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End of Life, News, Suicide by Physician

California: The Next Assisted Suicide Frontier?

Compassion & Choices (“C&C”)—the organization notorious for its attempts to bully state courts and legislatures into creating a “right” to suicide—is at it again.

But this time, a new strategy seems to be afoot.  C&C has filed a lawsuit in California (Hargett v. Vitas), claiming that a patient’s hospice acted negligently by failing to adequately provide options for pain management at the end of her life.  It claims that the patient was never given the option of palliative sedation, and that therefore she died in severe pain.

But C&C’s actions in filing this case are suspicious.  To best explain AUL’s concern, a little background is in order:

1)       The ultimate goal of euthanasia advocates is, obviously, the legalization of euthanasia (i.e., the consensual or nonconsensual killing of one person by another person).  When ballot initiative efforts to legalize euthanasia failed in California in the late 1980s and early 1990s, advocates “scaled back” and began pushing physician-assisted suicide.  For example, instead of pushing for euthanasia in the state of Oregon, advocates pushed for physician-assisted suicide in Measure 16—the measure that was ultimately enacted in 1994 that permits physician-assisted suicide in that state.  As Wesley Smith notes in his book, Forced Exit, “The campaign for Measure 16 illustrates the step-by-step political tactic that euthanasia advocates believe offers their best hope of establishing a broad euthanasia license: When necessary, take a half-step back in order to propel the euthanasia cause two steps forward.  But never stop agitating.  Never stop pushing.  Never stop propagandizing.  Wear down opponents.”

2)      C&C has spent years in its attempt to legalize assisted suicide.  Most recently, it has been active in Montana and Connecticut.  Specifically, in Montana C&C argued that there is a state constitutional right to physician-assisted suicide.  While the state supreme court did not conclude one way or another whether there is a state right, the court held that assisted suicide is not against the state’s public policy (at this time, anyway).  In Connecticut—where there is an explicit provision criminalizing assisted suicide—C&C argued that “aid in dying” is not “suicide.”  Fortunately, the state court saw through this ploy and ruled that “aid in dying” is “suicide,” and therefore illegal under the law; but we were able to see a new tactic by C&C: redefining the terms.  If C&C can induce courts to redefine statutory terms, C&C can avoid constitutional or legislative quagmires that have held its agenda back in the past. 

3)      C&C has argued that physician-assisted suicide is necessary because some patients are left suffering from uncontrolled pain in the end of life.  Yet AUL and our allies have continually pointed out that up to 97 to 98 percent of patients’ pain can be controlled in the end of life; for the remaining patients, sedation is available to help them die peacefully.  (For more on the issue pain in the end of life, see AUL’s amicus curiae brief in Gonzales v. Oregon, available here.)  Unfortunately, even the American Medical Association has acknowledged that physicians remain fairly unknowledgeable about controlling pain in the end of life, allowing C&C’s erroneous arguments that 1) pain cannot be controlled, and 2) sedation is an affront to a patient’s autonomy and dignity, to perpetuate.  AUL has attempted to combat these false assumptions with our “Pain Management Education Act,” available here.

4)      In 2008, the state of California enacted a measure that requires physicians to counsel their patients on legal end-of-life options.  If a physician does not want to provide certain end-of-life information to a patient (for reasons of conscience), that physician must affirmatively act to transfer or refer that patient to a physician who will.

So what does C&C stand to gain in this case?  In the complaint, C&C never mentions “suicide” or “aid in dying.”  It seems to focus on the provision of proper pain management and palliative care at the end of life.  Perhaps C&C really does want to bring attention to the lack of physician knowledge of proper pain management.  But why?  To demonstrate a need for physician education?  Or is there something deeper?  And why would C&C advocate for palliative sedation, a treatment option suicide advocates have scorned in the past?

Given C&C’s history and blatant agenda, one cannot help but think this is some backdoor attempt to legalize assisted suicide in California by redefining the terms.  Its legal strategy remains to be seen in future court filings in the case.

If C&C is somehow successful in this case in legalizing physician-assisted suicide, they will have in effect won two battles: 1) the legalization of physician-assisted suicide, and 2) the complete evisceration of health care provider’s rights of conscience in California.  As explained above, the law enacted in 2008 requires physicians to provide information on all legal options at the end of life; once physician-assisted suicide is legal in California, physicians will have to offer counseling on assisted suicide or transfer a patient to someone who will.

Of course, at this point this is speculation on our part.  We do not want to be alarmists, but we do know two things: C&C can never be trusted, and it certainly has an agenda with this case.