BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | ABX2 15|
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THIRD READING
Bill No: ABX2 15
Author: Eggman (D), Alejo (D), and Mark Stone (D), et al.
Amended: 9/3/15
Vote: 21
ASSEMBLY FLOOR: 44-35, 9/9/15 - See last page for vote
SUBJECT: End of life
SOURCE: Author
DIGEST: This bill permits a competent, qualified individual
who is an adult with a terminal disease to receive a
prescription for an aid-in-dying drug if certain conditions are
met, such as two oral requests, a minimum of 15 days apart, and
a written request signed by two witnesses, is provided to his or
her attending physician, the attending physician refers the
patient to a consulting physician to confirm diagnosis and
capacity to make medical decisions, and the attending physician
refers the patient to a mental health specialist, if indicated.
Sunsets these provisions on January 1, 2026.
ANALYSIS:
Existing law:
1) Establishes requirements for health care providers when a
provider makes a diagnosis that a patient has a terminal
illness, including that the patient has a right to
comprehensive information and counseling regarding legal end
of life options, which includes information about hospice
care at home or in a health care setting, that he or she has
a right to comprehensive pain and symptom management at the
end of life, including, but not limited to, adequate pain
ABX2 15
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medication, treatment of nausea, palliative chemotherapy,
relief from shortness of breath and fatigue, and other
clinical treatments useful when a patient is actively dying.
2) Provides that a resident of a long term care facility lacks
capacity to make a decision regarding his or her health care
if the resident is unable to understand the nature and
consequences of the proposed medical intervention, including
its risks and benefits, or is unable to express a preference
regarding the intervention. Requires the physician, in making
the determination regarding capacity, to interview the
patient, review the patient's medical records, and consult
with facility staff, family members and friends of the
resident, if any have been identified.
3) Makes it a felony to deliberately aid, or advise, or
encourage another to commit suicide.
This bill:
1) Permits an individual who is an adult with the capacity to
make medical decisions and with a terminal disease to request
and receive a prescription for an aid-in-dying drug if all of
the following conditions exist:
a) The attending physician has diagnosed the individual
with a terminal disease;
b) The individual has voluntarily expressed the wish to
receive a prescription for an aid in dying drug;
c) The individual is a resident of California and is able
to establish residency, as specified;
d) The individual documents his or her request for
aid-in-dying drug, as specified; and,
e) The individual has the physical and mental ability to
self-administer the aid-in-dying drug.
2) Requires a request for a prescription for an aid-in-dying
drug to be made solely and directly by the individual
ABX2 15
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diagnosed with the terminal disease and prohibits it from
being made on behalf of the patient, including, but not
limited to, through a power of attorney, an advance health
care directive, or any other legally recognized health care
decision-maker.
3) Requires a qualified individual wishing to receive a
prescription for an aid-in-dying drug to submit two oral
requests, a minimum of 15 days apart, and a witnessed written
request, as specified, to his or her attending physician.
Requires the attending physician to receive the three
requests, directly, and not through a designee.
4) Requires at least two adult witnesses who attest that to the
best of their knowledge and belief the individual is known to
them or has provided proof of identity, voluntarily signed
the request in their presence, is of sound mind and not under
duress, fraud, or undue influence, and not an individual for
whom either is the attending physician, consulting physician,
or mental health specialist.
5) Permits one of the two witnesses to be related by blood,
marriage, or adoption; or be a person entitled to a portion
of the person's estate upon death. Permits one of the two
witnesses to own, operate, or be employed at a health care
facility where the qualified individual is receiving medical
treatment or resides. Prohibits the attending physician,
consulting physician, or mental health specialist from being
one of the witnesses.
6) Permits an individual at any time to withdraw or rescind his
or her request for an aid-in-dying drug or decide not to
ingest an aid-in-dying drug, without regard to the
individual's mental state.
