When doctors gave 29-year-old Brittany Maynard a prognosis of six months to live, she considered spending her last days in hospice care at her San Francisco Bay-area home.
But Maynard decided she didn’t want her family to see her mind and body deteriorate. After some research, Maynard and her husband moved to Oregon, which is one of only five states in the U.S. with legalized physician-assisted suicide.
The couple settled into a new home in Portland and on Nov. 1, Maynard ended her life with a fatal dose of a lethal prescription. She was nearly 1,000 miles from her hometown in California.
California lawmakers wasted no time in harnessing the momentum of the assisted suicide movement in the wake of Maynard’s suicide. Two months after Maynard’s death, Senators Hannah-Beth Jackson (D-Santa Barbara) and Lois Wolk (D-Solano) introduced the End of Life Option Act, SB 128.
The measure would allow doctors in California to prescribe a lethal dose of medication to patients who have a prognosis of six months to live or less. It is modeled after Oregon’s Death With Dignity Act, which went into effect in 1997.
Proponents have painted SB 128 as humane and even empowering for terminal patients in California like Maynard. However, disabilities rights groups and Catholic leaders warn SB 128 is a recipe for abuse, not autonomy — and using Maynard as the poster child of the measure is deceptive.
“There is an idea of Brittany Maynard being a young, beautiful woman who was brave and took control of her life at the end; and I think people find that attractive,” said Andrew Rivas, director of government and community relations for the Archdiocese of Los Angeles.
“It’s deceptive,” Rivas continued. “The face of the people who are most affected and most impacted is not the face of Brittany Maynard. It’s the face of somebody like a grandmother.”
Public health records in Oregon reveal that Maynard’s age group of 34 years and younger accounts for less than one percent of assisted suicide patients. The average age of patients in the state is actually closer to 71.
California’s elderly are not only the most likely to take advantage of legalized assisted suicide in the state. They are also the most likely to be taken advantage of because of the measure.
California law recognizes that the elderly are particularly susceptible to abuse. The state has laws in place criminalizing the abuse of persons 65 years and older.
However, SB 128 would pave the way for new avenues of elder abuse in California because of the measure’s lack of oversight, said Margaret Dore of the organization, Choice is an Illusion.
In Oregon, any medical oversight ends the minute a lethal prescription changes hands from the pharmacist to the patient. A doctor is not required to be present at the time of the patient’s death and the patient is not required to ingest the medication within a certain time frame. Patients are also not required to administer the lethal dose themselves.
“With this situation, the opportunity is created for an heir, or some other person who will benefit from the patient’s death, to administer the lethal dose to the patient without her consent,” Dore said in a blog post. “Even if she struggled, who would know?”
Reports in Oregon reveal a trending disconnect between the time patients receive lethal prescriptions and the time they ingest these prescriptions. Of the 155 patients who received lethal prescriptions in Oregon in 2014, only 94 ingested the medication.
Thirty-seven of those patients died of other causes but 24 are still in possession of the lethal prescription. Eleven patients who received lethal prescriptions in 2012 and 2013 ingested the medication in 2014.
Another key problem seen in Oregon is the assimilation of assisted suicide into a for-profit economic sector like healthcare. Despite legal provisions to prevent the incentivizing of assisted suicide, the Oregon Health Plan has been implicated several times in denying coverage of expensive treatments but offering coverage of significantly less expensive lethal prescriptions.
In one case, a 64-year-old Oregon native was denied coverage of a chemotherapy drug for her lung cancer, which was in remission. The Oregon Health Plan did, however, offer coverage of a lethal prescription.
For instance, Barbara Wagner’s chemotherapy drugs would have cost $4,000 a month. The lethal prescription reportedly would have been a one-time cost of $50.
This troubling trend could have catastrophic implications in California, where a large percentage of the population receives some sort of financial assistance for healthcare.
Rivas warned these likely financial pressures on California patients would also be compounded by intrinsic cultural mindsets of California’s large minority populations.
“Then you translate that to populations such as Hispanic, Asian or African American, where you have a real cultural mindset of sacrificing for the family,” Rivas said. “In a situation where someone is faced with a decision of terrible financial cost … it’s very likely the pressure will be on to again sacrifice for the family.
“So it wouldn’t be a decision [patients] voluntarily take,” he continued. “It’d be one where they feel boxed in.”
Rivas said patients may also feel that assisted suicide is their only option because palliative care is more expensive and is also a fairly new and underdeveloped medical discipline. He warned SB 128 would also handicap developments of palliative care in California, specifically elderly long-term healthcare.
“The investment [in palliative care development] will not be made,” Rivas said. “The option will always be to go the cheapest route.”
California-based physician Ira Byock has also suggested SB 128 would make a lethal prescription more attainable for patients than admission into a hospice program. According to the Los Angeles Times, patients would be required to stop life-saving treatments to begin hospice care but not to secure a lethal prescription.
Patients would lose hospice care if their condition improves, but they would not lose access to a lethal prescription.
“That sends a message,” Byock said in comments to the L.A. Times. “If you’re terminally ill, it’s too expensive for us to continue to give you hospice care, but here’s this medication — go take care of yourself.”
Another troubling aspect of SB 128 is that its definition of “terminal disease” would apply to persons with chronic conditions. The California measure uses the same definition of “terminal disease” as Oregon’s Death With Dignity Act: “‘Terminal disease’ means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgement, produce death within six months.”
Dore warned this definition of “terminal disease” is interpreted in Oregon to include those with chronic conditions — including diabetes.
“An 18 year-old with insulin-dependent diabetes is ‘terminal’ under the law,” Dore warned. “‘Eligible’ people may have years, even decades, to live.”
Legalized assisted suicide has always been painted as the ultimate champion of personal autonomy. The overwhelming majority of patients in Oregon last year reported they were driven to assisted suicide by loss of autonomy, a decreased ability to participate in activities that made life enjoyable and a perceived loss of dignity.
Rivas warned the image of assisted suicide as empowering is a lie. And he said this fact is illustrated by the outcome of assisted suicide measures in Oregon and Washington.
“In the eagerness for people to gain control of the end of their lives, they don’t understand that they’re actually giving control over to somebody else,” Rivas said. “The control then belongs to everybody else they come in contact with when they’re faced with a seriously, life-threatening illness.”
Dore echoed Rivas’ warning.
“The claim of patient choice and control being assured is baloney,” she said. “These laws are a recipe for abuse.”