California Doctors’ Shift On Physician-Assisted Suicide Could Be A Harbinger Of Change

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In a move that’s being described as “historic,” and could potentially set a nationwide precedent, the California Medical Association (CMA) has formally dropped its decades-long opposition to laws that allow physicians to help terminally ill patients take lethal medication to end their lives.

CMA previously considered physician-assisted suicide to be unethical and unacceptable, which is the same position that the American Medical Association currently holds. However, the group says it’s now softening its opposition and opting to take a neutral stance on a piece of legislation — called the “End of Life Option Act,” or SB 128 — that’s seeking to legalize doctor-assisted suicide in California.

A spokeswoman for the group explained that doctors’ stances on the subject have gradually been evolving, following a “shift in the conversation” on the issue among the American public and the medical community.

“As physicians, we want to provide the best care possible for our patients. However, despite the remarkable medical breakthroughs we’ve made and the world-class hospice or palliative care we can provide, it isn’t always enough,” Dr. Luther Cobb, CMA’s president, wrote in a statement announcing the change. “The decision to participate in the End of Life Option Act is a very personal one between a doctor and their patient, which is why CMA has removed policy that outright objects to physicians aiding terminally ill patients in end-of-life options.”

The debate over doctor-assisted death has become particularly relevant in the Golden State thanks to Brittany Maynard, the 29-year-old woman with terminal brain cancer who moved from California to Oregon last year so she could take advantage of an Oregon law that allowed to end her life on her own terms. In the final weeks of her life, Maynard raised national awareness about “death with dignity” and helped facilitate a grassroots push to reform American’s end-of-life care.

Proponents of SB 128 say that CMA’s move could make a big difference in the political fight over the measure, which was introduced at the beginning of this year and has since moved through a key committee in the Senate.

By validating the medical ethics of so-called “death with dignity,” CMA’s move could convince more lawmakers to support the bill when it comes up for a vote early next month, according to the groups pushing for the policy change. State Sen. Lois Wolk (D), one of the co-authors of SB 128, told the Orange Country Register that the CMA’s stance on the issue is “critical to the success or failure of the bill.”

“The California Medical Association’s new ‘neutral’ position on medical aid in dying is a major milestone because its prior opposition to this legitimate medical practice doomed previous bills,” Barbara Coombs Lee, the president of Compassion & Choices, an organization that advocates for death with dignity, said in statement. “We are seeing an enormous shift among medical organizations that is more reflective of the opinion of practicing physicians.”

Coombs Lee’s organization recently spearheaded a lawsuit in California seeking to remove the legal barriers that currently prevent dying patients from ending their lives with lethal doses of medication. This week, the group filed suit on behalf of three Californians suffering from terminal or advanced diseases — including a single mother whose doctors told her she will die painfully within the next six months from lung cancer that has spread to her brain, spine, ribs, and liver.

In February, a separate lawsuit filed on behalf of several cancer patients in California made a similar case, arguing that the state shouldn’t define suffering patients’ decisions about their end-of-life care as “suicide.”

The issue of physician-assisted suicide — which typically conjures images of Dr. Jack Kevorkian, the now-infamous doctor who used carbon monoxide to euthanize more than 100 patients — has long been controversial in the medical community.

Under the Hippocratic Oath, doctors are ethically prohibited from administering treatment that harms patients. The American Medical Association says there’s no way to reconcile that with so-called “aid-in-dying” laws. “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks,” the group says in its policy statement on the matter. “Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.”

However, at least among individual physicians, support for the policy has gradually been inching up. According to a large survey of more than 21,000 medical professionals conducted last fall, the majority of doctors now support allowing patients suffering from an “incurable illness” to seek “a dignified death.”

In practice, physician-assisted suicide works quite differently than Americans might imagine, especially if they still associate the practice with Kevorkian. In the handful of U.S. states that have approved “aid-in-dying” laws, doctors are able to prescribe a lethal dose of medication to terminally ill patients who have just months left to live. Patients must make repeated written and oral requests for the medication, and must be independently examined to confirm their mental competency. Then, the dying individuals can keep the pills at home and choose when they want to ingest them. According to one study that examined data from Oregon, the majority of patients never actually follow through.