People sit on the beach and watch the sun set as seagulls fly overhead in Santa Monica, Calif. Photo courtesy of REUTERS/Carlo Allegri *Editors: This photo may only be republished with RNS-CALIFORNIA-DYING, originally transmitted on June 7, 2016.

California's End of Life Option law: More peaceful deaths or moral quicksand?

(RNS) Somewhere in California on Thursday (June 9), a terminally ill person may lift a glass and drink a lethal slurry of pulverized prescription pills dissolved in water.

And then die.

That's the day the nation’s most populous state implements a law, passed in 2015, making physician-assisted dying accessible to 1 in 6 terminally ill Americans, according to its national backers, Compassion & Choices.

Opponents condemn such laws as a plunge into moral quicksand -- a looming danger to the most vulnerable in society who may be coerced to end their lives.

Similar laws are already in effect in Oregon, Washington and Vermont. (In Montana, the state Supreme Court ruled in 2009 that assisted dying was legal under the state's Rights of the Terminally Ill Act).

Advocates cheer this “End of Life Option,” the formal name of the law that specifically covers only mentally competent adults. It’s normal for people to have options, right? They say.

“Normalizing” this process is the term big with supporters. It conjures a sense that this is the last autonomous act of a person who, two doctors must certify, is six months from death's door. Although the option is a multistep process that can take a few weeks, it can short-circuit months of intractable pain and suffering.

The real killer, in this view, is the terminal illness or injury. A lethal prescription, which the law dictates only the patient can administer, merely changes the timing.

Toni Broaddus, at the microphone, is California campaign director for Compassion & Choices. She is with Dan Diaz, the husband of the late Brittany Maynard who is pictured in her wedding gown, and legislators who sponsored the bill to legalize physician assisted dying, Senate Majority leader Bill Monning on the left and Senate majority whip Lois Wolk on the right. Photo courtesy of Compassion & Choices

Toni Broaddus, at the microphone, is California campaign director for Compassion & Choices. She is with Dan Diaz, husband of the late Brittany Maynard, who is pictured in her wedding gown; and legislators who sponsored the bill to legalize physician-assisted dying, Senate Majority Leader Bill Monning on the left and Senate Majority Whip Lois Wolk on the right. Photo courtesy of Compassion & Choices

 This image is available for web and print publication. For questions, contact Sally Morrow.

That was the view of 29-year-old Brittany Maynard, one of the people who inspired the California law.

In 2014, she was a California newlywed who refused to allow an incurable brain tumor to overtake her last days. Instead, Maynard moved to Oregon to have access to that state’s first-in-the-nation right-to-die legislation.

There, she died as she had planned, leaving a legacy of videos, created with Compassion & Choices.

RELATED STORY: Right to die act passes California Senate as Brittany Maynard’s family looks on

The last word in one Maynard video was “advocate.”

Legal aid in dying already has a foothold of national public support. Surveys show most people -- of all faiths and none -- support this as long as there are adequate legal safeguards such as limiting access to mentally competent adults.

Gallup, in a national poll in May 2015 using the hot-button word “suicide,” found that 68 percent of U.S. adults said, “When a person has a disease that cannot be cured and is living in severe pain, doctors (should) be allowed by law to assist the patient to commit suicide if the patient requests it.”

Compassion & Choices political director Charmaine Manansala said politicians should pay attention. “Aid in dying doesn’t result in more people dying. It means more people have less suffering.”

California Governor Jerry Brown said he consulted widely but ultimately decided to sign the End of Life Option law legalizing physician-assisted dying.

California Gov. Jerry Brown said he consulted widely but ultimately decided to sign the End of Life Option law legalizing physician-assisted dying.

Manansala, who is Catholic, cited the statement from Jesuit-seminary-trained California Gov. Jerry Brown, when he signed that state's law.

Brown said that after deep reflection and wide, diverse consultation he concluded: “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. And I wouldn’t deny that right to others.”

Neither does the law impose participation on people who object. It was elaborately constructed to allow physicians, pharmacies and health care systems to “opt out” on conscience grounds.

The next step, said Matt Whitaker, Compassion & Choices state director for Oregon and California, is to ensure access in a state where the two largest faith-based health care systems, Catholic hospitals and Adventist Care hospitals, have announced they will not participate.

Other large California systems, such as Kaiser Permanente and Sutter Health, are setting up procedures for doctors who say they are willing to aid patients seeking this option.

“People should be able to go to a doctor and have these conversations without facing institutional impediments,” Whitaker said.

Even as California deals with implementing the new law, advocates are stepping up efforts in state after state. Bills modeled on the California law have been submitted in 18 states and the District of Columbia.