7) Requires before prescribing an aid-in-dying drug the
attending physician to:
a) Make the initial determination whether the requesting
adult has the capacity to make medical decisions; if there
are indications of a mental disorder the physician is
required to refer the individual for a mental health
ABX2 15
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assessment and cannot prescribe the aid-in-dying drug
until the mental health specialist determines that the
individual has the capacity to make medical decisions and
is not suffering from impaired judgment; has a terminal
disease, has voluntarily made the request, and is a
qualified individual.
b) Confirm the individual is making an informed decision
by discussing with him or her the medical diagnosis and
prognosis, potential risks with taking the drug, the
probable result of taking the drug, the possibility that
he or she may choose to obtain the drug but not take it,
and the feasible alternatives or additional treatment
opportunities including, but not limited to, comfort care,
hospice care, palliative care, and pain control.
c) Refer the individual to a consulting physician,
(defined as a physician who is independent from the
attending physician and is qualified by specialty or
experience to make a professional diagnosis and prognosis
regarding the individual's terminal disease), for medical
confirmation of the diagnosis, prognosis, and for a
determination that the individual has the capacity to make
medical decisions and has complied with this bill.
d) Refer the individual for a mental health specialist,
if there are indications of a mental disorder. Defines
counseling as one or more consultations, as necessary,
between an individual and a California licensed
psychiatrist or psychologist for the purpose of
determining that the individual is competent and is not
suffering from a psychiatric or psychological disorder or
depression causing impaired judgment.
e) Confirm the qualified individual's request does not
arise from coercion or undue influence by another person
by discussing with the qualified individual, outside of
the presence of any other persons, except for an
interpreter as required by this bill, whether or not the
qualified individual is feeling coerced or unduly
influenced by another person.
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f) Counsel the individual about the importance of having
another person present when he or she takes the drug and
not taking the drug in a public place, notifying next of
kin, participating in a hospice program, and maintaining
the aid-in-dying drug in a safe and secure location until
the time it will be ingested.
g) Inform the individual that he or she may rescind the
request at any time and in any manner.
h) Offer the individual an opportunity to withdraw or
rescind the request before prescribing the drug.
i) Verify, immediately prior to writing the prescription
for medication, that the individual is making an informed
decision.
j) Fulfill the record documentation, as specified.
aa) Complete the attending physician checklist and
compliance form, established in this bill, include it and
the consulting physician compliance form, established in
this bill, in the individual's medical record, and submit
both forms to the Department of Public Health (DPH).
bb) Give the qualified individual the final attestation
form, with the instruction that the form be filled out and
executed by the qualified individual within 48 hours prior
to the qualified individual choosing to self-administer
the aid-in-dying drug.
8) Requires, prior to a qualified individual obtaining aid in
dying medication from the attending physician, the consulting
physician to perform all of the following:
a) Examine the individual and his or her relevant medical
records;
b) Confirm in writing the diagnosis and prognosis;
c) Determine that the individual has the capacity to make
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medical decisions, is acting voluntarily, and has made an
informed decision;
d) If there are indications of a mental disorder, refer
the individual for a mental health specialist assessment;
e) Fulfill the record documentation requirement, as
established in this bill; and,
f) Submit the compliance form to the attending physician.
9) Requires the mental health specialist, upon referral from
the attending or consulting physician, to examine the
qualified individual and his or her relevant medical records;
determine that the individual has the mental capacity to make
medical decisions, act voluntarily, and make an informed
decision; determine that the individual is not suffering from
impaired judgment due to a mental disorder; and fulfill the
record documentation requirements established by this bill.
10)Requires within 30 calendar days of writing a prescription
for aid-in-dying drug, the attending physician to submit to
DPH a copy of the qualifying patient's written request, the
attending physician checklist and compliance form, and the
consulting physician compliance form. Requires within 30
calendar days following the qualified individual's death from
ingestion of the aid-in-dying drug, or any cause, the
attending physician to submit the attending physician
follow-up form to DPH.
11)Establishes a format for the aid-in-dying drug request and
requires that a request be in substantially the same form,
and translated, as specified. Requires the interpreter to be
qualified, as specified, and not related to the qualified
individual by blood, marriage, or adoption or be entitled to
a portion of the person's estate upon death.
12)Establishes the format of the final attestation form given
by the attending physician to the qualified individual at the
time the attending physician writes the prescription.
Requires the individual to complete the form within 48 hours
prior to the individual self-administering the aid-in-dying
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drug. Requires if aid-in-dying medication is not returned or
relinquished upon the patient's death, as required by this
bill, the completed form to be delivered by the individual's
health care provider, family member, or other representative
to the attending physician to be included in the patient's
medical record. Requires upon receiving the final
attestation form, the attending physician to add this form to
the medical records of the qualified individual.
