12.1 Declaration on Euthanasia
"Euthanasia" to "Aid in Dying"
12.2.1. DISTINCTION: Physician-Assisted Suicide versus Refusal of Disproportionate Treatment
12.2.2. Denial of Distinction - Euphemisms
12.2.3. The Practice of Euthanasia:
I will give no deadly drug . . . Or will I?
12.2.1. US Shift in Thinking articles on euthanasia then and now
12.2.2. What are reasons (article once in NEJM) Once mostly pain, now independence and hopelessness
OJAI SUICIDE PARTY
May ch. 7, pp. 259-284; Declaration on Euthanasia.
THE issue of pastoral care for those facing terminal or debilitating illness has been rendered much more complex by recent legislation (June 9, 2016; amended 2021) that permits physician-assisted suicide in the State of California. It has always been the case that legalization of practices that were formerly forbidden both reflects changing cultural norms and is invariably accompanied by social pressure to “normalize” the now-legal practice.
THE issue of pastoral care for those who intend to take their own lives has been specifically addressed by the Dicastery for the Doctrine of the Faith in the September, 2020, document, Samaritanus Bonus / The Good Samaritan.
REQUIREMENTS UNDER CALIFORNIA LAW
“CALIFORNIA END of LIFE OPTION ACT”
(Approved Oct 5, 2015, Effective June 9, 2016; amended 2021)
• Adult / California Resident
• Terminal illness: (Prognosis of 6 months or less)
• Mentally capable of making informed medical decisions (has capacity)
• Able to self-ingest lethal medication
[now-deleted] Summary by: The California Board of Registered Nursing
What does the new California law do?
The law authorizes a resident of California
who is 18 years of age or older,
who has been determined to be terminally-ill
and has capacity,
to make a request for a drug prescribed for the purpose of ending his or her life.
What safeguards are included in the law?
The Act includes several safeguards, which are aimed at restricting access to patients who are terminally-ill and mentally-competent:
· Two physician assessments are required. The “attending” and “consulting” physicians must each independently determine that the individual has a terminal disease with a prognosis of six months or less, and is able to provide informed consent. Elements of informed consent, including disclosure of relevant information, assessment of decisional capacity and assurance of voluntariness, are stipulated in the law.
· If either physician is aware of any “indications of a mental disorder,” a mental health specialist assessment must be arranged to determine that the individual “has the capacity to make medical decisions and is not suffering from impaired judgment due to a mental disorder.”
· The attending physician must provide counseling about the importance of the following: “having another present when he or she ingests the aid-in-dying drug, not ingesting the aid-in-dying drug in a public place, notifying the next-of-kin of his or her request for the aid-in-dying drug, participating in a hospice program and maintaining the aid-in-dying drug in a safe and secure location.”
· The attending physician must offer the individual the opportunity to withdraw his or her request for the aid-in-dying drug at any time.
· The individual must make two oral requests,
separated by a minimum
of fifteen days, and one written request for the aid-in-dying drug.
[Changed Oct, 2021 to two oral requests a minimum of 48 hours apart]
· The written request must be observed by two adult witnesses, who attest that the patient is “of sound mind and not under duress, fraud or undue influence.”
· The patient must make a “final attestation,” forty-eight hours before he or she intends to ingest the medication.
· Only the person diagnosed with the terminal disease may request a prescription for the aid-in-dying drug (i.e., surrogate requests are not permitted).
· The individual must be able to self-administer the medication.
What are the documentation and reporting requirements?
The law explicitly stipulates a number of requirements for documentation in the patient’s medical record, largely corresponding to the safeguards above. In addition, the law creates two reporting obligations:
1. Within 30 days of writing a prescription for an aid-in-dying drug, the attending physician must submit to the California Department of Public Health (CDPH) a copy of the qualifying patient’s written request, an attending physician checklist and compliance form, and a consulting physician’s compliance form.
2. Within 30 days following the individual’s death, the attending physician must submit a follow-up form to CDPH. All forms will be posted on the CDPH and Medical Board websites.
