ANALYSIS OF CALIFORNIA'S ASSISTED SUICIDE PROPOSAL "COMPASSIONATE CHOICE ACT" (AB 654)

AB 654 would legalize assisted suicide. It would make assisted suicide a medical treatment. AB 654 would give doctors the power to prescribe lethal drug overdoses to patients for the purpose of causing death.

On February 17, 2005, Assemblywoman Patty Berg (D-Santa Rosa) and Assemblyman Lloyd Levine (D-Van Nuys) introduced AB 654, the California "Compassionate Choice Act" (CCA). It is patterned after Oregon's law permitting assisted suicide.

AB 654 does not require that family members be notified when a doctor is going to help a loved one commit suicide.

Family notification is not required, only suggested. [Sec. 7196.4] The patient's family doesn't need to be notified until after the patient is dead.

AB 654 would give government health programs, managed care programs and HMOs the opportunity to approve prescriptions for suicide to cut costs.

In Oregon (the only state with a law permitting assisted suicide), Medicaid pays for assisted suicide for poor residents under the category of "comfort care," and spokes-persons for health insurance plans said assisted suicide "…would be no different than any other covered prescription." [Oregonian, 2/27/98; Statesman Journal, 12/6/94] The drugs for assisted suicide cost about $50 – far less than medications to make patients comfortable.

AB 654’s supporters claim that, if the bill passes, physicians would not be able to suggest assisted suicide to their patients. That claim is false.

AB 654 does not allow anyone to "coerce" or use "undue influence" to obtain a request for assisted suicide. [Sec. 7198.5 (b)]

However, nothing in AB 654 prohibits HMOs, insurance companies, health providers, or others from suggesting assisted suicide to a patient or encouraging a patient to request a lethal prescription.

AB 654 would permit doctors to help mentally ill or depressed patients commit suicide.

A referral for counseling is only necessary if, in the "opinion" of the attending or consulting physician, the patient requesting death has a "psychiatric or psychological disorder, or depression, causing impaired judgment." [Sec. 7196.2, emphasis added.] "Counseling" is defined as "a consultation" between a psychiatrist or psychologist and the patient. [Sec. 7195.1(e)]

Even if the counselor determines that the patient is mentally ill or depressed, that patient would still be able to get help to commit suicide as long as the counselor determines that the patient's judgment is not impaired.

During the last year for which Oregon reports are available, only 5% of patients were referred for a psychological evaluation or counseling before receiving a prescription for assisted suicide. [American Medical News, 4/5/04]

AB 654 would allow drugs for suicide to be mailed to the patient.

Nothing in AB 654 requires the patient to obtain the drugs in person. In one reported death under Oregon’s assisted-suicide law, the patient received the lethal overdose by Federal Express. [Oregonian, 1/17/99]

AB 654 does not require that requests for assisted suicide be made in person.

Under AB 654, a patient must make two oral requests and one written and witnessed request for assisted suicide. [Sec. 7196.5] The two oral requests (which do not need to be witnessed) could be made by phone and the witnessed written request could be sent by mail to the doctor, who could then prescribe the drugs for assisted suicide.

AB 654 has no safeguards for the patient at the time the drug overdose is taken.

AB 654 covers only the time until the prescription for suicide is written. The lethal drugs could be stored over time, with no concern for public safety or patient protection. There are no provisions to insure that the patient is competent at the time the overdose is taken.

AB 654 has no provisions to track abuse or the number of deaths from assisted suicide.

As with the Oregon assisted-suicide law, AB 654 requires that assisted suicide be reported [Sec. 7197.1], but there are no penalties for not reporting. Following the first year after the Oregon law went into effect the Oregon Health Division (OHD) – now called the Department of Human Services (DHS) – which is responsible for collecting the required information, issued a report stating that "it is difficult, if not impossible, to detect accurately and comment on underreporting." [NEJM 2/18/99, 583]

And since whatever is reported comes from the very doctors who prescribe the lethal doses, the information may be fabricated. According to the OHD, "For that matter, the entire account could have been a cock and bull story. We assume, however, that physicians were their usual careful and accurate selves." [OHD, CD Summary, vol. 48, no. 6, 3/16/99; emphasis added.]

From the time Oregon’s assisted-suicide law went into effect, state officials in charge of formulating annual reports have conceded "there’s no way to know if additional deaths went unreported" because DHS "has no regulatory authority or resources to ensure compliance with the law." [American Medical News, 9/7/98]

AB 654 supporters claim it would offer a choice to people who want it. But it would actually victimize minorities, people with disabilities, and poor people.