KPBS our top story on midday edition terminally ill Californians who have this month to live will soon be able to get medical help to in their lives. After hearing arguments from all sides, Governor Jerry Brown signed the end-of-life option act Monday. The push for legalization of assisted suicide in California came last year with the death of 29-year-old Brittany Maynard. Maynard was diagnosed with terminal brain cancer. And she publicized her move from California to Oregon to be able to use that states death with dignity law. Now that Californians have their end-of-life option. The terminally ill and their families and the doctors will have to learn how those options can be used. Joining me our doctor Ted Mazer he is a San Diego physician and speaker of the California assertion of delegates. Dr. major welcome to the program. Ken Barnes is also here. He spokesman for Californians against assisted suicide. Can walk them. Thank you. Let me start by getting your reactions to the fact that Governor Brown signed this bill into law because it was not at all certain that he would sign it. Dr. major you first. Yes we were not sure what he was going to with this bill. Between his background and where the public has gone on this, controversial issue. The question was whether he was going to sign it or veto it are based on the special session. He had mentioned that before. Whether he was going to sit it best that I had let it pass without his signature. I won't say was a surprise that it's a law. I think it's a bit of a surprise he chose to sign it himself and not just what it going to lot given his background. In the background you refer to is Governor Brown's is a former seminarian. And the Catholic Church is not in support of this end of of options bill. The governors statement yesterday which was very impressively worded kind of spoke to why he decided -- despite his religious beliefs in his back ground, he thought this was the appropriate way to go by signing law. And Ken Barnes, what is your reaction to the fact that Governor Brown signed this into law? It was disappointing it from other religious perspective, historically Governor Brown has been known for standing in the gap for those at the margins of society, lower income persons, disabled over the past 40 years. And his signing statement that she was very clear that this was based on his own personal beliefs and based upon how would impact him as an individual. That's were the challenges. It is not how it impacts the fortunate in society and those who are well connected -- but how does it impact those on the margins you can't speak up for themselves. That's why was quite disappointing it would heat -- with sinus and law. He did say was a struggle for him and his end-of-life option bill has been a struggle for the California medical Association. Sure they dropped their long-standing opposition to physician assisted suicide. What was the reasoning behind dropping that opposition quick Medical Association Dass Association had a 30 year position opposed to the whole concept of physicians assisting in end-of-life I giving medication to in life. Things have changed over 30 years. We had debated this a couple of times with our house of the get -- delegates. This time around beginning at the last year with the Brittany Maynard story going public. We realize this is going to be a front and center issue in California. We were not looking at specific legislation, we were looking at the policy of whether or not we were still in the right step with the physicians and with the current epic -- things change over time. We did a great deal of internal vetting with our Council on ethical affairs, legislative committee, with our membership and with our leadership to determine whether or not we would stay interposition of opposition which likely would've killed the bill. We came to that conclusion over several months that our membership, the physicians of California, said this is a more personal decision. This is something between the doctor and the patient and in fact we were surprised to see that the number of people who were fully in opposition of physician participation was far lower than anticipated. Can -- back to Jerry Brown. He said in making his statement about why he signed this line to -- bill into law, the essential deciding factor is whether the state should continue to make it a crime for dying person to end his or her life. He obviously came to the answer of no. Is that the essential factor that you see in this ? No I don't. I see the essential factor not as do we make end-of-life decisions criminal or not criminal, but really what we do for persons who are at end-of-life who are in pain and suffering to alleviate the pain likes to alleviate the suffering? To make them more comfortable and their Families more comfortable who have to experiences trauma as well? The focus of that shouldn't be -- well for only a few hundred dollars we can kill the person off in terminated all, versus the kind of time and effort and resources that it would take to invest more in palliative care and hospice care and really diving into how do we create more comfort for persons who are passing away? And to do it more comfortably? About where we believe the focus should be. And really focus on the individual and a compassionate way. Just terminating their lives early isn't the compassionate way that we always have as Americans. Let's talk about the idea of just terminating their life early. Dr. Mazer how would this new law work? Patients diagnosed with terminal illness in six months to live will be able to ask the physicians for what quick Does not quite that simple. I actually agree with Ken. Compassion and hospice. Best care is front and center. This law requires the physician to inform patients about primitive and hostile -- hospice care. This is not a shortcut. This is not economically base. We work very hard -- one session went neutral on the topic we work with the people in the Senate to put language on safe -- and safeguard about what kind is talking about here to. To make sure patients were protected against abuses of this. The process here is not that easy. The patient would ask to ask twice over a 15 day period for medications to be prescribed that would in their life. They would then have to sign a written agreement. The physician would have to make sure they had the capacity to make that decision. And make sure they understood it. Make sure they patient understood they could reveal -- revoke that decision. They don't have to use the medications. There's a lot of paperwork and reporting. There is a lot of protection here to to make sure insurance companies -- HMOs -- don't have any wherewithal to pressure people. It's not about cutting the cost of care. Is not about eating them to not get care. In fact we are very strong on saying hospice and palliative care much be best supported much better than they are now. The question becomes when that's not enough, does the help -- patient have options? California medical Association did not support this legislation. We said if California is going to move forward with something like this, we need appropriate protections for the patients as well as for the physicians who both participate and say they do not feel their role to participate. One of the requirements is that the patient be able to take the lethal medication by themselves. Is that right quick Correct. That is the patient best the doctors not giving the medication. Is not a relative giving the medication. The request is that someone be with them when they take it. That they give notice to family and the physician that they are going to take the medication. Is not about the physician actively doing except -- anything except saying if you've made this decision and you get to the point where your beyond having your pain-and-suffering relief, you may take the medication. But you have to be able to do that yourself. And Dr. Mazer your thing the physicians will not be required to write out these prescriptions if they are asked to do so by their patients? Not only required to write it, they're not required to bring the subject up. A are required if the patient brings it up, to refer to someone else if they don't want to participate in this. It's a very important thing, physicians are divided about whether the role of the physician is to engage in this type of behavior. The questions between the patient and the physician and their own ethic at that point. Now can, do you think the safeguards we have then talking about in this bill make the scenario of someone being pressured to end their life any less likely quick The challenge with the scenarios that are built-in and the safeguards for the medical community, they are not safeguards for the patient. By the CMA went neutral on it, the amendments that were added in to make sure that the doctors can be sued and they are not liable. There is no way to protect the patient from what happens to them once they are at home. Once they have this bottle of pills -- 50 or 60 pills that they have to ingest so they can die. They take their -- those home. There's no requirement for them to take it. Is no tracking or reporting. This is created on the Oregon model. In Oregon colleges because you take it home -- doesn't mean you have to use it. There is no control and checks in place. There's also no way to stop the implicit pressure being applied to someone to terminate their lives early. I will give you an example, you take someone who is in the hospital and when they are there at the end of the life -- they have family members coming in binning gets desperate need yesterday. Lower income communities, there is no sickly. We were just losing money. What often happens around families of end-of-life, family members suffer massive financial challenges. Because they are unable to pay rent, utilities -- you have a person there who is feeling proud and is wondering my gosh what I'm doing to my family. And now there's this low cost option on the table -- where they can take this option. They make to request, they'd get the medication, the doctor deems that they are of a sound mind -- there is no psychological referral unless there should be one, but there's not one that's mandated. So you could take someone and say sure, seemingly everything is fine. But they are making this decision based upon how they feel it is impacting their family. I will give you a moment to respond. Let me make the point. You plenty to Oregon and the fact that a lot of times these prescriptions are gotten about 1100 prescriptions according to the LA Times of been written over 17 years. About 750 people have used the drug to end their life. It seems to support the idea that for many people -- not an inside look -- outside looking in, but for people grappling with the end of their own lives, that actually just having that option is a comfort at the end of life. Do see any value to that can? The challenges to things. One, no one knows what apps to the other 400 packages of death pills that are out there. They are not required to bring them and track them. The other challenge is that if this was an individual choice, but had no effect on others -- it probably would be okay. The challenges to make that individual choice available to someone like myself or others who can speak for themselves who have great insurance, you have to expose a lot of -- a huge group a population to it. That's where the challenges is not an individual but a group choice. Let me have your respond to some of the things canvassing. Distally to clarify. There are reporting requirements. When a patient asked for and is given the prescription, their reporting requirements when the prescription is used. One of the things the medical Association really try to push forward was a return process. How do you recoup the medications if the patient dies from other reasons or decides to revoke the right to use this? All that is in process and that is how laws work. You have to work through the regulatory process. As far as protections, I will tell you that the medical Association once we went neutral, Navy original set of authors multiple amendments. They were pretty evenly balanced between the doctor protections in the patient protections. Were focusing really on the patient protections other than making sure a doctor that doesn't want to participate in this, is enforced in any way to do so. It is an individual choice. If you look through the law carefully, one of the mandates is that the doctor -- once they determine the patient is qualified by terminal illness, but they have the capacity -- or if they determine that they can't make a decision topic refer to a mental health expert. One of the requirements is the patient, must be interviewed away from potential course of factors a family friends etc., to make sure they understand what they are doing and if they want to go forward. There are only so many ways you can go to make sure the patient is making their own decision. I think the law has bent over backwards to make sure a patient is asking for this understands the rights and the physician is doing their best to determine that this is not a course decision in any way save -- a perform. Can. This has been signed into law. So now that this is the law of California, does your organization plan