BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | ABX2 15| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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 Page 2 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 Page 3 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 Page 4 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. ABX2 15 Page 5 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 ABX2 15 Page 6 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 ABX2 15 Page 7 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 ABX2 15 Page 8 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 Page 9 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 Page 10 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 Page 11 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 Page 12 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 Page 13 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 Page 14 (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 Page 15 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 ****