California Medical Association Drops Opposition Against Right To Die Bill
Our top story a midday edition, and end-of-life option bill must like the death with dignity law in Oregon is being considered by lawmakers in Sacramento. Today one major opponent of the legislation stepped aside. The California medical Association formally withdrew its opposition to SB 128 making it the first state medical association to drop its opposition to an assisted suicide bill. Earlier today I spoke about the CMA's change with Dr. Ted Mazer, San Diego here knows and throat doctor in speaker of the California medical Association house of delegates. Dr. Mazer, why is the California medical Association withdrawing its opposition to this state end-of-life legislation? Marine, we started this policy of opposition back in the 1980s and we revisited it many times. Society has changed his o pinions. We have had a lot of advancements in medicine prolonging life. We had a great task of improving end-of-life with hospice and quality of care but the reality is for some people that simply hasn't been enough. We have answers of the question, are we in the right position and being opposed to any form of physician aid in dying or is this something that needs to be left up between the physician and patient and not something we need to be outright opposed to. A lot of soul-searching, this was done through committee structure at the CMA and done with asking doctors questions. We have vigorous online testimony and debate on this subject. The bottom line is much like the public, physicians have moved their opinions where most physicians are in a position of either let's stay neutral on this and it's a decision between the patient and the did position only or even to a position of supporting the position should have the ability to do this. The concern is making sure patients are protected in making sure physicians are protected and have a voluntary ability to participate or not. Much like other controversial private sessions in medicine. It's been a long tanning tenets of the CMA helping terminally ill patients die threatens the physician's role as healer. How is that being resolved with this change? The best way to look at it is we have put our emphasis for many years now on palliative care and hospice care. There is excellent hospice and palliative care as a result of those efforts in trying to get the patient to use those services. The reality is in some cases patients feel that's not enough and they are suffering and loss control of their lives. They have reached out to the medical community in many cases and said, can you help me make a decision on how to die with dignity, how to be in control? I think in large part this whole concept the physician aid in dying is getting patients some control at the end of their l ife. Physicians have been in this position before. We've had a lot of controversial ethical issues before. Things like in vitro fertilization even to the extent of abortion and the reality is physicians like the general public are of different opinion about this, but the profession as a hole at least in California has said there may be a reason to consider helping a patient make a decision giving them the ability if they so choose to end their lives peacefully when they are facing a terminal illness with no hope and what we can offer them to hospice and palliative care just isn't enough for them. Dr. Mazer, a group of terminally ill doctors came out in public support of this right to die legislation. Do you think that influence the CMA's change on this issue? I really don't. We've always had people on both sides of this issue. When we debated this week that people say we should be doing this, I'm worried about what I would do if I was terminally ill and we've had other -- in aiding death. We have had a long role in extending life and we put people in positions with that extended life is not a comfortable one and I think just independent of those physicians we had a lot of public things. We had the unfortunate young lady who was a Californian who went Oregon to take advantage of their physician aid in dying laws. We think this is a much better protected environment for patients and doctors if this were to pass. I don't think these doctors were different than other doctors we talked before and I don't think they have any real influence. We have had to do some soul-searching. While we as individual citizens may have different opinions, we have an obligation to be guardians of the public and the public's health and we have to take that into consideration. The result of all of that internal debate was we had seen positions in California have moved on that track towards saying at least let's not oppose this, even if I personally don't think it's right for some doctors and patients, they think this is something they should be able to avail themselves of and that is why we have moved not into a position of support, we are not supporting physician aid in dying, what we're saying is we have moved out of that opposition into a neutral stance and let the patient and physician make a choices. If the medical association analysis every doctor can make up his or her own mind at supporting end-of-life options as they are written in this bill, does not potentially make the issue even more confusing for patients? Why would it? I think it is saying that CMA worked with the office once we removed that opposition and to make sure both the doctor had the right to bring it up or not bring it up, participate or not participate and have legal protection if they brought it u p. We have put things in with the authors that allowed the patient to be screened to make sure they are not being unduly influenced or pushed by family, not doing this for financial reasons and the daring narrow band of who can participate in this with terminal illness. All the concerns people have of this becoming just widespread euthanasia because we want to get of people costing the system too much money, no. Physicians are not there. We want to say we have the ability to help patients live longer but we have to put the patients in some cases into a tenuous situation of living a suffering life even with great end-of-life care and the public and many physicians have now said it's time to allow at least that decision to be made between the patient and the doctor, whether they can ask for this medication and be able to get i t. I don't think that is more confusing. I think we helped try clarify when it might be reasonable but leave that decision between physician and patient. There's a couple of lawsuits pending now being pursued by doctors in California that claim positions already are allowed to aid in dying for terminally ill patients. How is the CMA taking a stance on those lawsuits? I don't think we have a formal position. We have looked through these suits that came up around the same time this bill was first being introduced. They are looking at a different aspect then we are looking at. They are looking at the aspect, our laws prohibiting physicians from doing something they might otherwise do? Let's be historical for just a moment. Physicians have in many cases over many decades been any position of trying to release suffering at the end of life by giving things like narcotic pain medications which we know may cause the patient to fall asleep and not wake up again. That's not news. What is news is saying we have kind of been doing that in a private physician-patient family relationship on rare circumstances. If we are willing to go there, and this is controversial, but if we are willing to go there why have we been so opposed to even considering that some physicians and patients feel it's appropriate to say, as long as you have the capacity to make the decision, nobody is forcing you, you have a truly terminal illness, you're not going to live presumably