Anita Friedman doesn’t believe many patients will end up taking advantage of the aid-in-dying bill Gov. Jerry Brown signed into law this week.
However, the executive director of the S.F.-based Jewish Family and Children’s Services, one of the largest family service institutions in the United States, does believe the law will change for the better the way society manages end-of-life care.
Noting that in Oregon 859 patients (a small number relative to the state’s population of 3.97 million) have followed through with physician-assisted suicide since a similar law went into effect there 18 years ago, Friedman, a frequent speaker and writer on issues of health, social services and senior care, said the value of the California law is that it “raises the issue and inspires conversation about how to improve quality of life for seriously ill people so they don’t feel so desperate that they want to commit suicide.”
The End of Life Option Act, signed by Brown on Oct. 5, allows doctors to prescribe lethal doses of drugs to terminally ill patients, as long as certain safeguards are met. Those include verification from two doctors that the patient has fewer than six months to live and that patients be physically able to ingest the meds themselves. Those living with dementia are not eligible.
The lead author of the bill was Assemblywoman Susan Talamantes Eggman (D-Stockton), a practicing Catholic who was born in Castro Valley; state Sen. Lois Wolk (D-Vallejo), a charter member of the California Legislative Jewish Caucus, was a major supporter.
California joins Montana, Oregon, Vermont and Washington as the only states where the practice is legal.
According to an online poll conducted by U.C. Berkeley’s Institute of Governmental Studies in August, 76 percent of Californians support allowing the terminally ill to voluntarily end their lives by taking drugs prescribed by a doctor.
The issue of physician-assisted suicide has been debated within the Jewish community for years, and disagreements remain.
Writing for the Jewish Virtual Library, Orthodox Rabbi Yitzchock Breitowitz says active termination of a life is prohibited under Jewish law, though withholding treatments such as chemotherapy, as well as a “Do not resuscitate” order for terminally ill patients, may be permissible.
Some activists assert that Jewish ethics support the active ending of suffering. Rabbi Seth Castleman of Congregation B’nai Harim in Grass Valley lobbied for passage of the law, citing Jewish text for support.
“The Talmud says endless suffering is worse than death,” he told J. when the bill was working its way through the Legislature. “The more suffering is extended, so, too, is it worse than death. Medicine has lost some perspective in the last decades: Death is a failure of medicine, and keeping someone alive at all costs can be the goal.”
Others in the Jewish community decry the new law, saying it fails to account for potential elder abuse, coercion on the part of family members, and economic disparity.
Marilyn Golden, a senior policy analyst for the Berkeley-based Disability Rights Education and Defense Fund, strongly opposed the bill and worries it will usher in unwelcome changes.
“There is a deadly mix between our broken, profit-driven heath care system and suicide, which becomes the cheapest treatment,” she said. “Insurers will deny or delay approval of someone’s expensive life-saving treatment, and steer toward hastening their death. Do we think insurers will do the right thing or the cheap thing?”
She also scoffed at proponents’ assertion that the law gives patients more choice.
“In California, millions of people are on MediCal or are underinsured [and] have few, if any, health options,” Golden said. “Some cannot find hospice care or palliative care, but to have this choice and no other health-care options seems a cruel irony. Are we doing this so people with limited economic means are ending their lives sooner because they don’t have money?”
Golden, who is Jewish, believes the Jewish community should consider the social justice aspects of the issue. She also said there are reasonable alternatives to physician-assisted suicide.
“Palliative care can palliate any pain, doctors tell us,” Golden said, “and when it doesn’t work, the person can be sedated to the point that the person is relieved. My heart goes out to people dealing with terminal illness, but we’re also trying to heed the need of a larger number of people who stand to be harmed [by the law].”
Dr. Jessica Nutik Zitter, an intensive care and palliative care physician at Highland Hospital in Oakland, has written extensively on the subject of end-of-life medical care, including pieces for New York Times. The subject of a feature article in J. last year, she has been a supporter of the bill and is encouraged that it is now law.
However, she does have concerns with the manner in which it may be applied. Zitter worries that doctors, families and patients may now not give palliative care a proper trial.
“I wouldn’t want a physician to assist patients in ending their lives unless a very adequate, intensive approach at palliation had first been employed and failed,” she said. “I would want a committee of doctors, not just one, even if it’s the patient’s longstanding primary care doctor.”
She also thinks medical matters as weighty as end-of-life decisions merit an ethics committee to make the decision.
“There are a lot of cases in the hospital where we call in an ethics committee — why not when we talk about end-of-life assistance?” Zitter posited. “Hastening death to me seems like a time to call in more than one doctor, maybe in the model of the ethics committee.”
Conversations about end-of-life care are nothing new to Daniel Ruth. The executive director of the Jewish Home in San Francisco said the topic often comes up when he’s talking with elderly residents and their families. “I find that when people approach me about this, typically they are in favor of this kind of legislation,” Ruth said, “because it’s about control: control of their own destiny and their own outcome.”
Speaking for himself and not for the Jewish Home, Ruth said he is “a big believer in wanting to have control over my life and my death. Knowing that the law exists would give me all kinds of comfort emotionally and spiritually. I’m a proponent of anything that provides me with choice and a sense of control.”
Golden said she was deeply disappointed by the governor’s decision to sign the bill, but added she and her allies will “keep all options on the table” in fighting the law.
Meanwhile, Castleman echoed Friedman’s observation that relatively few Oregonians have ended their lives via that state’s law, and he expects the same will hold true in California.
“Few actually went through with it,” he noted. “Which goes to another major value: People feel so disempowered at the end of life. Just having the medicine on hand, knowing they will be able to exercise this decision, if you talk to those families they’d say it helps enormously.”