First, the proposal will have to overcome opposition from the state’s influential religious and disability rights groups. It could also face pushback from doctors and hospitals that have historically been hesitant to loosen rules around the process.
Introduced in March by a first-term lawmaker — an attorney with a background in estate planning– the proposal would enable people without a specific terminal prognosis to request life-ending drugs, a lower threshold than any of the other 10 states that currently allow some form of aid-in-dying.
“It’s about personal autonomy and making decisions about your own exit from your one precious life on your own terms,” San Diego-area state Senator Catherine Blakespear said in an interview.
Blakespear is motivated in part by her experience as an attorney working with clients planning end-of-life care who are forced to leave the ultimate decisions of their passing in the hands of others through advanced directives.
Her proposal faces strong opposition, including from some who support current state law that allows adults in California to request lethal medication as long as they are able to make their own decisions, swallow the drug themselves and are expected to die within six months from a terminal disease.
California has allowed limited use of self-administered lethal medication after intense debate, fueled by concerns that patients — especially those with disabilities — would be too quick to end their own lives or would do so under pressure from others. Opponents also believe the practice is wrong for religious or moral reasons. Since the law was enacted eight years ago, around 3,350 people have officially used medication to end their lives.
As California promotes choice in reproductive health, Blakespear is hoping the state is well poised to make assisted end-of-life more widely available under those same ideals. But the opposition’s concerns have lingered, even as the practice becomes more widely accepted, and more in demand by an aging population.
“Certainly our perspective is that we don’t want the End of Life Options Act at all, I think we’ve made that very clear,” said Kathleen Domingo, the executive director of the California Catholic Conference said about the 2016 law. “And this is a really far, far reaching expansion.”
The six-month timeline is arbitrary to Blakespear, who wants options available to people before they’re that close to death. Suffering until you’re in hospice care is too long to wait for relief, she said.
Her proposal, Senate Bill 1196, eases the restrictions on eligibility and the timeline around when patients can request a prescription for life-ending medication. Instead of a terminal illness with six months left, Blakespear wants a scenario where it is available to people with “grievous and irremediable medical conditions,” a change that means people who are declining or suffering without relief can be eligible if they’re reasonably expected to die from the disease, even if the timeline is unclear.
Patients would no longer need to be residents of California, opening the practice up to out-of-state people. It also allows patients to opt for self-administered intravenous drugs, instead of just pills.
Perhaps the most controversial part of an already explosive proposal is allowing early and mid-stage dementia patients to request the medication while they still have the faculties to do so. Because of the cognitive decline with Alzheimer’s and dementia, people with those conditions are basically disqualified from using this option, Blakespear said. Instead, families often have to wait until the very end and provide “comfort care” where they stop giving nutrition and let a person pass naturally, essentially dying of starvation. That’s a “horror” to Blakespear.
Including dementia patients is a bridge too far for critics, including those who generally advocate letting people end their lives with medication. That provision has caused Compassion & Choices, the main group that lobbies for end of life options around the country, to come out against the bill.
“Though we recognize the proposed amendments intend to provide more options for people living with dementia, it’s imperative to approach this issue carefully and with compassion,” the group said in a statement. “However, expanding medical aid in dying is not a suitable solution.”
Instead, they advocate for more dementia-specific advanced care planning.
Keeping dementia patients out of this discussion is the rare occasion the California Catholic Conference and the pro-aid in dying group are on the same page. Domingo said that people are often pushed to end their lives because they don’t have access to quality health care that could relieve their suffering. With hospitals closing and a shortage of mental health professionals, it’s vulnerable and underprivileged people who may feel like they’re out of options, Domingo said, when in reality they’ve just gotten substandard care.
“California is not ready for this, because we have not put the infrastructure in place yet to be able to say that all of our elderly, all of our disabled, all of our folks with dementia are receiving the best quality care,” Domingo said. “Until then, creating the End of Life Options Act is giving up, it’s saying we’ll never get to that point. Let’s fight for that.”
Compassion & Choices also doesn’t agree with expanding eligibility outside of the six-month prognosis. It’s not a coincidence that the timing lines up with when people usually enter hospice. Those safeguards make sure that people aren’t being coerced into ending their lives early because they can’t get better medical care, the statement said.
California has had aid in dying available since 2016, but the law was amended in 2021 to ease some restrictions. Last year, disability rights advocates sued the state, saying the updates remove important safeguards. Patients must make two oral requests for lethal medication, and the 2021 updates shortened the length of time between those requests from 15 days to 48 hours.
Blakespear isn’t interested in waiting for the results of that ongoing litigation, she wants people to have more options sooner.
“There’s a lot of indignity at the end of life, and not everyone wants to go all the way through that,” Blakespear said. “Personally, I would like to have the option. I may or may not use it, but I’d like to have that option.”