Is participation required?
No. Participation in the law is voluntary for all parties. Individual providers -- and institutions as well -- may make personal, conscience-based decisions about whether or not to participate.
[Changed, Oct 2021 - Physicians who do not wish to participate are required to:
inform the individual seeking an aid-in-dying medication that they do not participate, document the date of the individual’s request and the provider’s notice of their objection, and transfer their relevant medical record upon request.
“THIS is a challenge to all of us. Especially to all of us who have faith,” [...] “to teach always about the infinite value of each human life.”
“THIS is a failure of our love, A failure of heart, really, that we can’t think of anything else we can do for people who have been told that they have terminal illness than to offer them a package of pills, where they can take their own life, and say, ‘Go ahead; just commit suicide.’”
[With regard to the effect of this law on the poor: ]
“IN our hospitals, it is the poor who are being advised and counseled more and more towards abortions [...] “Now it’s going to happen, also, I’m sorry to say, with the elderly, the most poor and most vulnerable.”
Bishop David O'Connell,
Mass at Santa Teresita Hospital, June 1, 2016
WHY DO PEOPLE REQUEST
Pain, AIDS, and neurodegenerative disorders are the most common conditions in patients requesting assistance in dying. There is a wide range in the age of such patients, but many are younger persons with AIDS.10 From the limited data available, the factors most commonly involved in requests for assistance are[:]
 concern about future loss of control,
 being or becoming a burden to others,
 or being unable to care for oneself and fear of severe pain.10
A small number of recent studies have directly asked terminally ill patients with cancer or AIDS about their desire for death.25-27 All these studies show that the desire for death is closely associated with depression and that pain and lack of social support are contributing factors.
10. Back AL, Wallace JI, Starks HE, Pearlman RA. Physician-assisted suicide and euthanasia in Washington State: patient requests and physician responses. JAMA 1996;275:919-925
25. Brown JH, Henteleff P, Barakat S, Rowe CJ. Is it normal for terminally ill patients to desire death? Am J Psychiatry 1986;143:208-211
27. Breitbart W, Rosenfeld BD, Passik SD. Interest in physician-assisted suicide among ambulatory HIV-infected patients. Am J Psychiatry 1996;153:238-242
Advances in palliative medicine have produced effective strategies for managing and relieving pain for most terminally ill patients, including the possibility of palliative sedation. Inadequate pain control therefore ranks among the least common reasons that patients in Oregon request lethal medication. Most say that they are motivated by[:]
 a loss of autonomy
 and dignity
 and an inability to engage in activities that give their life meaning.2
Patients in the United States may already decline to receive life-sustaining treatment through advance directives, but that is a reactive stance: only when an acute condition occurs can patients decline intervention, and many patients have no life-sustaining treatments to withdraw. Some terminally ill patients wish to exercise their autonomy and control the timing of their death rather than waiting for it to happen to them.
2. Thirteenth annual report on Oregon’s Death with Dignity Act. Portland: Oregon Office of Disease Prevention and Epidemiology, 2010.
WITH regard to palliative care/hospice agencies, it is important to ask:
1. Does the agency offer Physician-Assisted Suicide (“ City of Hope pdf)Medical Aid in Dying”) as one of the services they provide? (e.g.
2. If so, how do they respond to patients and surrogate decision-makers who regard “Medical Aid in Dying” as immoral?
WHEN someone we love, or for whom we are responsible raises the question of Physician Assisted Suicide, the following are important:
1. LISTEN: encourage the person to speak freely before you comment.
2. Obtain as much INFORMATION as possible.
3. Avoid emotionally-charged or judgmental language.
WHY the person is considering suicide: what do
(e.g. Dependency; Physical Linitation; Isolation; Pain.)
5. Help the person clarify their
INTENTION: What do they really
(e.g.: Not to be a burden; Not to be dependent; Not to be alone; Not to be in pain.)
6. SUGGEST alternatives: Address the underlying reasons for the person's request.
This Webpage was created for a workshop held at Saint Andrew's Abbey, Valyermo, California in 2002