to continue its fight against this end-of-life option? Sure. We will All options on the table. There's a variety ways to go about it. Obviously this just happened yesterday. We will not make the decision in 12 or 13 hours. The biggest challenge, the big it -- the reason this is an individual choice, believe to believe it is, you have to believe there are no discrepancies in the healthcare system. And all persons have the same access to healthcare. Is an example, if I'm diagnosed tomorrow that I have formants to leave. I'm going to see doctors all over the place. I will get a second, third or maybe 10th opinion. I will go to multiple countries or states -- if I'm on Medi-Cal, that one opinion is it. I barely have any access to specialist. I don't have the ability to put a credit card down and fly to Houston or Cleveland. That is where it is. This is an evenly spread here because all persons don't have equal access to our healthcare system. So your organization hasn't decided whether you're going to see you are try for a referendum --? We haven't made any decisions about actually what we will do next. Dr. Mazer, as I said -- the Oregon death with dignity law has been working for 17 years. They have had better year -- up there for 17 years. Does a way that low has worked plus the amendments or the requirements that the CMA has worked to put in this law -- this all this give you hope that all this might turn out to be a sound law for the state? Again, not talking about whether this law are this the best thing are the worst thing that ever happened. You can only put as much protection in the law as you can. You go through that process and if that protections weren't there, we would have been in a [Indiscernible] position. We let the authors know that. The Oregon law is somewhat different. I think it's important -- the numbers you cited before, not very many people even avail themselves of asking. Those that do don't necessarily use the medication. The governor was pretty clear in his signing statement. What he said was, it really isn't about myself, but if I were in that position, I would want to have the ability to make the choice. Dimension before the the concept before is it really just the idea that you have control of being your life. Is that why people want this? I think that plays a lot into it. As long as we do our best now -- since this has been done through a legislative process and not a ballot initiative, we can see what changes need to be made in the law. We as physicians will be watching to make sure patients are not doing this for the wrong reasons are asking for it for the wrong reason. I think we go forward and remember that this is an unusual law. It has a ten-year sunset provision. It will be tracked carefully and require a vote to extend it or terminate it. I want to thank you gentlemen very much. I've been speaking with Ted Mazer speaker of the medical Association House of delegates and Ken Barnes spokesman for Californians against assisted suicide. Thank you so much. Thank you.
In a rare personal message, California's 77-year-old governor provided insight into his deliberations before deciding to sign a bill allowing terminally ill Californians to legally take their own lives, reflecting on religion and self-determination as he weighed an emotionally fraught choice.
Gov. Jerry Brown, a lifelong Catholic and former Jesuit seminarian, said he consulted a Catholic bishop, two of his own doctors and friends "who take varied, contradictory and nuanced positions."
"In the end, I was left to reflect on what I would want in the face of my own death," wrote the Democratic governor, who has been treated for prostate cancer and melanoma. "I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill."
Brown's signature on the right-to-die legislation Monday capped an intensely personal debate that dominated much of this year's legislative session and divided lawmakers. Many lawmakers also drew on personal experience to explain their decisions to support or reject legislation making California the fifth state to allow terminally ill patients to use doctor-prescribed drugs to end their lives.
At the center of the debate was Brittany Maynard, a 29-year-old California woman with brain cancer who drew national attention for her decision to move to Oregon to end her life.
In a video recorded days before Maynard took life-ending drugs, she told California lawmakers that the terminally ill should not have to "leave their home and community for peace of mind, to escape suffering and to plan for a gentle death."
Maynard's husband and mother were regular visitors to the Capitol, testifying at committee hearings and meeting with undecided lawmakers. Maynard's mother, Debbie Ziegler, said Brown "listened with a compassionate heart and a discerning mind."
Ziegler said in a statement that Brown's decision "allows true principles of mercy to guide end-of-life care for the terminally ill in California."
The measure applies only to mentally sound people and not those who are depressed or impaired. The bill includes requirements that patients be physically capable of taking the medication themselves, that two doctors approve it, that the patients submit several written requests and that there be two witnesses, one of whom is not a family member.
Supporters hope that adoption of right-to-die legislation in the nation's most populous state will spur approval elsewhere, although legislation introduced this year in at least two dozen other states stalled. Doctors in Oregon, Washington, Vermont and Montana already can prescribe life-ending drugs.
The Catholic Church and advocates for people with disabilities opposed the legislation, saying it legalizes premature suicide and puts terminally ill patients at risk for coerced death. Opponents targeted Catholic Latino lawmakers, urging them to block its passage.
Opponents said Monday that they were disappointed the governor relied so heavily on his personal experience in his decision and that they were considering options to stop it.
As someone of wealth with access to the world's best medical care, "the governor's background is very different than that of millions of Californians living in health care poverty without that same access," the group Californians Against Assisted Suicide said in a statement.
The passage of the bill by Assemblywoman Susan Eggman, D-Stockton, was the latest attempt to advance such legislation in California. A proposal earlier in the year stalled and the measure was brought back as part of a special session on health care. The law cannot take effect until the session formally ends, which probably will not happen until at least mid-2016.
