May 21, 2015; San Jose Mercury News
This is the story of a nonprofit’s power to effect change.
NPQ has been covering the vulnerable position of right-to-die advocacy groups that face criminal prosecution for assisting in the deaths of terminally ill patients. In the fall of last year, terminally ill Brittany Maynard made the choice to move to Oregon. Under that state’s Death with Dignity Act, the 29-year-old Berkley graduate could terminate her life with the assistance of her physician. Suffering from brain cancer, she determined that when her health had deteriorated to the extent that she had little quality of life and her death was imminent, she would make the decision to take a lethal dose of doctor-prescribed medication and die peacefully at home.
Compassion & Choices, a nonprofit committed to “helping everyone have the best death possible” partnered with Maynard to establish the Brittany Maynard Fund to support legalization of aid in dying in states where it is now illegal. In a six-minute video, Brittany announced her choice to the country in a story that went viral through social networks: “My dream is that every terminally ill American has access to the choice to die on their own terms with dignity. Please take an active role to make this a reality.” After her death on November 1, 2014, People magazine published a cover story featuring her and her husband Dan Diaz, promoting the Fund.
Public outcry for federal and state legislators to revisit laws prohibiting physician-assisted suicide is now ubiquitous. Last week, the California Medical Association (CMA) a powerful physicians lobbying group, announced a reversal of its three decades–long opposition to aid-in-dying legislation. The determination was made just as California is considering a bill (SB 128) that would permit doctors to prescribe a lethal dose of a pharmaceutical drug to those with less than six months left to live.
Last year when it became evident that the legislature would likely take up a fresh bill, the association launched another intensive review. Calling the decision to terminate a life “a very personal one between a doctor and their patient,” CMA has “removed policy that outright objects to physicians aiding terminally ill patients in end-of-life options,” according to a prepared statement from Dr. Luther F. Cobb, the association’s president.
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State senators Bill Monning (D-Monterey) and Lois Wolk (D-Davis) are the sponsors of the End of Life Option Act. The bill is “a major breakthrough—a game changer,” they said in a joint statement. “This comes as the result of months of productive discussions with physicians, psychiatrists, oncologists, family physicians and palliative care specialists.”
That’s not to say the association approves the bill, but rather has taken a stated stance of neutrality. Dr. Ted Mazer, speaker of the CMA’s policymaking body, said, “There are lots of doctors who think doctors should not be in the position of ending life,” adding that he himself remains “on the fence” and continues to wrestle with the issue. “Physicians’ opinion remains divided, but the majority of physicians believe you should either allow this and participate or you should be neutral and allow the physician and the patient to make the decision.”
The American Medical Association, the most powerful physician association in the country, recommends hospice care for those seriously ill and nearing the end of life. Other California physician groups support the national association’s position. “No amendments can change the fact that ‘an act that directly causes the patient’s death’ is contrary to the role of the physician,” said a statement released by the Association of Northern California Oncologists and the Medical Oncology Association of Southern California. “We feel that better palliative care efforts can improve end-of-life care when death is inevitable, without the guilt and ethical dilemma engendered by SB 128.”
Those in opposition cite the gray area of physician-assisted suicide proposing that it’s an ethical slippery slope. Given the high cost of medical care, would euthanasia be extended to patients who are incompetent or people from vulnerable populations including the elderly? What if the loss of quality of life as a determinant would have a broader focus to include those with chronic disease or disability?
At this time, the Senate Appropriations Committee is determining whether the bill should go to the senate and the assembly for approval. The committee’s research indicates that it would cost $235,000 per year for the Department of Public Health staff to collect data, follow up on prescriptions with physicians, and create a required annual report. Another $275,000 per year would be needed to review medical records and ensure compliance to established requirements.
The effect of Compassion & Choices’ Brittany Maynard campaign in bringing about a sea change in the debate is profound. The power that nonprofits gain through social media comes in mobilizing the public and changing the political landscape.—G. Meredith Betz