California Weighs Physician-Assisted Suicide for Patients With Dementia

A new bill would expand the pool of qualified applicants to include patients with ‘early and mid-stage dementia,’ while dropping a required waiting period.

A doctor prepares a syringe with "Thiopental" a barbiturate that is used in the practice of euthanasia in a hospital in Belgium, on February 1, 2024. According to California data, between 2016 and 2022, a reported 3,349 people died by assisted suicide and 5,168 total prescriptions for lethal medication were written, primarily for people suffering from cancer or cardiovascular disease.
A doctor prepares a syringe with "Thiopental" a barbiturate that is used in the practice of euthanasia in a hospital in Belgium, on February 1, 2024. According to California data, between 2016 and 2022, a reported 3,349 people died by assisted suicide and 5,168 total prescriptions for lethal medication were written, primarily for people suffering from cancer or cardiovascular disease. (photo: Simon Wohlfahrt / AFP/Getty)

When the California Legislature considered a bill to legalize physician-assisted suicide in 2015, Dr. Vincent Nguyen was among those who publicly doubted that vulnerable people wouldn’t be coerced into hastening their deaths, as the measure’s proponents insisted.

While the End of Life Option Act had been presented as a compassionate option for patients suffering from “terminal” illness, the Newport Beach geriatrician and hospice and palliative care specialist warned at the time that it could be “expanded to include persons with disabilities, maybe patients with dementia, and people with depression.” 

Nguyen’s fears could soon be vindicated, though that will give him no satisfaction.

The End of Life Option Act, which became law in June 2016 and was amended in 2022, would now undergo a dramatic expansion, if state lawmakers approve legislation sponsored by California Sen. Catherine Blakespear, D-Encinitas.

Blakespear’s bill would replace the term “terminal disease” with “a grievous and irremediable medical condition,” a definition critics say could include anorexia or common conditions like diabetes. 

 


What the Bill Proposes

A fact sheet for the proposed expansion of the law explains that a qualified candidate for assisted suicide would need to have a “serious and incurable illness or disease” that causes them “to endure physical or psychological suffering ... that is intolerable to the individual and cannot be relieved in a manner the individual deems acceptable.”

Additionally, it must be “reasonably foreseeable that the condition will become the individual’s natural cause of death.”

The new bill would make lethal medication available “to those with early to mid-stage dementia” and allow it to be administered via an IV. 

It also would drop the 48-hour waiting period between a patient’s verbal requests for aid-in-dying medication and set aside state residency requirements.

Christopher Kaczor, a professor of philosophy at Loyola Marymount University in Los Angeles and the author of Disputes in Bioethics, called the proposed expansion of state law a dire threat to the frail elderly, those struggling with mental illness, and others with limited resources or family support. 

“If it becomes law, even more people will face pressure to choose their own death as the ‘right to die’ becomes the ‘duty to die,’” he said. 

Father Tad Pacholczyk, senior ethicist at the National Catholic Bioethics Center in Philadelphia, told the Register that the expansion of the assisted-suicide law, to accommodate a broader range of people, and the incremental removal of protections for the vulnerable were entirely predictable. 

“Once we have given up on the principle that suicide is wrong, it becomes a mere matter of haggling over the details,” said Father Pacholczyk. 

“Fuzzy ideas about the ‘imminence of death’ become passé and are gradually ignored,” he added. “As the story line evolves into ‘Autonomy Rules!’ the initially useful guardrails, having fulfilled their function of getting the camel’s nose under the tent, are phased out as ‘hindrances to freedom.’”

The Register contacted Sen. Blakespear’s office for comment, but had not received a reply by publication time. However in an April 1, 2024 interview with Politico, Blakespear suggested that her effort to expand access to assisted suicide was in sync with California Democrats' stepped-up support for "choice" regarding reproductive rights. “It’s about personal autonomy and making decisions about your own exit from your one precious life on your own terms,” she said. 

 


Legalized by Brown in 2015

When then-Gov. Jerry Brown signed the bill legalizing assisted suicide in 2015, he issued a letter that underscored the serious nature of the matter at hand and acknowledged the dueling arguments from religious leaders, patients’ advocates and disability activists on both sides of the debate.

“In the end, I was left to reflect on what I would want in the face of my own death,” Brown, a former Jesuit seminarian who backed abortion rights, wrote in a signing message

“I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others.”

