Reversing a long-standing aversion to letting doctors assist in a patient’s intentional death, the California Medical Association has dropped its opposition to a California bill allowing terminally ill people to take their lives with prescribed drugs.
The shift immediately buoyed Senate Bill 128’s prospects. In past years the powerful doctors group has represented an immovable pillar of opposition to the notion of helping people hasten their deaths, arguing that it undermines their fundamental role as healers and violates their oath to avoid harming patients.
While short of an outright endorsement, the medical association’s neutrality silences one of the most influential and well-respected voices opposing assisted death. SB 128 is parked in the Senate Appropriations Committee, and if it advances it would next face a Senate floor vote. Gov. Jerry Brown has not weighed in.
“It’s a game-changer,” Sen. Lois Wolk, D-Davis, the bill’s author, said of the CMA’s announcement. “It is a major breakthrough.”
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It has been nearly three decades since the California Medical Association’s members voted to stand against any law permitting doctors to help patients end their lives, whether with medicine or with advice, and they have repeatedly debated their stance since. Last year, as it became clear the Legislature would likely take up a fresh bill, the organization launched another intensive review.
“I don’t think we have internally vetted an issue as hard as we did this one,” said Dr. Ted Mazer, speaker of the CMA’s policymaking body. “If the state is going to go forward and the public wants to go that way, we needed to be at the table.”
Medical advances have extended patients’ lives and increasingly forced doctors to confront the reality of people who are surviving but suffering, Mazer said. The policy change does not mean doctors universally accept the idea of helping end lives, he said, but instead gives individuals the option of choosing.
“There are lots of doctors who think doctors should not be in the position of ending life,” Mazer said, adding that he himself remains “on the fence” and continues to wrestle with the issue. “Physicians’ opinion remains divided, but the majority of physicians believe you should either allow this and participate or you should be neutral and allow the physician and the patient to make the decision.”
Doctors with ethical objections could still opt out and refuse to administer lethal drugs, a provision that Mazer called “critically important.” They would not need to inform patients about the option.
Fatally ill patients seeking lethal drugs would need to clear a series of hurdles and win the approval of multiple doctors if SB 128 becomes law. They would need to obtain a prognosis of having six months or less to live; make two separate requests and a written one; see a second physician to have their prognosis confirmed; and have a doctor ensure they are mentally competent.
California, where a majority of residents have long supported assisted death, is part of advocates’ multi-state campaign in support of aid-in-dying laws. Backers take their impetus from the tale of a Brittany Maynard, a terminally ill California woman who traveled to Oregon to die.
Assemblywoman Susan Eggman, D-Stockton, argued that the California Medical Association’s change reflects a growing acceptance of assisted death as lifespans have lengthened. She said more evidence for the idea comes from Oregon, where legalizing has not produced the abuses detractors envisioned.
“I think the CMA, like the general population, has evolved, has grown, has a different life experience,” said Eggman, a co-author of SB 128. “The scares about this did not bear out. Those scares of ‘everybody’s going to be using this, we’re going to be killing seniors’ – it’s just not true.”
Some medical professionals continued to urge the bill’s defeat. Arguing that their members have the most direct and regular exposure to dying patients, California’s two oncologist organizations argued that SB 128 upends a physician’s role and forces on doctors an impossible ethical dilemma. They instead advocated better palliative care.
“For many practicing physicians, end-of-life issues are purely theoretical,” the Association of Northern California Oncologists and the Medical Oncology Association of Southern California said in a statement. “As the physicians who will be most affected by SB 128, we continue to ask legislators to oppose this legislation.”
When California last took up an aid-in-dying measure, the medical industry was not the only powerful institution helping to ultimately defeat the bill. Religious groups protested as well, even inveighing against it during Sunday sermons. The California Catholic Conference remains opposed.
So do advocates for disabled Californians, who warn that people will be pushed toward ending their life, either by insurance companies seeking to keep costs down or by unscrupulous relatives and caregivers. Marilyn Golden, a policy analyst for the Disability Rights Education & Defense Fund, called the CMA’s reversal “reprehensible.”
“We’re shocked about CMA,” Golden said. “We’re very, very disappointed.”
Even with those groups continuing to assail the bill, the California Medical Association’s standing down could prove decisive.
Three times, former Assemblywoman Patty Berg carried bills seeking to legalize aid-in-dying. Three times she failed, an outcome she attributed in large part to the CMA’s resistance.
“It was more even than the Catholic Church. CMA’s opposition was what held up the bill, so this really opens the gate,” Berg said. “I think it will now coast to the governor’s desk.”