America is a country of different cultures, different races, different sexes, views, communities, personalities, thoughts, persons—it is a country of differences. Such differences, so many, that there is division on all issues. One of the most controversial issues that has a wide variety of viewpoints is physician-assisted suicide. It directly conflicts with religious views, with physician oaths (i.e. Hippocratic Oath), plays with a slippery slope—legislation needs to be exact in what is legal, qualifications, what is illegal, etc.; it needs to be a beneficial compromise to help aid those in need and keep strict wording for legal and illegal actions. There are many problems with establishing physician-assisted suicide. America is divided over it, and as of now there are only six states that make it legal, California being one. Topics that will be addressed in this research paper include views that are against such legislation, current legislation in California, and the consequences of such legislation. Despite all the different views and arguments over whether or not physician-assisted suicide should be legal or remain legal, the legislation that is currently in place by the California legislature takes out the guess work and potential problems of such practice and makes the action a suitable way for the dying to choose a dignified end.
There are many views that are against legislation that would allow for physician-assisted suicide in California. One such view is that assisted suicide will be an option that people will lean towards because of financial reasons—living on technology that prolongs life is expensive and will cost a fortune for themselves and their family members. Many experts, according to Arthur Caplan, believe that the bulk of money put towards health care has gone to the introduction of technologies that have found their way into specialty care facilities, and to those that live in and receive care in such facilities—the elderly. “America is a graying society. More Americans are living longer. And, an unusually large percentage of the U.S. population is on the threshold of old age” says Caplan, and with the Baby Boomers nearing retiring age and being a large portion of the population in America, and less younger generations marrying and having children, this “graying society” grows grayer each day. There is a large portion of our population being elderly, and many of those are suffering from terminal diseases. Another interesting view, according to Caplan, assisted suicide is the result of a combination of an aging population and a “health-care system that is not prepared to manage death humanely”. This health-care system that is not prepared to manage death humanely comes from the ugly parts of technology, feeder tubes, IV cords, that would be surrounding a dying elderly person, and would take away the beauty of their life and put the ugly in death. There are many people dying from terminal diseases who do not want to go through such an ordeal, and take their death into their own hands, and let their end be dignified, as Professor Battin also said in her studies about physician-assisted suicide.
Another view is that there is a large voice about the ethics that come with physician-assisted suicide, and what the legislation would look like, especially with the physician-assisted suicide method and the active euthanasia method being compared. According to “On the Difference between Physician-Assisted Suicide and Active Euthanasia”, there is little difference between physician-assisted suicide and active euthanasia, except for who does the actual deed of administering the drug—which, according to the author, is such a minuscule detail that is should not even make a difference. However, this is a large difference—the patient being the one to administer the drug, versus the physician being the one to administer the drug—puts the decision and the act into the hands of the one that is requesting the drug, requesting the resources to their dignified death. Physician-assisted suicide, which is not accurately coined, would let the patient have the hand of their death, the control of when they inject or drink the lethal dose, and would save the physician from the burden of ending a life. Active euthanasia, however, takes that control out of the patient, and thus also takes a large portion of why terminally ill patients request an aid-in-dying drug in the first place—the control of a dignified death. While there have been voices claiming that physician-assisted suicide and active euthanasia are the same, ergo neither should be legal, acting legislation in America, and California, legalizes physician-assisted suicide.
This type of legislation is not new to the people of the United States of America, and is not new to the ballots either—there are quite a few states and there have been quite a few advocates who have large voices in the country. Interestingly enough, this was not the first time that legislation along these lines was legal in California—“In 1976, California became the first state to enact natural death legislation”, the California Natural Death Act (Redleaf). The California Natural Death Act gave the right for a terminally ill person to authorize ending all medical treatment that was prolonging their life when it is believed that death is imminent. Another prominent example of legislation that California followed example from was a neighboring state’s attempt at physician-assisted suicide legislation. According to the chapter “Assisted Suicide: 1. America” one of the first states to see such legislation on the ballot was Washington. Initiative 119 was legislation that would allow “adult patients who are in a medically terminal condition be permitted to request and receive from a physician aid-in-dying”; it was certified to the legislature on February 8, 1991, but was rejected by less than 110,00 votes (Washington State). Finally, in 2008, Washington’s Death with Dignity Act, Initiative 1000, was passed and made Washington the second state to legalize assisted suicide. Another example of support for this type of legislation is the large voice of advocate Dr. Kevorkian. An England native, he immigrated to America after his wife’s death, one people whom he assisted in suicide when she was suffering from her terminal illness and did not want to continue. According to Caplan, he was “flamboyantly dangerous” and only gained traction with the people because of their fear of death. However, many people joined in on Dr. Kevorkian’s idea, and helped people learn to understand and desire legislation that would allow it. One example is when “The book “Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying” reached No 1 in the category of hard cover books on advice on New York Times best seller list. The book’s author, Derek Humphrey, is the executive director of the Hemlock Society, a voluntary euthanasia society based in Eugene, Oregon, which has 40,000 members and uses the motto ‘Good life, good death’” (“Assisted Suicide: 1. America.”). With the book going to number 1 in the first week of publication, selling all printed copies and tens of thousands more ordered, that showed that people who are dying, are surrounded by people who are dying, and want to be more informed are trying to educate themselves. The notion of physician-assisted suicide has been around in America for decades, and such legislation has been advocated for and against. However, the advocators in California have won, and were able to help enact legislation.