13)Makes a provision in a contract, will, or other agreement,
executed on or after January 1, 2016, whether written or
oral, affecting whether a person may make, withdraw or
rescind a request for aid-in-dying drug, invalid. Prohibits
an obligation owing under any contract in effect on or after
January 1, 2016, from being conditioned upon or affected by a
person making or rescinding a request for an aid-in-dying
drug.
14)States that a death resulting from the self-administering of
an aid-in-dying drug is not suicide and therefore prohibits
health and insurance coverage from being exempted on that
basis.
15)Provides, notwithstanding any other law, that a qualified
individual's act of self-administering aid-in-dying drug may
not have an effect upon a life, health, or accident insurance
or annuity policy other than that of a natural death from the
underlying illness.
16)Prohibits an insurance carrier from providing any
information in communications made about the availability of
aid-in-dying drug absent a request by the individual or the
individual's attending physician at his or her behest.
Prohibits any communication from including both the denial of
treatment and information as to the availability of
aid-in-dying drug coverage.
17)Prohibits a person from being subject to civil or criminal
liability solely because the person was present when the
qualified individual self-administers the prescribed
aid-in-dying drug. Permits, without civil or criminal
liability, a person who is present to assist the qualified
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individual by preparing the aid-in-dying drug so long as the
person does not assist the qualified person in ingesting the
drug.
18)Prohibits a health care provider or professional
organization or association from censoring, disciplining,
suspending, or revoking licensure, privileges, membership, or
administering other penalty to an individual for
participating or refusing to participate in good faith
compliance with this bill.
19)Provides that a request by a qualified individual to an
attending physician to provide aid-in-dying drug in good
faith compliance with the provisions of this bill shall not
provide the sole basis for the appointment of a guardian or
conservator.
20)Provides, notwithstanding any other law, a health care
provider shall not be subject to civil, criminal,
administrative, disciplinary, employment, credentialing,
professional discipline, contractual liability, or medical
staff action, sanction, or penalty or other liability for
participating in this bill, as specified. States that
nothing in this provision shall be construed to limit the
application of, or provide immunity from 30)-34) below.
21)Permits a health care provider to prohibit its employees,
independent contractors, or other persons from participating
in activities under this bill while on premises owned or
under the management or direct control of that prohibiting
health care provider, as specified. Indicates that nothing
shall be construed to prevent, or to allow a prohibiting
health care provider to prohibit its employees or contractors
from participating in activities under this bill outside the
scope of the employee or contractor's duties, or while on
premises not owned by the prohibiting employer, as specified.
22)Prohibits a health care provider from being sanctioned for:
making an initial determination that an individual has a
terminal illness and informing him or her of the medical
prognosis; providing information about the End of Life Option
Act to a patient upon the request of the individual;
ABX2 15
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providing an individual, upon request, with a referral to
another physician; or, contracting with an individual to act
outside the course and scope of the provider's capacity as an
employee or independent contractor of a health care provider
that prohibits activities under this bill.
23)States that notwithstanding any contrary provision in this
bill, the immunities and prohibitions on sanctions of a
health care provider are solely reserved for actions of a
health care provider taken pursuant to this bill.
Additionally, health care providers may be sanctioned by
their licensing board or agency for conduct and actions
unprofessional conduct, including failure to comply in good
faith with this bill.
24)Makes it a felony to knowingly alter or forge a request for
aid-in-dying drug to end an individual's life without his or
her authorization or concealing or destroying a withdrawal or
rescission of a request for an aid-in-dying drug if the act
is done with the intent or effect of causing the individual's
death.
25)Makes it a felony to knowingly coerce or exert undue
influence on an individual to request or ingest an
aid-in-dying drug for the purpose of ending his or her life
or to destroy a withdrawal or rescission of a request, or to
administer an aid-in-dying drug to an individual without his
or her knowledge or consent.
26)Indicates that 24) and 25) above shall not be construed to
limit civil liability, and do not preclude criminal penalties
applicable under any law for conduct inconsistent with the
provisions of this bill.
27)Provides that nothing in this bill may be construed to
authorize a physician or any other person to end an
individual's life by lethal injection, mercy killing, or
active euthanasia. Provides that actions taken in accordance
with this bill shall not, for any purpose, constitute
suicide, assisted suicide, mercy killing, homicide, or elder
abuse under the law.
ABX2 15
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28)Requires DPH to collect and review the specified information
and to be collected in a manner that protects the privacy of
the patient, the patient's family, and any medical provider
or pharmacist involved with the patient under this bill.
