The California Medical Association has become the first state medical association in the nation to drop opposition to what has long been known as "physician-assisted suicide," it said, acknowledging a shift in doctor and patient attitudes about end-of-life and aid-in-dying options.
The move comes as the doctors organization removed its opposition Wednesday to a controversial aid-in-dying bill that would allow terminally ill Californians to end their lives with doctor-prescribed drugs.
The medical association recently changed its internal policies so that it is neutral on the issue, deleting language that referred to aid in dying as "physician-assisted suicide." The group has long opposed aid in dying on grounds that it violates doctors' ethical and moral obligations to provide the best treatment possible.
"A substantial amount of people still believe this is a step toward active euthanasia," Dr. Luther Cobb, president of the California Medical Association and a Humboldt County general surgeon, said Tuesday. "I don't think that's the case. This is a limited situation. By and large, medical care takes people and fixes them, ... There will be a few people per year who will say this is too much, I will take the black pill."
The move paves the way for the bill in the Legislature, although opposition remains in the Catholic Church and among some disability rights groups.
"This is a major breakthrough," said Sen. Lois Wolk, D-Davis, a co-author on the bill. "Those members of the Legislature who had doubts about the legislation and concerns about the legislation based on physicians and their opposition will be reassured that the protections placed in the bill meet the standard set by the CMA."
The medical association agreed to stand down after lawmakers amended the bill to provide more protections for doctors and hospitals that don't wish to participate. The bill, SB128, is in the Senate Appropriations Committee, but Wolk said she's confident it will be moved to the Senate floor by the first week of June. All bills have to make it out of their house of origin by June 5.
Similar efforts to legalize physician-assisted death have come up short. California voters rejected a 1992 ballot initiative to legalize aid in dying, and state lawmakers struck out four times between 1995 and 2008 attempting to pass bills in the Legislature.
"We still have a ways to go before SB128 becomes law in California," said bill co-author Sen. Bill Monning, D-Carmel. "With this development, my level of cautious optimism has greatly increased."
Lawmakers introduced SB128 in January, three months after East Bay newlywed Brittany Maynard set off a worldwide movement in support of aid in dying by sharing her own decision to die with the help of her doctor. Maynard, who had terminal brain cancer, moved to Oregon to access the state's Death with Dignity law, which the California legislation uses as a model. The 29-year-old Maynard said her final months were made more difficult by not being able to access life-ending drugs in her home state.
Maynard died Nov. 1 after using the lethal prescription. Her husband and mother have continued to share her story in the state Capitol to encourage lawmakers to change California's laws so that others don't have to move for similar end-of-life options. The bill passed along party lines in two Senate committees -- health and judiciary.
Titled the End of Life Option Act, the bill would require two California physicians to agree that a mentally competent patient has six months or less to live before prescribing life-ending drugs. The patient would have to discuss with a doctor other treatment options, such as palliative care and pain control. A terminal patient seeking the lethal prescription would then be required to make a written request and two oral requests at least 15 days apart.
Once prescribed, the patient could choose whether to use it and when. People choosing to end their life with the drugs would be required to administer the drugs themselves without assistance.
Opponents of the bill have argued that vulnerable people can be coerced into seeking the deadly prescription by heirs looking to profit or by health insurers who find it cheaper to offer aid in dying rather than chemotherapy to live.
"It's a bad bill because it has the possibility of impacting the most vulnerable in California who don't have access to health insurance or the best of care and whose options are limited," said Tim Rosales, spokesman for Californians Against Assisted Suicide.
One of the primary amendments the medical association sought in removing its opposition was to ensure that doctors who did not want to participate would also not be required to provide information on assisted-dying or refer a patient to a medical provider willing to offer such services. Monning said there will still be opportunities for patients to learn about aid in dying.
The amendments are expected to be finalized and made public next week. The medical association's official position on the bill is neutral.
The medical association had to change its bylaws to remove its opposition, which Cobb said reflects a change in patient and doctor attitudes about assisted-death and acknowledgment that there are times when palliative care is not enough to make the terminally ill comfortable.
"I've always felt that way, but I was surprised the membership of the organization had changed," Cobb said.
San Diego doctor Ted Mazer said his own feelings have shifted on the issue. Once strongly opposed when the medical association first took a critical view of assisted death in the 1980s, Mazer said the death of patients for whom palliative care was not enough along with the deaths of his parents and in-laws, caused him to rethink the issue.
"I guess I can describe it as going from being opposed to being on the fence," said Mazer, who is on the executive committee of the California Medical Association. "I don't know I would engage in this with a patient, but I see society has changed. The best way I can look at it is I don't think I can make that decision for the patient and physicians who want to gain some control of their life and need something beyond excellent hospice and palliative care."
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