California PAS Bill Passes State Senate Committee

That’s the page 1 story in my local paper this morning (Thursday, March 26).  The California State Senate Health Committee passed SB 128 by a 6-2 margin.  The debate was accompanied by the usual testimonials, including one videotaped by Brittany Maynard before her suicide.

Opponents raised appropriate arguments against the bill.  Perhaps the key statement was made by Dr. Warren Fong, president of the Medical Oncology Association of Southern California, who said that physician-assisted suicide “is against everything a physician stands for.”

Bingo.  The key argument against PAS, in my view, is that it fundamentally alters the nature of medicine by abolishing the Hippocratic divide between the healer and the executioner.  This is a more essential argument than the (also correct) consequentialist arguments about the risks of abuse, etc., about which I have posted on several occasions in the past.  Note also that, even if one’s motivation against PAS is ultimately driven by a belief in God, theism is not required to adopt the position that Dr. Fong took.  As such, it is not “epistemologically privileged” in any way that can be disqualified from public policy-making on grounds of liberal neutrality, nor is opposition to PAS simply a matter of my “imposing my morality” on someone else.

Legalizing PAS would be a terrible mistake.  Regrettably, my paper says that a recent poll it took in San Diego, where I live, showed that 56 percent of those polled would support this bill, 26 percent would oppose it, and 16 percent were not sure. 

Yipes.

Next step is the California Senate Judiciary Committee.  After that, passage of both houses of the legislature is required, then the governor’s signature.  I certainly plan to beseech my representatives, and the governor, to oppose SB 128.  Governor Brown is said to have studied for a time, years ago, to be a Catholic priest, so it may not be a slam-dunk even if it gets to his desk.

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Barry Orvell, MD
Barry Orvell, MD
6 years ago

In quoting Dr. Fong, on his testimony that a physician is healer I would ask “What is the role of a healer when faced with a dying patient? How does the Healer comfort the dying and ready them to accept this part of the process of their time in the world?”
And should the Healer stand in opposition to the person who is about to die and who requests an end to his suffering?
I am a retired physician in favor of asstance in dying. I was at the Senate committee hearing and Dr. Fong also said that not one patient among 5000 with terminal cancer that he care for, not one requested aid in dying.
Same here. I never got a request while in practice . And where it is legal, Oregon, only about 70 chose this way out among the over 15,000 Oregonians who died in 2015.
The importance of this option is not in the using of it, few do, but in just knowing it is there just in case.

Carol Eblen
Carol Eblen
6 years ago

Unfortunately, PAS will mean many premature deaths and further sanction of the involuntary euthanasia of the elderly/disabled/poor on both Medicaid and Medicare as orginal Medicare is transformed to a huge Health Maintenance Organization where profits will be protected for Big Insurance by refusing life-sustaining treatments as non beneficial.

PAS is the fastest, cheapest, and less burdensome FINAL solution for Medicaid, Medicare, Big Insurance, the patient, the family, and the heirs. PAS and Hospice will be the ONLY option when Hospice is no longer an option, a choice, but the ONLY option and choice open to Medicare/Medicaid patients. The trial conducted by CMS last year indicates that CMS wants to make curative care and Hospice a concurrent entitlement under Medicare/Medicaid and redefine the meaning of “terminal” in terms of time.

Do you think the Legislators don’t know that PAS in conjunction with Hospice will be a money saver?

Steve Phillips
6 years ago

I believe that the truly compassionate physician says to the patient who is dying and is considering PAS “Your life has value even if you are unable to see that right now. I will be with you and help you live your life the best that you can for the time you have left. I care about you too much to say that your life has no value by helping you kill yourself.”

Barry Orvell, MD
Barry Orvell, MD
6 years ago
Reply to  Steve Phillips

A greed some insurance companies are the villains, somewhat and I agree with Phillip “human life has value always”.
But when we consider that 1. the patients suffereing and will soon die no matter what is done. Some cancers are pretty bad esp. when in bone, or brain. The onlymercy is sedation to unconsciouness.
The metaphor of the burning building : The flames arrive at the 70th floor. I have only 2 options. Death by fire (my original diagnosis) or quick death by jumping out the window.
Is this suicide? Would you hope that the person stick around.
As far as insurance companies , they may need supervision on this. And all their decision would be negative is they could , and that will be the same with or without PAD. But, it is the patient’s decision? Not the Healers. nor the payers. If the healers says, my view of life is not to help people like suicidal people like you. Suffering make you a better person.
Would anyone choose a life without death ever?

Carol Eblen
Carol Eblen
6 years ago

Yes, of course. The patient who has received an honest terminal diagnosis should have the right and does have the right under the law of the 1991 Patient Self Determination Act to shorten his/her life by refusing life-sustaining treatment, including food and water.

But, the 1991 PSDA is being circumvented both in terms of “right to die” and “right to live.” The Congress, under both political parties, have failed to clarify the provisions of the law of the PSDA and the states have interpreted the PSDA in many different ways.

Under the PSDA, unilateral Do Not Resuscitate Code Status is prohibited. However, in the real world covert and overt unilateral DNR Code status is often used by the hospitals to withhold or withdraw life-sustaining treatment that they KNOW will not be reimbursed by Medicare/Medicaid and Advantage and private big insurance.

The ABA offered an opinion to The Congress and CMS that medical treatment in opposition to the patients’ advanced directives would not have to be reimbursed by CMS but, of course, if they clarified this in federal law, they would have to clarify the right to full code status and legally define “medical futility” under federal law. The Congress would have to talk about the 14th Amendment Right to Live and reconcile and justify the necessity for rationing if Medicare/Medicaid patients aren’t going to be allowed to live as long as medically possible (if and when they want to live as long as is medically possible).

Surely, physicians must understand when so many states have changed their laws these past few years to prohibit discrimination against vulnerable elderly/disabled Medicare/Medicaid patients and disabled infants in code status that unilateral covert DNR that shortens life is a problem throughout the USA.

Yet, you ignore it! Why?

It is because so many physicians and bioethicists really don’t know what is going on financially in terms of lack of reimbursement to the hospitals that the involuntary euthasnasia of the elderly/disabled/poor/mentally ill on Medicare/Medicaid has become an ugly reality that is ignored.

Jon Holmlund
Jon Holmlund
6 years ago
Reply to  Carol Eblen

Thanks to all for the comments. I’ve been meaning to respond but keep putting it off because of my day job, etc…

Dr. Orvell, I particularly appreciate your participation here, and I think your points call for a more detailed response, probably in the form of a reprise of points I’ve made on this blog in the past, than fits in the comments section. I intend to do that with my next post of this coming Thursday–and, I must confess, I intend to challenge you and insist that the burden of proof rests with those who take your position to rebut, point by point, several arguments I’ve made–or, better, re-broadcast from others–in a series of past posts on this blog. For starters: the autonomy and “minimal harm” argument you suggest, one that I heard from another Oregonian physician at last October’s ASCO Palliative Care Conference, misses what I think is the key point; viz., that PAS fundamentally alters what it is to be a physician. That’s what I think Dr. Fong was after, too. More on that, and other points, later this week.

And, briefly, to Ms. Eblen: I don’t quite have the capacity to tackle the Medicare issues you bring up in detail. I am trying to address, a bit more formally, the matter of unilateral DNRs, but it is taking me some time…