Requires a report annually beginning on or before July 1,
2017, to be posted on the department's website.
29)Requires a person who has custody or control of any unused
aid in dying medication to personally deliver the unused
medication to the nearest qualified facility that properly
disposes of controlled substances, or if none is available,
dispose of it by lawful means.
30)Sunsets this bill on January 1, 2026.
Comments
1)Author's statement. According to the author, ABX2 15, the End
of Life Option Act allows an adult in California with a
terminal disease that has the capacity to make medical
decisions and who has been given a prognosis of less than six
months to live, to make end of life decisions. By giving these
patients the legal right to ask for and receive an
aid-in-dying prescription from his/her physician, ABX2 15
provides one more option to the number of options one has when
faced with the end of their life. This bill includes strong
provisions to safeguard patients from coercion and to allow
voluntary participation by physicians, pharmacists and health
care facilities. This medical practice is already recognized
in five other states. There is substantial evidence from those
states that prove this law can be used safely and effectively.
Californians that are faced with a terminal disease should not
have to leave the state in order to have a peaceful death. In
the end, how each of us spends the end of our lives is a
deeply personal decision. That decision should remain with the
individual, as a matter of personal freedom and liberty,
without criminalizing those who help to honor our wishes and
ease our suffering.
2)Other States. According to the National Conference of State
Legislatures, four states currently allow a person to request
ABX2 15
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a drug to end one's life, including: Montana, Oregon,
Vermont, and Washington. Montana's authorization was
determined in the 2008 case of Baxter v. State of Montana.
New Mexico's authorization was determined in 2014 Morris v.
New Mexico, however the New Mexico Attorney General appealed
the district court's ruling. According to the Albuquerque
Journal News, a divided New Mexico Court of Appeals reversed
the 2014 ruling in August 2015 but virtually guaranteed the
issue to be revisited by the New Mexico Supreme Court.
Oregon, Vermont, and Washington have authorized the practice
in statute, by voter initiative in Oregon (passed in 1994 and
enacted in 1997) and Washington (in 2008). In 2013, Vermont
passed legislation to authorize physician aid in dying.
Arkansas and Idaho have enacted laws which specifically
prohibit physician aid in dying.
3)Other Countries. Belgium, the Netherlands, Luxembourg,
Switzerland and, beginning next year, Canada, allow physician
aid in dying. The Netherlands and Belgium also allow
euthanasia (administered by a physician). Belgium extended
its law in 2014 to include children of any age living with
terminal illness. In the Netherlands, the law is not
available to children under 12 years old and for teenagers,
the law requires parental consent.
4)Oregon Data. According to the Oregon Public Health Division
2013 report, from 1998 to 2013, 1,173 were prescribed aid with
dying medication and 752 deaths occurred as a result of
ingesting prescribed medications. From 1998 to 2013, the
gender break down of those who died from ingesting a lethal
dose of medication was 52 percent male and 48 percent female.
Less than 32 percent of the individuals who ingested the
medication were between ages 18-64. Almost 70 percent were
over aged 65. The race breakdown was white (97 percent),
African American (.1 percent), American Indian (.3 percent),
Asian (1.1 percent), Pacific Islander (.1 percent), other (.1
percent), two or more races (.3 percent), and Hispanic (.7
percent). Over 46 percent of those who ingested the
medication were married and the remaining 64 percent were
widowed, never married, divorced, or status was unknown (three
individuals). Less than 28 percent of those who ingested the
medication had a high school education or less and 72 percent
ABX2 15
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had some college or higher education levels (five individuals
had unknown status). Ninety percent of those who ingested the
medication were enrolled in hospice. Sixty-three percent had
private insurance, 35 percent had Medicare, Medicaid or other
governmental insurance, and less than two percent were
uninsured (35 individuals had unknown status). Almost 80
percent of those who ingested the medication had malignant
neoplasms, seven percent had Amyotrophic lateral sclerosis,
five percent had chronic lower respiratory disease, two
percent had heart disease, one percent had HIV/AIDS and six
percent had other illnesses. Six percent of those who
ingested the medication were referred for psychiatric
evaluation. Ninety-four informed their family of their
decision. Ninety-five percent died at home, four percent died
in long-term care, and .1 percent died in the hospital.
