Coercion Risk Clouds Euthanasia Bill

SACRAMENTO — Elisabeth Kübler-Ross, the late Swiss-born psychiatrist who wrote extensively about death and dying, found that “those who put a high value on being in control of their own existence are offended by the thought that they too are subject to the forces of death.” I thought of her writings after Senate committees approved the “End of Life Option Act,” which would legalize physician-assisted suicide in California.

Death is a difficult topic. Our society is reluctant to talk about it openly and forthrightly, even though it is a ubiquitous part of our world. Advocates for SB 128 are trying to raise the issue — and in doing so, they bring up that “control” issue. Advocates for the bill wore T-shirts at the hearing touting the need for “choices” in death, which they see as a fundamental human right. But it’s a much thornier matter than they admit.

According to the Senate analysis, the bill would “permit competent, terminally ill, California residents over the age of 18 who meet certain criteria to request aid-in-dying medication to be self-administered by the individual for the purpose of ending his or her life.” It was inspired by 29-year-old Brittany Maynard who, suffering from terminal brain cancer, went to Oregon, where it is legal to take “aid-in-dying” medicine. This made national headlines.

While Maynard was able to control the terms of her death, many critics worry that such laws provide an incentive for coercion — e.g., by family members seeking to hasten a death, by insurance companies who find such aid less expensive than months of additional treatment, by governments worried about limited health-care dollars.

Euthanasia supporters say there hasn’t been a problem with coercion in Oregon, but others point to troubling incidents. Marilyn Golden, with the Disability Rights Education & Defense Fund, told the San Francisco Chronicle’s Debra Saunders about a health plan’s denial of chemotherapy while it offered instead to pay for that patient’s euthanasia. “Golden chalks up the low numbers (of such reported incidents) to Oregon’s toothless law that has no mechanism to uncover abuses,” Saunders wrote.

“Perhaps the most significant problem is the deadly mix between assisted suicide and profit-driven managed health care,” Golden wrote on her organization’s website. “Again and again, health maintenance organizations (HMOs) and managed care bureaucracies have overruled physicians’ treatment decisions.”

Anyone who has dealt with our current health-care system can certainly imagine these scenarios. The potential problem is not just with for-profit operations, either. Government health-care bureaucracies are likely to do the same thing, especially as soaring costs turn the provision of health services into a zero-sum game (if we pay more for one patient, we must provide fewer services for others).

The California Medical Association opposes this bill unless amended (even though there are differing opinions among doctors). It “has expressed concern that physician-assisted suicide contravenes the fundamental principal of the medical profession: ‘Do no harm,’” according to the Senate analysis.

The bill promises to “protect individuals from obtaining such medication as a result of coercion or undue influence.” But how many laws promise extensive oversight and accountability, yet fail to deliver? SB 128 promises exemptions for health-care providers with religious objections, but such protections will almost certainly come under fire eventually, as we’ve seen with regard to other contentious social policies (abortion, gay marriage).

Advocates share sad stories of loved ones who endured intense suffering in their last stages of life. “This legislation is long overdue for California residents who have a terminal diagnosis and are concerned with the unknown suffering and physical effects from the disease,” said co-author Sen. Bill Monning, D-Carmel, in a statement. I see his point.

But the choice comes down to this: Is the broader risk of coercion worth a reduction in suffering for those who choose to end their life this way?

I’m not sure the answer, but I’ve never found the California Legislature to be a font of moral clarity. It’s at times hard to trust legislators to make nuanced judgments about regulatory and tax issues, let alone issues of life and death. I’d prefer if the Legislature spent more time letting us control our own destinies during our lives and worried less about giving us choices on our death bed.

Steven Greenhut is the California columnist for U-T San Diego. Contact him at


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