The California State Assembly passed legislation Wednesday that would allow physicians in the state to prescribe life-ending medications to those with a terminal illness who wish to end their lives. The End of Life Option Act, passed late Wednesday by a vote of 43-34, outlines specific and detailed circumstances under which life-ending drugs could be prescribed. The bill now moves on to the State Senate, which will vote to approve or deny. A similar bill was passed by the Senate by a narrow vote earlier this year.
The Assembly’s passage of the bill has re-ignited the entire spectrum of reactions, from those who say it is state-sanctioned suicide to those who say it is a long-overdue step forward in the right to choose death with dignity. The bill, saddled with a decades-long history of debate among religious leaders, medical ethics leaders and death-with-dignity advocates, would also have to gain the signature of Calif. Gov. Jerry Brown before becoming law.
As written, the California bill would require two verbal requests for life-ending medication, at least 15 days apart, as well as a written request. The written request, the bill states, must be attested in front of two witnesses, and must be conducted by a resident who is “of sound mind,” according to the Los Angeles Times.
For the long-term care industry, California’s actions trigger deep questions on care processes and protocols, including a much stronger impetus to educate residents with life-threatening conditions on the values—and limits—of advanced directives. A California right-to-die law also could change that state’s legal guidelines pertaining to the definitions and roles of guardianship and how a resident’s wishes need to be documented, creating a nationwide impetus to rethink the documentation of care wishes for those with terminal illnesses.
Should the California bill become state law, the biggest hurdle for the state’s long-term care facilities will surely be in the realm of late-stage dementia care. Ironing out the legal ramifications for residents with degenerative diseases affecting cognition–diseases that affect a resident’s ability to make decisions—will place much greater emphasis on earnest care discussions and advanced directives in the early stages of cognitive diseases like Alzheimer’s and Parkinson’s.
If the bill becomes law, California would become the fifth U.S. state to legalize the prescription of life-ending drugs to terminal illnesses, along with Montana, Oregon, Vermont and Washington.