Ninety-one percent of those who ingested the medication were
concerned about loss of autonomy, 89 percent were concerned
about being less able to engage in activities that make life
enjoyable, 81 percent were concerned about loss of dignity, 50
percent were concerned about losing bodily function, 40
percent were concerned about being a burden on family, friends
or caregivers, 23 percent were concerned about inadequate pain
control, and three percent were concerned about financial
implications of treatment. There were 22 complications of
regurgitation reported and six individuals regained
consciousness after ingesting the medications. A range of
between 15 and 1,009 days elapsed from the first request for
medication and death.
5)Brittany Maynard. According to Compassion and Choices, a
nonprofit that works to expand end of life choices, Brittany
Maynard was a California native with a terminal brain cancer
diagnosis who moved to Oregon to access its death with dignity
law. Brittany Maynard died in Oregon after taking
aid-in-dying drug on November 1, 2014. In the final weeks of
her life, Ms. Maynard partnered with Compassion and Choices to
launch a campaign to make aid in dying an open and accessible
medical practice in California and throughout the country.
According to Brittany Maynard, as published on CNN Opinion
Tuesday, October 7, 2014, "Because the rest of my body is
young and healthy, I am likely to physically hang on for a
long time even though cancer is eating my mind. I probably
ABX2 15
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would have suffered in hospice care for weeks or even months.
And my family would have had to watch that." After moving to
Oregon with her family, establishing the residency
requirements, and finding new physicians, Ms. Maynard obtained
aid-in-dying drug. "Now that I've had the prescription filled
and it's in my possession, I have experienced a tremendous
sense of relief. And if I decide to change my mind about
taking the medication, I will not take it?..When my suffering
becomes too great, I can say to all those I love, I love you;
come be by my side, and come say goodbye as I pass into
whatever's next."
6)Concerns. Allstate Insurance Company is concerned that the
language contained in Section 443.13 (a) and (b) could be
interpreted to constrain a life insurer's ability to conduct
its traditional underwriting practice, including the
consideration of the underlying terminal illness.
Related Legislation
SB 128 (Wolk and Monning) permits a qualified adult with
capacity to make medical decisions, who has been diagnosed with
a terminal disease to receive a prescription for an aid in dying
drug if certain conditions are met, such as two oral requests, a
minimum of 15 days apart and a signed written request witnessed
by two individuals is provided to his or her attending
physician, the attending physician refers the patient to an
independent, consulting physician to confirm diagnosis and
capacity of the patient to make medical decisions, and the
attending physician refers the patient for a mental health
specialist assessment if there are indications of a mental
disorder. SB 128 is pending in the Assembly Health Committee.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
According to the Assembly Committee on Finance:
Department of Health Care Services
Potential minor costs and savings in Medi-Cal based on the
Medi-Cal program choosing to cover this end-of-life option
ABX2 15
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(General Fund (GF)).
Department of Public Health
One-time GF costs of $90,000 for information technology
services, and ongoing GF costs in the range of $250,000. DPH
anticipates that a secure drive with password protection would
be needed to store the confidential data collected pursuant to
this bill, and would require an SQL database to perform data
collection and storage. DPH states that a database could be
developed with one-time development costs of approximately
$88,000, and ongoing yearly maintenance by Information
Technology Services Division of approximately $10,000 per year,
as shown in the chart below.
----------------------------------------------------------------
|Database Development Task |Hours |Cost |
|-----------------------------------------+---------+------------|
|Application Development | | |
|-----------------------------------------+---------+------------|
| Requirements Specifications |267 |$16,000 |
|-----------------------------------------+---------+------------|
| Design/Test Plan |133 |$8,000 |
|-----------------------------------------+---------+------------|
| System Development / Code & |800 |$48,000 |
| Test | | |
|-----------------------------------------+---------+------------|
| Acceptance Testing/User |133 |$8,000 |
| Training | | |
|-----------------------------------------+---------+------------|
| Initial Internet/SQL DBA |133 |$8,000 |
| setup | | |
|-----------------------------------------+---------+------------|
| | | |
|-----------------------------------------+---------+------------|
|Total One-Time Cost |1466 |$88,000 |
|-----------------------------------------+---------+------------|
|Ongoing yearly maintenance ($845 x 12) |14/mo |$10,140 |
| | | |
----------------------------------------------------------------
Additionally, once the database is established, DPH estimates
ABX2 15
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that two full-time positions would be required to perform
confidential program and reporting duties outlined in this bill,
with duties including:
Collect data, enter reports received, collect forms,
track program utilization and associated deaths;
Follow-up with providers that submit incomplete reports;
Perform data analysis, cross-check decedent deaths with
list of prescribed participants, and draft annual reports;
Prepare the annual report mandated by the bill;
Maintain program information on the public website, and
respond to inquiries regarding program policy; and
Update website as needed, and make reporting forms
available for download online.
