealing words, but inequity in health care is a harsh reality. As disability rights activist Diane Coleman has observed, “Assisted suicide is primarily promoted by those who are ‘white, well-off, worried and well.’”
IF AB 374 BECOMES LAW, ASSISTED SUICIDE COULD BECOME THE ONLY TYPE OF “MEDICAL TREATMENT” TO WHICH MANY PEOPLE WOULD HAVE EQUAL ACCESS. THE LAST TO RECEIVE HEALTH CARE WOULD BE THE FIRST TO RECEIVE ASSISTED SUICIDE.
Note: Supporters of AB 374 point to Oregon to claim that there are no problems with the law and that safeguards are meticulously followed and monitored. Yet, in closed-door sessions, they acknowledge that this is not true. For documented information about this contradiction, see “The Oregon Experience“.
