By Marilyn Golden | 05/22/08 12:00 AM PST
From the title of Assemblymember Patty Berg’s piece (Capitol Weekly, May 15, “A little honest talk isn’t going to hurt anyone — really”), you would think the article would reflect some truth in advertising. Unfortunately, readers had no such luck.
The real “honest talk” about AB 2747 is that it has very little to do with improving care. For this bill, the devil is really in the details. Close inspection reveals it to be a vehicle for Compassion and Choices’ long-term agenda: facilitating assisted suicide. Let’s not forget that this is the organization formerly known as the Hemlock Society and one of the primary sponsors of this legislation. The bill includes many elements that would significantly undermine end-of-life care in service of this goal.
This bill represents a change in strategy by Compassion and Choices after three years of defeat. Every year since 2005, the group tried to legalize assisted suicide in California. Each year, strong bi-partisan opposition defeated that legislation. On a new tack, this bill would pave the way for their hoped-for future legalization of assisted suicide.
AB 2747 would mandate that doctors discuss with patients still a year from death, unusual end-of-life courses of action including voluntarily starving and dehydrating themselves, which is not even a medical treatment. Opposition by the doctors who are most experienced with end-of-life care, such as the Association of Northern California Oncologists, illustrates how medically inappropriate these mandates are. This heavy-handed bill would damage doctor/patient relationships by mandating a discussion of ways a patient can end her life at the very time when physicians are pursuing valuable treatment efforts, such as surgery, radiation, and chemotherapy. Patients will be confused about physicians’ true motivations and whether they are doing all they can for patients’ health and well-being.
Moreover, mandating a discussion on ways a patient can end his life by forcing a doctor to discuss the same life-ending options with every terminal patient is risky and inappropriate. It is risky because it can sound like the doctor is endorsing or encouraging the patient to end his life. It is inappropriate because intimate, personal discussions during emotional times should not be mandated by law.
To mandate this discussion a year in advance of death is shockingly early. It is not unusual for a “terminal” patient to dramatically outlive her terminal prognosis by many years. To force such a discussion on a patient at that time is not fair to the patient. One must ask what end is served by this timing.
Moreover, many cancer patients who see a doctor with a late diagnosis are in the final stages of their disease, and are uninsured or under-insured. Such patients may feel the economic pressures are too great, and submit to the physicians’ mandated directions on ways to end their lives, in order to save their families the burden of health care costs. The option of ending their lives prematurely should not be the solution to the economic problems associated with health care.
AB 2747 also suggests patient referrals to the very groups promoting assisted suicide, such as Compassion and Choices, to provide information and counsel patients on their eventual end-of-life care options at this very early one-year prognosis point. Again, one must ask why.
Despite recent minor amendments, the problems with the bill remain significant and numerous. It should be opposed unless significantly amended, to bring the bill into line with the ostensible, harmless goals being touted as AB 2747’s true aims.