Summary of Total Cost to DPH
------------------------------------------------------------
| Total Budget Year Cost |Total Cost Budget Year + 1 |
|--------------------------------+---------------------------|
| $323,087 |$245,227 |
| | |
------------------------------------------------------------
Department of Managed Health Care
Due to the sensitive and controversial nature of aid-in-dying
medication, the Department of Managed Health Care (DMHC)
anticipates a high level of public interest, which will result
in Public Records Act (PRA) or Information Practices Act (IPA)
requests during the first three years. The Office of Legal
Services (OLS) anticipates PRA/IPA requests regarding which
health plans that cover aid-in-dying medications and under what
terms the medications are covered, as well as information on
relevant policy decisions, enforcement policies, and consumer
grievances. OLS estimates that these tasks will have no cost in
the current fiscal year, $276,000 (Managed Care Fund (MCF)) and
ABX2 15
Page 16
2.0 positions in the 2015-16 fiscal year, and $244,000 MCF and
2.0 positions each in the 2016-17 and 2017-18 fiscal years. OLS
does not anticipate ongoing costs after the 2017-18 fiscal year.
The Help Center, Office of Administrative Services, Office of
Technology and Innovation, Office of Enforcement, Office of Plan
Licensing, Division of Plan Surveys, and Office of Financial
Review anticipate absorbable workload that will have no
significant fiscal impact on those programs.
Medical Board of California
Minor costs to the Medical Board to update several of the forms
required by this bill as deemed necessary (Contingent Fund of
the Medical Board of California).
Board of Pharmacy
Minor costs to the Board of Pharmacy. The Board would not need
to amend or adopt any regulations. The Board estimates that any
additional enforcement actions due to this bill would result in
minor costs (Pharmacy Fund).
SUPPORT: (Verified9/10/15)
Advisory Council of the Central Coast Commission for Senior
Citizens
AIDS Healthcare Foundation
AIDS Project Los Angeles
American Nurses Association\California
California Association for Nurse Practitioners
California Association of Marriage and Family Therapists
California Chapter of the National Association of Social Workers
California Church IMPACT
California Commission on Aging
California Democratic Party
California Primary Care Association
California Psychological Association
California Senior Legislature
Cardinal Point at Mariner Square Residents' Association
Church Council of West Hollywood United Church of Christ
City of Cathedral City
ABX2 15
Page 17
City of Santa Barbara
Coastside Democrats
Compassion and Choices California
Conference of California Bar Associations
Democratic Party of Orange County
Democratic Party of Santa Barbara County
Democratic Service Club of Santa Barbara County
Desert Ministries United Church of Christ
Desert Stonewall Democrats
Ethical Culture Society of Silicon Valley
Five Counties Central Labor Council
Full Circle Living and Dying Collective
GLMA: Health Professionals Advancing LGBT Equality
Gray Panthers of Long Beach
Humanist Society of Santa Barbara
Humboldt and Del Norte Counties Central Labor Council
Laguna Woods Democratic Club
Lompoc Valley Democratic Club
Los Angeles LGBT Center
Mar Vista Community Council
Potrero Hill Democratic Club
Progressive Christians Uniting
Sacramento Central Labor Council, AFL-CIO
San Benito County Democratic Central Committee
San Francisco AIDS Foundation
San Mateo County Democracy for America
San Mateo County Democratic Party
San Mateo County Medical Association
Santa Barbara County Board of Supervisors
Santa Cruz City Council
Sierra County Democratic Central Committee
South Orange County Democratic Club
Tehachapi Mountain Democratic Club
Unitarian Universalist Church of the Verdugo Hills
Ventura County Board of Supervisors
Visalia Democratic Club
OPPOSITION: (Verified9/10/15)
Agudath Israel of California
ABX2 15
Page 18
Alliance of Catholic Health Care
Association of Northern California Oncologists
California Catholic Conference
California Disability Alliance
California Foundation for Independent Living Centers
Coalition of Concerned Medical Professionals
Communities Actively Living Independent and Free
Communities United in Defense of Olmstead
Dignity Health
Disability Action Center
Disability Rights California
Disability Rights Education and Defense Fund
FREED Center for Independent Living
Independent Living Center of Southern California
Independent Living Resource Center of San Francisco
Medical Oncology Association of Southern California
Patients Rights Action Fund
Placer Independent Resource Services
Rabbinical Council of California
Silicon Valley Independent Living Center
The Arc of California
ARGUMENTS IN SUPPORT: Compassion and Choices writes that
this bill will improve the quality of end-of-life care for
terminally ill Californians and their families, while protecting
physicians who care for them. According to Compassion and
Choices less than one percent of dying Californians would take
the medication, but many people would benefit from the peace of
mind of having access to it if they need and want it. Simply
knowing the option is available can provide a palliative effect
for dying people. The Advisory Council of the Central Coast
Commission for Senior Citizens, Area Agency on Aging based their
support on the thorough efforts in the proposed legislation to
provide safeguards to individuals. The AIDS Healthcare
Foundation writes that this bill contains explicit protections
against manipulation of the law for inappropriate purposes.