New York -- where similar legislation passed a health committee in the state assembly in May -- could be the next “significant win,” said Manansala.

New Jersey lawmakers will likely hold hearings this summer and Utah has scheduled hearings for July, she said.

In Colorado, a signature campaign is underway to put a referendum, Initiative 145, on the November election ballot.

However, a bill similar to California’s was withdrawn before a committee vote in the Maryland Assembly this spring after a coalition of religious and secular activists lobbied against it.

RELATED COMMENTARY: Does God really want us to suffer unrelenting pain?

Opposing forces wield spiritual, social and moral arguments.

Although some religious voices have spoken up for this legislation, across the country, Catholic bishopsMormons and conservative evangelicals have condemned such bills in one legislature after another. They say humans cannot usurp God's role as author of life and death.

Secular opponents say the critically ill don't truly have autonomy. By the time they are eligible for the "option," they're in a fog of fear and pain and vulnerable to outside pressures.

Elena Boisvert, an Annapolis, Md., attorney specializing in elder law, testified against the bill because “every day, I see the most incredible acts of greed by kids who abuse and rob their parents blind."

Boisvert said such laws “are creating incentives to say, ‘Mom, Dad, maybe you really do want to leave the planet a little earlier than otherwise.’”

Equally horrific, in their view, such laws put society on the road to euthanasia -- direct killing -- that is already legal in parts of Europe for the mentally ill, even for children.

A new movie in American theaters, “Me Before You,” concludes (spoiler alert!) with the smart, handsome disabled man, one with all the love and support he could want, choosing to die in a Swiss “suicide hotel.”

RELATED COMMENTARY: How ‘Me Before You’ promotes an ableist agenda

Ultimately, opponents say the right-to-die movement has a force beyond the exact confines of any particular state law. It legitimizes suicide culturally -- with potentially tragic implications for the mentally and emotionally distraught.

This cultural context “scares me,” said evangelical scholar Richard Mouw, former president of Fuller Theological Seminary in Pasadena, Calif.

Evangelical scholar the Rev. Richard Mouw, former president of Fuller Theological Seminary, opposes right-to-die legislation such as the new California law.

Evangelical scholar the Rev. Richard Mouw, former president of Fuller Theological Seminary, opposes right-to-die legislation such as the new California law.

Mouw cited comments in The Christian Century by a Dutch Christian ethicist, Theo De Boer, who has seen legalized suicide in the Netherlands shift from strict regulation to loose application, from a rare choice made usually for cancer patients to one commonly chosen by people terrified of encroaching dementia.

One in 25 deaths in the Netherlands is the consequence of assisted dying," De Boer wrote. "Terminal cancer now accounts for fewer than 75 percent of the cases. Many of the remaining 25 percent could have lived for months, years, or even decades. In some reported cases, the suffering largely consists of being old, lonely, or bereaved.”

Mouw said that despite his deep empathy for people who are suffering, he has little faith in California’s law, which, like all legislation promoted by Compassion & Choices, expressly forbids euthanasia.

Although the law also specifies that the “option” may not be called “suicide,” that doesn't mean it eventually won't lead to more people choosing death -- by this law or other means. It acts in the culture to "normalize" the notion in ways that politicians can't control, said Mouw.

Joni Eareckson Tada is an author, disability advocate, opposed the California law. Photo courtesy of Joni Eareckson Tada

Author and disability advocate Joni Eareckson Tada opposed the California law. Photo courtesy of Joni Eareckson Tada

 This image is available for web and print publication. For questions, contact Sally Morrow.

Joni Eareckson Tada has stepped up her decades of lobbying against such laws, saying Jesus’ love and the belief that God is with her in this life and beyond give her strength and comfort through cancer, chronic plain and quadriplegia.

RELATED STORY: Joni Eareckson Tada to Brittany Maynard: God alone chooses the day you die, not you

Pastor Dave Watson, of Calvary Chapel on Staten Island, is fighting the bill in his state and beyond because “it is not just one person’s private business. It's a moral absolute: It is wrong to destroy your body.”

His columns for the Staten Island Advance spell out how Compassion & Choices -- originally founded decades ago as the Hemlock Society -- offers a secular vision of autonomy-at-all-costs that doesn't square with a biblical worldview.

Everyone in this Judeo-Christian country needs to rely on “a source beyond yourself that is true in all times and all places,” said Watson.

RELATED STORY: 5 things to know about death-and-dying debates

Decisions at the end of life are never easy.

