It looks like California is moving toward following in the footsteps of Oregon, Washington and Vermont and passing their own “death with dignity” law, allowing mentally competent, terminally ill patients to receive a prescription from their doctor intended to end their life. This remains highly controversial, even in a granola loving state like California, and it’s unclear as to whether or not the governor will sign it into law. But assuming he does, it seems to follow in the pattern of the previous three states. (Reuters)

The California legislature on Friday approved a bill to legalize physician-assisted suicide for terminally ill patients despite opposition from religious and disability rights groups, sending it to Democratic Governor Jerry Brown for his approval or veto.

The bill would allow mentally competent patients to request a prescription that would end their lives if two doctors agree the patients have only six months to live.

The measure, based on a similar law in Oregon, passed the state Senate on Friday on a vote of 23-14, after passing the Assembly on Thursday.

“We are here today on the precipice of granting a wish that I was not able to give my mother,” said Senator Hannah-Beth Jackson, who said her mother died in agony from a form of leukemia.

The bill has drawn opposition from the same forces which opposed parallel laws in the other three states, including the Catholic Church and certain patients’ rights groups. The objections on religious grounds are easy to understand, but groups looking to protect elderly (and perhaps incompetent) patients are jumping into a complicated debate. There’s an obvious concern that some families might try to coerce an ill family member to do this against their will for reasons which might range from a wish to avoid costly medical bills to a desire for a faster inheritance.

These are all valid concerns to be sure, but this legislation has at least made an effort to allay them by including provisions which make it a felony to “trick or coerce patients to end their lives” against their will. Of course, when it comes to such a personal and painful decision, particularly after the patient has passed on, prosecution could be tricky to say the least. There are other provisions designed to prevent such things though, such as the requirement that two independent doctors agree to and approve the decision.

It sounds to me like patients may still have a hard time finding a doctor willing to help them out with their request. The other restrictions include a requirement that the patient be in such grave shape that they have “less than six months to live.” That’s a tricky call to make. Many of us may know of someone who was told by a doctor that they had “X” number of weeks or months left to live but who then went on to surprise everyone and live considerably longer. Will doctors want to expose themselves to not only additional lawsuits but potential criminal charges if they issue end of life drugs to someone only to have other doctors come back later and question their diagnosis? Further, some patients change their mind and don’t take the drugs after they are prescribed. What happens if they live for more than six months? The doctors could then be looking at what would essentially be an automatic lawsuit. (You can read some of the basics as to how this works in Oregon, Washington and Vermont here.)

These questions seem almost too complicated and personal to frame them inside of a set of laws. I’m reminded yet again of Ken Murray’s landmark essay, How Doctors Die, which shows the difference between medical professionals and the rest of us. There seems to be little doubt among doctors who are willing to speak about it openly that “assisted suicide” happens on a regular basis all across the country, but it’s not spoken of very much and it’s never called by that name. Doctors will sometimes “help someone along” when the end is near and the suffering is too much to bear. And as Murry notes, the doctors themselves very often take a different and less protracted, painful exit when their time comes as compared to the last ditch efforts expended on their patients.

It still seems to me that a law like this simply brings something out in the open which has already been happening anyway. And being exposed to the light of day should, in theory, provide for a chance to reduce any abuse in the system. It’s never going to be an easy decision, but the choice – as well as the consequences in this life or the next – should remain in the hands of the individual, not strangers.