California dreams while UK MPs disappoint

Dr. David Amies, in his latest post for the blog, examines two large, very different jurisdictions — the United Kingdom and California — whose legislatures voted recently on assisted dying bills. As it stands, the outcomes, perhaps surprisingly, couldn't have been more different.

More and more legislatures in the Western world are talking about right to die laws. To date, four European countries have such laws on their books, along with three US states. In February this year, the Canadian Supreme Court struck down existing law that had considered assisted dying a criminal enterprise and placed the assistant in jeopardy of a long spell in jail. We are now waiting to find out what our federal and provincial lawmakers are going to put in its place.

The past couple of weeks have been a little like the proverbial curate’s egg: good in parts and bad in others. In the United Kingdom, a private member’s bill that proposed the introduction of right to die laws was defeated by a two-to-one margin. This means that such proposals will now be put on hold for some time.

The people’s representatives took their action knowing well that polls of the citizenry had shown them to be largely in favour of such laws. Although the United Kingdom is one of the most secular European countries, the Church of England — dying on its feet as far as church membership and attendance are concerned — still exerts considerable influence: mandatory acts of worship in schools, prayers before town council meetings, control of a large number of high schools, 26-six unelected members of the House of Lords, the so-called Lords Spiritual. The Church was determined to scupper this bill and it succeeded. That was the bad part of the egg.

On the cusp in California

The good bit was the action of the lawmakers in the State of California, who passed a right to die law by a 42-33 margin. An earlier attempt had been defeated by an alliance of church and disability groups but not this time round. The bill now has to go to the governor’s office for signature. Governor Jerry Brown’s spokesperson has been unwilling to say if the governor will sign and that he, the governor, would have to weigh the issues before making a final decision.

The bill mandates that patients can obtain suitable lethal drugs with a medical practitioner’s prescription if they are mentally competent and if two licensed doctors affirm that they have six months or less to live. The drugs must be self-administered.

Marilyn Golden, a senior policy analyst with the Disability Rights and Defence Fund has claimed that the bill is “a recipe for abuse,” The Guardian reported. She is worried that, “an heir who stands to inherit, or an abusive caregiver, can steer a person — legally witness their request, pick up the lethal dose and even administer it, because no objective witness is required at the death.” Doubtless there will be rapacious children ready and willing to persuade mum “to go gentle into that good night” a little before she is ready. No law about anything has yet been devised that is not open to gaming. The world is full of self-seeking rogues but we must not permit the perfect to be the enemy of the good. We do not ban automobiles because some people have fatal accidents in them.

Marilyn Golden is an exemplar for the slippery slope argument. It is a flawed argument for in countries and states that have assisted dying legislation there has not been an avalanche of people ending their lives on medical grounds. Why should it be different in California?

Mark Stone, representative of Monterey, a Democrat, spoke before the vote. “There is no dignity in suffering. This legislation represents the will of the people of California and we want to make sure the assembly implements this reflection,” The Guardian quoted Stone as saying.

Flaws in California's proposed law

So it looks likely that the State of California will join the small but growing community of jurisdictions that allow mentally competent citizen to choose the time and place of their deaths when and if they consider that their lives have become intolerable because of terminal illness. I think that the proposed legislation has flaws. The main one is that the applicant must self-administer the fatal drugs. There will be those who are unable to do so because of paralysis or weakness but who , nevertheless, are anxious to go. It is unclear if a caregiver or relative would be in breach of this law if they were to hold the cup to the lips of the sick person or to mix or prepare the fatal dose. The requirement that a patient must have six months or less to live is fatuous because it is just about impossible to forecast accurately how long a gravely ill person will hang on. Surprising remissions can and do occur as often as forecasts prove to be wildly optimistic. The law comes with a sunset clause and so could be allowed to lapse after ten years. The argument behind this provision is that it would allow sober review. Better surely, would be new legislation framed in the light of ten year’s experience.

However, the law as it stands is to be welcomed. It is, at least, a good start and California’s law makers are to be congratulated on their enlightened outlook. Let us hope that Governor Brown shows himself to be as enlightened as the representatives.

Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWD Canada's Physicians Advisory Council.

(Photo credit: Makaristos/Wikipedia)

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