CMA On-Call: Online Health Library
From the California Physician's Legal Handbook
Document #3455: Physician-Assisted Suicide/Physician Aid in Dying. CMA Legal Counsel, January 2016




IT is a crime for anyone, including a physician, to assist anyone to commit suicide, even if the person is terminally ill and competent to make medical decisions. However, under a law that will go into effect in California in 2016, death resulting from the self-administration of an aid-in-dying drug is not considered suicide, and under certain circumstances physicians can prescribe such drugs to terminally ill patients who have capacity to make medical decisions.

[...] in California assisting a suicide is a crime. Proposition 161, an initiative to legalize active euthanasia that was on the California ballot in 1992, failed. In both 2005 and 2006, the sponsors of the Oregon legislation that legalized physician aid in dying in Oregon introduced similar legislation in California. Both attempts failed. In 2015, a California Court of Appeal affirmed a lower court ruling that rejected an attempt to have the courts declare that physicians who prescribe lethal medications to terminally ill patients were essentially exempt from the California Penal Code provision that makes it a crime to assist a suicide. The court found that prescribing the lethal medication is direct participation and instrumental in accomplishing a patient's suicide and thus, is illegal under California Penal Code section 401. (Donorovich-Odonnell v. Harris (2015) 241 CalApp.4th 1118.)

However, in 2015, after the Donorovich-Odonnell decision, the Governor signed into law the End of Life Option Act, which effectively creates an exemption to the penal code by declaring that it is not suicide to self-administer an aid-in-dying drug pursuant to the End of Life Option Act and providing immunity to physicians and other health care providers who participate in the End of Life Option Act.

[p.8] After stalling in the California Assembly Health Committee, Senate Bill 128 was effectively reintroduced as Α.BX2-15 through a special session of the legislature. CIA’s con­cerns were addressed in the legislation, which was passed and signed by the Governor in 2015. A.BX2-15 creates The End Of Life Option Act in California. For more information, see CIA ON-CALL document #3459, “The California End of Life Option Act.”







AMONG CΜA’s specific concerns about active euthanasia and physician aid in dying were the following, as outlined in the 1988 white paper and further articulated during the Proposition 161 campaign and the 2006 effort to legalize physician-assisted suicide:

Legalizing physician “aid-in-dying” would introduce disturbing POTENTIALS for ABUSE. The “right” to a lethal injection could become an expectation of appropriate behavior, and then a duty, pressed forward by other demands on scarce resources and by the perceived burden imposed on others. Further down this “slippery slope,” an expectation might arise for other “unfit” members of society (e.g., certain disabled individuals) voluntarily to end their expensive suffering as well. By passing the ethical threshold of having physicians endorse the concept of PAS, physicians would have no defense against an extension of the right to patients other than those terminally ill.

Suicide is rarely a rational decision; most often it is a psychologically abnormal event associated with DEPRESSION or other disorders. This has been found to be as true among terminal patients as among others. Suicidal behavior suggests a condition deserving medical treatment, not lethal medication. Of those people who commit suicide—terminally ill or not, more than ninety-five (95%) percent of those had a major psychiatric illness at the time of death; 1994 “When Death is Sought Assisted Suicide and Euthanasia in the Medical Context,” New York State’s Task  Force on Life and the Law. [For a copy of this report, go to

PAIN suffered by the vast majority of terminal patients CAN BE CONTROLLED, and other needs, including emotional counseling and support, can be provided for through hospice care. Legalizing euthanasia could undermine efforts to further improve pain control and to promote hospice care, since an expectation could arise that ter­minal patients should simply dispatch themselves rather than consume valuable resources by “pro­longing the inevitable.”

There is always an element of UNCERTAINTY in MEDICAL DIAGNOSIS and PROGNOSIS. Errors are bound to occur, as hospices and cancer research centers have learned through experience. The course of a terminal illness is not always predictable. Someone given six months to live may actually live several more years with a reasonable quality of life.

Legalizing assisted suicide might GLAMORIZE the PRACTICE and establish its acceptability, thus inviting imitative suicides. Studies have shown that publicized suicides raise the overall suicide rate, especially among teens.

Physician-assisted suicide and physician-administered lethal injections contravene the fundamental ethic of the medical profession: “Do no harm.” Proponents seek the moral authority of the medical profession to legitimize an attempt to overturn ancient prohibitions against taking the life of another. Placing physicians in the DUAL ROLE of HEALER/ KILLER would undermine trust in the physician-patient relationship, since patients may fear that physicians will steer them toward a lethal injection rather than pursuing what may be a more difficult course of treatment to relieve suf­fering. Further, CIA fears that out of deference to physicians, patients may feel pressured to accept physician-assisted suicide as an option, particularly if the patient feels obligated to relieve their loved ones of the burden of caring for them.

CONSENT: It is inherently difficult for a physician to determine capacity or voluntariness. Physicians often state that they are ill equipped to know if patients are being abused or if the patient is requesting or not requesting treatment because of some internal or external pressure. How will physicians be able to determine this in this context, especially when under both the Oregon and proposed California law, there is no obligation for the patient to involve his or her family? Some argue that PAS forces physicians to make a highly subjective decision that the patient’s life is no longer worth living.






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