Most people have not discussed how they want to be treated. Many don’t understand their prognosis. And often patients who can no longer speak for themselves are supported by family members or other surrogates who don’t understand – or won’t accept – a dying prognosis.

But in California all this moves from theory to reality. The state government will post the official forms. The countdown will start for patients and physicians.

If asked to write a prescription for the deadly potion, Dr. Timothy Gieseke, a Northern California physician and palliative care specialist, will refuse.

Gieseke, medical director for skilled long-term care facilities in Northern California, calls the law an “overreaction” to the “bad deaths” people have seen.

Too many people, particularly the poor and marginalized in society, have not had access to the best in care that can alleviate pain and ease suffering, he said.

Even so, Gieseke acknowledged, “if I were convinced in my own mind that I and my team had exhausted optimal palliative care, I would likely refer someone” to a prescribing doctor.

Family medicine specialist Catherine Sonquist Forest says she willing to write prescriptions for terminally ill patients who qualify for California’s End of Life Option law which allows them to choose when they die. Photo courtesy of Owen Forest

Dr. Catherine Sonquist Forest says she is willing to write prescriptions for terminally ill patients who qualify for California’s End of Life Option law, which allows them to choose when they die. Photo courtesy of Owen Forest

 This image is available for web and print publication. For questions, contact Sally Morrow.

Dr. Catherine Sonquist Forest will say yes.

The family medicine specialist and assistant professor of medicine at Stanford Health Care at Los Altos/Stanford School of Medicine said she’s long been aware of desperately ill patients moving to Oregon or Washington to die with medical assistance.

By the beginning of June, she said, she was already hearing from patients expressing interest. She’s deeply involved in training Stanford faculty -- “the willing and the unwilling” -- in understanding all the options at the end of life, including aid in dying.

"What is wonderful is that we are moving toward ways to ease suffering. We are finding legal ways for people to have the dignity of defining how they live their last days. Monumentally, this is about what medicine is about at the end of life," Forest said.

"I can't stand in judgment," she concluded. "These people are dying. Now, I can decide in the privacy of my office with my patient what is next."


  1. There are plenty of issues with assisted suicide (consent, professional medical ethics, responsibilities…). I am not a fan of it for entirely personal ethical reasons.

    But I think the religious arguments have it entirely wrong. They posit that patient consent and privacy is of less concern than adherence to religious doctrine and dogma. It posits that clergy have the final say on a patients medical condition and options and not issues of medical necessity or consent. The premise is their version of God supersedes all personal conditions of a patient in their care. It undermines professional medical ethics and the duty of healthcare providers to the public. In many cases there is not a huge marketplace for hospitals to render certain kinds of care in a given area. So it’s not like many have the option of choosing a healthcare provider who doesn’t have the religious hang ups.

  2. Can you name any abuse of this law that is not already illegal? If not, let us be rid of that 6 months clause and move on.

  3. I can see possible consent issues with patients suffering from dementia. If anything it would limit the application if the law to those deemed mentally competent.

  4. From the uterus to the grave, human dignity requires control of one’s personal life.

  5. Yes, that is a problem, but not an abuse. People will need to plan ahead.

  6. Note much abuse has been documented in the Oregon assisted suicide system.
    See the federal case of Thomas Middleton who was killed with the Oregon law for his assets according to the feds.
    There are more details at http://dredf DOT org/public-policy/assisted-suicide/some-oregon-assisted-suicide-abuses-and-complications/
    Opposition to euthanasia comes from the entire spectrum of humanity once they learn how these laws can easily be administered wrongly against the individual.

  7. Your source has done you a disservice. The promoters of assisted suicide have worn out their thesaurus attempting to imply that it is legal in Montana. Assisted suicide is a homicide in Montana. Our MT Supreme Court did ruled that if a doctor is charged with a homicide they might have a potential defense based on consent. They acknowledged it is a homicide in the ruling.

    The Court did not address civil liabilities and they vacated the lower court’s claim that it was a constitutional right. Unlike Oregon no one in Montana has immunity from civil or criminal prosecution and investigations are not prohibited like Oregon. Does that sound legal to you?

    Perhaps the promotors are frustrated that even though they were the largest lobbying spender in Montana their Oregon model legalizing assisted suicide bills have been rejected in Montana in 2011, 2013 and 2015.

    Your source have also done the public a disservice. Their ordinary bait and switch campaign is demonstrated by their selling “must self-administer” then they do not provide in their legislation for an ordinary witness of the “self-administration”. This omission eviscerates the flaunted safeguards putting the entire population at risk of exploitation.
    Respectfully submitted,
    Bradley Williams
    Mtaas dot org

  8. Better not get old or disabled in California, folks.
    Unless you want to get “Optionned” !!!

  9. The abuse thing is largely overblown for effect by the religious set on the subject. Just an excuse to slip in extremist rhetoric.

