California is in the midst of a passionate debate over Senate Bill 128, which would legalize physician-assisted suicide.
Laws dealing with such emotionally charged issues are better left to the deliberative process of the Legislature, but SB 128 still needs better crafting before it can be considered good public policy.
It is important that a dying patient who decides to take a lethal drug does so with a sound mind and not under coercion from family members, health care providers or anyone else. While many claim that there are adequate safeguards in this bill, I would strongly disagree.
SB 128 needs more work to achieve a reasonable standard of protection from more coercive abuse. Current safeguards consist of the doctor interviewing the patient in private and the patient making two requests within 15 days, plus a written request signed by two witnesses.
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While the reporting requirements now in the bill are left up to a state agency to determine later, requiring detailed information would improve this legislation.
When an aid-in-dying request is made, the doctor should report who initiated the request, why the patient is requesting help, what medication is prescribed, what informed consent is done and how the other requirements in the legislation were fulfilled.
Documenting this information is already standard medical practice. The pharmacist should report what medication was given, who picked it up or how it was transferred to the patient. Having to submit this information would make all parties more likely to follow the rules. In addition, we would obtain meaningful data on the treatment of dying patients, which we don’t have from Oregon, despite claims to the contrary.
We must also consider that under current state law, a physician who is asked by a patient about end-of-life alternatives is obligated to present both treatment and palliative care options. Should SB 128 be enacted, it would be optional for the doctor to add aid in dying to the list.
The discussion might go like this: “You unfortunately are suffering from a terminal cancer. The options open to you are painful debilitating chemo or radiation therapy that may extend your life for a few months; hospice care that will treat your pain but may leave you dizzy, confused or sleepy from pain medication; or an easy way to end your life when you want to by taking this lethal pill.”
Is this not subtly coercive? Do we really want to persuade patients that taking a lethal drug is the desirable option?
The legislation should prohibit the physician from mentioning aid in dying unless the patient initiates the issue by specifically asking about it. Terminal patients who wish to end their life know how to ask for it without prompting. They already do now.
Unfortunately, prohibiting a doctor’s speech is legally untenable. However, requiring a doctor to document and report that interaction will help ensure that a proper conversation takes place and that we will be able to obtain the data needed to better understand and care for dying patients.
If the bill’s proponents are really interested in accommodating the few patients who ask to die, then let’s at least maximize the safeguards to protect the rest of us from serious and irreversible consequences.
Irving Lebovics is chairman of Agudath Israel of California, a Jewish fraternal organization.