Currently, there is legislation that makes physician-assisted suicide lawful in California. California Assembly Bill No. 15, End of Life, colloquially known as “End of Life Option Act”, was approved by Governor Jerry Brown on October 5, 2015, was stalled for a few months in 2016, and became “reestablished”, and is in effect today. The bill marks California as the sixth state in the country to enact any legislation that allows for physician-assisted suicide, with provisions and qualifications outlined. The bill outlines specifically what the requirements are for the situation to be applicable, for the “qualified individual” to be qualified, what their age, diagnosis and prognosis, capacity for making such a decision and how it is made and tests administered to determine the decision making, their residency, among others listed; for the physician—who they are, what reports they fill out, how their diagnosis and prognosis affect the qualification of the patient, reverification of their diagnosis and prognosis by another consulting physician, among other provisions as well. Another explicit detail in the bill’s text is another, very important qualifying detail—that a “qualified individual” only becomes qualified and their request for an aid-in-dying drug to be approved, save all required provisions are met, when their terminal disease meets this definition requirement—“a terminal disease means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, result in death within six months” (AB-15). This means that the only time an aid-in-dying drug can be given and administered is within six months of the estimated time of death. This provision helps keep the death-inducing drug away from the hands of all patients who have been given life sentences, and instead makes sure that it stays in only the hands of those who have very little life left, and in many cases, have suffered from poor life quality because of the eminent end. Each line in the bill is clear-cut about each qualification and the definitions of terms found in the text, and keeps the bill from being taken advantage of by many people. Another clear-cut item in the bill is the creation of a new crime.
The bill establishes a new crime by making any fraudulent activity, manipulation linked and/or involving an aid-in-dying drug of a patient or of the patient themselves in any way illegal. This is a new crime because the ability and accessibility of an aid-in-dying drug to those that qualify is also a new action that the people of California may pursue. This helps protect those who seek to use the drug and those who surround those qualified individuals from committing any crimes, but also does make any negative action a crime. Since the enactment of the bill, there has been annual data reports administered by the California Department of Public Health, and such reports have followed specific data points, such as “the number of people for whom an aid-in-dying drug prescription were written, number of people who died from using the prescribed drug, where each person was enrolled, number of known deaths in California per 10,000 deaths, number of physicians who wrote prescriptions, and demographics (age at death, education level, race, sex, type of insurance and whether or not they held it, and underlying illness) of each patient who died”. The California End of Life Option Act 2017 Data Report takes all data of the calendar year, from January 1, 2017, to December 31, 2017. The data shows that the median age of individuals who died from prescription aid-in-dying drugs was 74, 90.4 percent being 60 years are older, 88.9 percent white, and 72.7 percent had received at least some college education, with 68.5 percent were suffering from cancer and the next highest group at 9.4 percent suffering from neurological disorders. These numbers show that those individuals who asked for and used an aid-in-dying drug were educated individuals, older people who were near eminent death, and suffered from terminal diseases.
California is one of the leading states in the United States that shows legislation that enables qualified individuals the option of assisted-physician suicide is a bill that makes a positive impact on its residents, and may work without the potential backlash that many opposed voices claim. Without this bill, those who are suffering from a terminal disease and will die no matter what would not have the option to take that death into their own hands, and die in a dignified manner. However, many people still argue against it, claiming that such legislation will create chaos, cross ethic lines, and will not be used for the use of a dignified death of a dying patient, but rather a solution to other problems, i.e. finances, and could potential be taken advantage of for evil means. The question still stands—is such legislation good, or bad? If you ask those who have used this bill, and ask their loved ones, I’m positive the answer is yes, it is good.