    But consent issues are really the ones which need to be worked out the best. It Is what separates legitimate humane efforts to end suffering with the worst excesses of Dr. Kevorkian.

  10. I agree, until you rundown Dr Kevorkian. We would not be at this point, if not for him.

  11. Better not get old in the other states, unless you want to suffer with unbearable pain, while the church prays to jesus for relief.

  12. Mother Teresa showed us the position of the catholic church, by withholding funds from the poor and the dying, because she thought suffering was appealing to her god.

  13. Several of our churches think human suffering is a beautiful gift to their god figure.

  14. Kevorkian is why I bring up the consent issue. He got into trouble working the suicide machine on a couple of people who may not have entirely been capable of forming consent.

  15. “They say humans cannot usurp God’s role as author of life and death.”
    And when a Tele-operator drops that explosive laden drone onto an occupied building tell me how Humans haven’t already usurped “God’s role as author of life and death”.
    If you are a Pacifist and against the Death Penalty you can sincerely push that line, otherwise such claims are merely a practice in hypocrisy.

  16. Found One–your postings are a series of untruths and your own misunderstandings (maybe deliberately) of events, words, situations, etc. You are looking to put a stick in someone’s eye. The dignity of human life should be understood from “conception to natural end.” There is a lot of understanding and knowledge necessary to know how that statement was made. Read more. Instead of Mother Teresa, read about Saint John Paul II’s later years.

  17. Not much better on that front.

    The Catholic Church was a lot of problems with the notion of personal consent. They seek unwarranted and unwanted trespasses into the lives of others for the sake their dogma. It is not up to a clergyman whether an individual has “suffered enough” nor does ones life belong to the tenets of the catechism.

    It’s one thing to believe suffering makes one closer to God. It’s quite another to use deception, coercion and force to demand others abide by that.

    They don’t even like the idea of people making their own decisions without consulting their authority. (As seen in Supreme Court recently). Your notions of human dignity are your own. You do not get to dictate to people how to live or in this case die.

  18. I care not a whit for the life of any pope from uterus to John Paul’s unnatural end. I care about suffering people, in extreme pain, and blank blank blank any silly religion which does not.

  19. Now come on all you people voice your opinion condemning people who consider the option when you have never confronted the problem personally. My church is against the option and against removing life support. At this very moment my niece and I are faced with do we remove life support from my 88 year old sister that is suffering one stroke after another. Late last night I finally broke down and told her there is no right and wrong to the question as to what to do. She must do what she things is best regardless of what the church teaches. My sister has a personal relationship with God not a denominational relationship with God. It is not going to effect her salvation one way or the other what ever decision her daughters makes and it not going to effect her daughters salvation. If it does God is not a just God and I certainly believe he is.

  20. People deserve the right to choose their dying. It’s up to the community, on all levels, to protect the vulnerable ones, just as we do with children and some disabled adults.

  21. The end of life option law is needed and will become clearer and valuable to those who desire its usage.In time more and more states will pass laws legalizing this law. As for religious organizations that are against its passage,they to will become the minority.People are becoming more aware that God is in a relationship with the individual not the religion..

  22. The only people who seem to have issues with it are the perfectly healthy ones who aren’t facing an agonizing death (yet). What I choose with my dr. is MY business and nobody else’s. It’s my life.

  23. I am a firm believer that a person should always have choices in life as well as their own death. As long as we have the mental capacities to make these decisions.

  24. I am a RN (retired) and a hospital chaplain (8 units of CPE). My nursing specialty was level 1 trauma (the most critically injured patients) and admin. supervisor. In my career of nursing and my time as a hospital chaplain I have been with literally 100’s of patients when they died. No one has the right to take away choice regarding how an ill person dies. And unless you have been there as a doc,nurse, chaplain, or other medically knowledgeable person you don’t even have the ability to make an informed comment. If you haven’t seen it over and over you don’t know what you are talking about.
    Catherine Meadows RN

  25. The argument for a peaceful death seem unassailable. The idea of dying in agony is not an attractive one. However, not all people are kindly disposed towards the old and the infirm. In a country where medical costs fall on the individual or the family, there will be pressure on the sick to die rather than to increase expenses for the rest of the family. It is so easy to make someone feel that they are a burden or worthless.

  26. Hey, Falcon! Why is Al Qaeda more compassionate than you?

    The 9/11 hijackers got to die instantly.

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