Few bills this legislative session garnered more attention or inspired more passionate divisions in the Legislature than a proposal to allow dying patients access to life-ending medication. Its long and winding journey to the governor’s desk finally came to an end this week when Gov. Jerry Brown signed the measure, issuing an unusually personal statement in which he reflected, “If I were dying in prolonged and excruciating pain ... it would be a comfort to be able to consider the options afforded by this bill.”
Now that assisted death is set to become legal in California, what does it mean for you? Here’s a primer.
Q: How do you get a prescription?
A: Assisted death is intended only for terminally ill adults seeking more control over the end of their lives. If diagnosed with less than six months to live, a patient may take advantage of the law by making two separate oral requests, 15 days apart, to their physician, and then providing another written request signed by two witnesses, only one of whom can be a family member. The doctor must assess whether the individual has the physical and mental ability to self-administer the lethal drug, then a second physician must confirm the diagnosis and the patient’s capacity to make medical decisions before a prescription can be filled.
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Q: Who can administer the drugs?
A: The law makes clear that it is not legalizing euthanasia; patients must be able to take the life-ending drugs themselves. A “final attestation” is required within 48 hours before the medication is used, confirming that the patient is choosing to do so. (Following the death, that form must be given to the prescribing physician, or the drugs must be returned.) Family and friends present for the death are cleared of liability, and someone can prepare the medication, but they are not allowed to help the patient ingest it.
Q: How will assisted death affect insurance policies?
A: Life insurance policies often include a clause that benefits will not be paid if a policyholder takes their own life, at least within the first few years of purchasing insurance. The law explicitly states that the act of administering life-ending medication is not a suicide, however, and prohibits that any coverage be denied on that basis. It also requires that life, health and other insurance coverage for an individual cannot treat the act any differently than a natural death from the underlying illness.
Q: When does the law take effect?
A: It’s unclear. Because it was ultimately passed through a special legislative session on health care, the law will not take effect until 90 days after the session concludes. That takes a vote of both houses; lawmakers are not scheduled to return to Sacramento until January, and they could keep the special session open through Nov. 30 of next year. Further complicating matters, opponents have launched an effort to overturn the law by voter referendum. They have until Jan. 3 to collect signatures; if the referendum qualifies, the law will be suspended until after the results of the November election. The law is effective until 2026.
Q: What do doctors think of the assisted-death law?
A: They are divided. After years of opposition that helped stop previous iterations, the California Medical Association went neutral on this proposal because of changing attitudes among its members. Oncologists remained vocal critics, testifying in committee hearings that individuals often outlive their terminal diagnoses, and that the law might create mistrust among patients by undermining a physician’s fundamental oath to do no harm. Doctors and health care providers are not required to offer prescriptions, and many will not. Catholic hospitals, for example, firmly object to what they consider a devaluing of the sanctity of life.
Q: Who else is against it?
A: The Catholic Church lobbied to defeat the measure, but the face of the opposition was the disability rights community, which argued that the law would hurt the state’s most vulnerable populations, including the elderly and the poor. They raised concerns that profit-driven insurance companies and inadequate health care services might drive patients to choose assisted death over more expensive treatment options they cannot afford. Californians as a whole are largely supportive. A recent Field Poll showed 65 percent of voters favor the law.
Q: What protections are in the law?
A: The authors assert that the system includes enough steps and safeguards to prevent abuse, such as inheritors trying to expedite the death of an elderly relative. They point to the example of Oregon, where assisted death has been legal for nearly 20 years with no recorded cases of misuse. But the law does make it a felony to forge requests for a prescription, coerce someone into requesting the life-ending medication or administer it without their consent. A patient can also withdraw their request at any time, and health insurance carriers are not allowed to provide any information about assisted-death options unless someone asks for it.
Q: Where else is assisted death legal?
A: California joins four other states that allow terminally ill people to end their lives: Oregon, Washington, Montana and Vermont. New Mexico may be next. A lower-court ruling that assisted death is a fundamental right under the state’s constitution is headed to the New Mexico Supreme Court. A handful of other countries around the world, mostly concentrated in Western Europe, allow assisted death and euthanasia. Belgium has the most expansive policy, allowing patients to request euthanasia for non-terminal and psychiatric conditions. Even terminally ill children can request euthanasia. Assisted death is set to become legal in Canada next year.