These provisions ensure a balance between meeting the critical
goal of the bill and protecting against acts by people who do
not have the patients' best interests in mind. The Conference of
California Bar Associations indicates that this bill includes
numerous safeguards to ensure that the medication is provided
ABX2 15
Page 19
only to terminally ill individuals according to their own choice
and knowing, well-considered decision after consideration of
feasible alternatives and additional treatment opportunities.
Proponents indicate that 20 years of data collected in Oregon
demonstrate that this law works as intended, with no
substantiated reports of abuse or coercion and it resulted in
improved end-of-life pain management and increased use of
hospice for all dying patients.
ARGUMENTS IN OPPOSITION: A coalition of physicians and other
health care providers, organizations dedicated to the rights of
people with disabilities, and faith-based organizations write in
opposition that while protections for health care providers are
present, it is the patient who remains without adequate
protections. The coalition writes that physician suicide is bad
for Californians, particularly those with low incomes who may
lack adequate access to health care, including mental health
services. The coalition writes that this bill does not require a
psychiatrist to evaluate a patient before he/she decides to end
their life; does not require anyone to be present when the
patient takes his/her lethal prescription; allows the patient,
or designated agent, to pick up their lethal prescription at the
local pharmacy. In addition, the opponents believe this bill
will have a devastating impact on the treatment of terminally
ill and disabled patients because it will quickly become another
treatment option, always being the cheapest. Disability Rights
California writes that there is no oversight of the fatal dose
once it has been dispensed and no way to know if the patient has
changed her mind but is given the dose anyway. The Medical
Oncology Association of Southern California, Inc, believes no
matter how many parameters are placed around the practice,
legalizing a form of suicide will have spillover effects in
society at large. One physician writes that the "good faith"
legal standard in this bill that protects physicians is found
nowhere else in medical practice, where physicians are required
to practice according to the higher "medical standard of care."
ASSEMBLY FLOOR: 44-35, 9/9/15
AYES: Alejo, Baker, Bloom, Bonilla, Bonta, Burke, Calderon,
Campos, Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Dodd,
Eggman, Frazier, Cristina Garcia, Eduardo Garcia, Gatto,
ABX2 15
Page 20
Gomez, Gordon, Gray, Hadley, Holden, Irwin, Jones-Sawyer,
Levine, Low, Maienschein, McCarty, Medina, Mullin, Nazarian,
Perea, Quirk, Rendon, Salas, Mark Stone, Thurmond, Ting,
Weber, Wood, Atkins
NOES: Achadjian, Travis Allen, Bigelow, Brough, Brown, Chang,
Chávez, Dahle, Beth Gaines, Gallagher, Gipson, Gonzalez,
Grove, Harper, Roger Hernández, Jones, Kim, Lackey, Linder,
Lopez, Mathis, Mayes, Melendez, Obernolte, O'Donnell, Olsen,
Patterson, Ridley-Thomas, Rodriguez, Santiago, Steinorth,
Wagner, Waldron, Wilk, Williams
NO VOTE RECORDED: Daly
Prepared by:Teri Boughton / HEALTH /
9/10/15 23:36:14
**** END ****