more than six months, you want some control over your own end-of-life. Is that any different than what we've done in the past p rivately? I'm not a big fan of taking something between physicians and patients and codifying it. The reality is we are in a legal society in sometimes you have to codify what is what these doctors are trying to do. Dr. Mazer, given that next Oracle context between the physician and patients, things like this have been happening all through the years. How do you think approval SB 128, the end-of-life options bill would change the way medicine is practiced in California? I don't think is going to be a vast change. I think it will bring up new conversations with terminal patients. I think it will allow more openness in the patient relationship and hopefully what it will drive, we are not pushing passage, we are not in that opposition position, you will open up more conversation steering people to better end-of-life options including and hopefully dominantly using things like palliative care and hospice care, things we know are much better than they were 10 or 20 years ago as an alternative to do thinking about ending one's life. At some point, people think they are out of control. They have no control on their lives. They want to work with their physician to get some control back and this is one mechanism that can at least be on the table when the physician and patient are both considering this as something they think is a reasonable option. I've been speaking with Dr. Ted Mazer, San Diego Ted Mazer, San Diego year no central doctrine speaker at the California medical Association. This is going to be an interesting one to watch. Joining me doubt is Dr. -- internist with UC San Diego health system. She is part of one of those lawsuits followed by -- thank you for coming in and thank you for listening and being here. Thank you for inviting me. What's the aim of the lawsuit you brought against the state? We are challenging the law in place in California that expressly prohibits anybody to aid another person in committing suicide, which is viewed as prohibiting physicians to offer aid in dying for patients. Why does the suit claimed California law already allows aid in dying for terminally ill patients? California law allows the practice of two things now, withdrawal or withholding life-sustaining treatment when it's clear the patient is not going to survive. That is legally and ethically allowed for patients who are on life-sustaining treatment, did play a ventilator in the hospital. They are allowed to decide they don't want that anymore and that is not viewed as any kind of suicide. Also the practice of control for terminal sedation for patients who are at the end-of-life but are still suffering i nordinately. We are allowed to offer them sedation to alleviate suffering, but there's been a clear distinction between doing that and offering aid in dying which I've always thought as kind of an artificial distinction and so this is really viewed as just extending that practice. You've been involved in hospice and palliative care for many years. Why did you want to join this lawsuit? Because I worked with so many terminally ill patients directly and I have seen what things can evolve to at the end-of-life. The majority of cases we've been able to facilitate and comfortable death for people, but in some cases we were not. I saw a lot of what seemed to be unnecessary suffering that could have been prevented. Is there a patient or specific case that stays with you? There was one patient I took care upon hospice a few years ago who had been under treatment for ovarian cancer for over 10 years and had battled through a lot of treatment and at the end, she was bedbound. She had open wounds. She was completely dependent for everything and this to her was not tolerable. She requested terminal sedation with the hospice caring for her. They refused. She spent an additional last two weeks suffering which to her was not what she wanted and put the family through a lot. I think the hospice was reluctant to sedate her because they did not want to be viewed as participating in euthanasia, but I thought that was unfortunate and that has stayed with me. Have you dealt with terminally ill patients who don't want anything to do with assisted suicide? Absolutely. I've worked with cancer patients most often and I see patients who want every kind of treatment to extend their lives up until there last breath and I've seen other patients that come in and from the time they are diagnosed they want no treatment to extend their lives. They just want to live out what time they have left without any intervention. It's a very personal choice. I think none of us really knows what we would choose until we were there but I think we should support and respect the choices people make. Dr. Cedar Quist, DC the lawsuit you are involved in and the legislation working its way in Sacramento, do you see them working together to change the law on end-of-life options in California? Absolutely.I think they are trying to accomplish the same goal. I want to thank you again. First of all we have a statement from Californians against assisted suicide about the California medical Association's change on SB 128 and you can find that on our website at KPBS .org. I've been speaking with Dr. Lynette Cedar Quist, thank you so much. Thank you.
The California Medical Association announced Wednesday that it has become the first state medical association in the nation to drop its opposition to what is known as "physician-assisted suicide."
CMA says it is formally withdrawing opposition to Senate Bill 128 or the End of Life Option Act, which would allow doctors in California to prescribe lethal doses of medication to terminally ill, mentally competent patients.
In a statement, CMA president Dr. Luther Cobb said:
“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. We believe it is up to the individual physician and their patient to decide voluntarily whether the End of Life Option Act is something in which they want to engage. Protecting that physician-patient relationship is essential.”
Ted Mazer, speaker for the association’s House of Delegates and a San Diego doctor, said the decision is a result of “soul-searching.”
“We revisited this many times,” Mazer told KPBS Midday Edition on Wednesday. “The profession as a whole has said there may be a reason to help a patient when they are facing a terminal illness with no hope.”
Mazer said the association isn’t supporting the idea of the right to die, but has chosen to stay neutral on the subject. He said CMA is in talks with the authors of Senate Bill 128 to amend the legislation so that doctor participation in physician assisted suicide would be voluntary.
But the debate is far from over. The group, Californians Against Assisted Suicide, remains staunchly opposed to aid-in-dying and released this statement.
Marilyn Golden, senior policy analyst for Disability Rights Education & Defense Fund also released the following statement:
"It is reprehensible for CMA to drop opposition to this bad public policy that endangers so many vulnerable people for narrow political reasons. The AMA and both associations of California oncologists continue to oppose SB 128. Assisted suicide is a deadly mix with our broken, profit-driven health care system and puts elders and people with disabilities at great risk."
Ken Barns is a San Diego resident and part of Californians Against Assisted Suicide. He echoed Golden's sentiment.
"Introducing assisted suicide into a cost conscious healthcare system endangers those unable to effectively advocate for themselves. It creates a particularly dangerous situation for the poor, disabled, undocumented, and any other high cost patients," he said.
SB 128 is tied up in the Senate Appropriations Committee pending a report on how much the bill will cost.