Brown’s decision to sign the bill marked the culmination of a high-profile political campaign that drew supportive media attention and national headlines, but also unexpected headwinds.

After the California Senate passed the bill, it stalled in the California Assembly’s Committee on Health and was pulled in July 2015 by its sponsors. 

According to Los Angeles Times columnist George Skelton, a “handful of southern California Democrats, mostly Latinos under pressure from the Catholic Church, are withholding support” for the aid-in-dying bill.

 


Widespread Opposition

But polling suggested that opposition was more widespread, and several Latino Assembly members told the Register at the time that their misgivings were not only faith-based.

“[T]here were not enough safeguards in the bill to ensure that an assisted suicide would be done in a safe, humane and necessary manner, and for the right reasons,” said state Sen. Tony Mendoza, D-Artesia.

The bill resurfaced in a special legislative session later in 2015, where it could bypass Assembly committees. 

And it was endorsed by the editorial board of The New York Times, which flagged its “robust safeguards,” such as “two oral requests for the prescription, two weeks apart.” 

That requirement was reduced to a 48-hour period in 2022 and could now be removed entirely, if Blakespear’s bill passes.

According to California data, between 2016 and 2022, a reported 3,349 people died by assisted suicide and 5,168 total prescriptions for lethal medication were written, primarily for people suffering from cancer or cardiovascular disease. 

In April 2023, disability-rights groups, including the Institute for Patients’ Rights and Not Dead Yet, filed suit against state officials, alleging that California’s assisted-suicide law contributed to discrimination against people with disabilities who already struggled to obtain needed and sometimes-costly health care and could now face pressure to hasten their deaths. 

“California law creates even more unequal treatment for people with disabilities, puts us at greater risk of coercion, and makes us more vulnerable to a system preventing access to the care we need,” Matt Valliere, executive director of the Patients’ Rights Action Fund and the Institute for Patients’ Rights, wrote in an opinion article for The Hill

 


Raising Public Awareness

The California Catholic Conference, which worked with disability-rights groups, health-care professionals, and other opponents of assisted suicide to block the initial bill legalizing the practice, will now take part in a new campaign to raise public awareness about the proposed expansion of aid in dying in California.

Kathleen Domingo, the executive director of the California Catholic Conference, told the Register that she was especially disheartened by the shift in tone from the 2015 legislative debate. 

The initial deliberations grappled with the very real threats that legalized assisted suicide posed to the frail elderly and the poor, she noted. 

Now, Blakespear’s bill sets aside safeguards, but has yet to provoke significant pushback.

Blakespear’s bill is still new, so opposition could build quickly. But Domingo is also worried about its potential to weaken resistance to suicide across the state. 

She noted, for example, that a bill permitting those suffering from dementia to receive lethal medication could become law at the very time that “the state of California is spending a great deal of time, energy and funding to stop suicide among other populations.”

And if the last safeguards for assisted suicide are removed, she said, there will be “two different tiers of people: those we deem worthy of living,” like the teenagers “who have anti-suicide resources printed on the back of their high-school I.D. cards,” and “those who will be offered drugs to help them end their life, like people in nursing homes, people on public health insurance.” 

 


Spate of Assisted-Suicide Bills

Robert Vega, director of public policy for the U.S. Conference of Catholic Bishops’ Office of Pro-Life Activities, told the Register that California’s 2016 law sparked new campaigns for assisted suicide in a host of U.S. states, while Oregon, Washington, Montana and Vermont had already approved aid in dying beforehand. 

Four more states, plus the District of Columbia, now allow the practice. 

And after a brief lull in legislative activity, about 20 states are considering similar bills, Vega reported. 

At the same time, Vega celebrated the recent failure of campaigns to secure assisted suicide in Maryland and Virginia, a reminder that aid-in-dying bills can be defeated. 

“One of the most important things for people to understand is that this is not solely a religious issue, which would only be of interest to Catholics,” said Vega. 

“It is an issue of civil rights and non-discrimination for persons with disabilities or disabling illness and diagnoses. It has been very important for the disability community to be engaged in these legislative battles.” 

Likewise, the legalization of assisted suicide “can disproportionately impact families facing more strains on resources, or those with less family support,” he added. 

“Once people think about it from that lens, they realize there are a broad range of reasons to stand against this legislation.”

And what’s equally important, he stressed, is proposing a “positive alternative: more robust, authentic and holistic palliative care and accompaniment of those who are disabled and elderly.”

 


Keeping Close Watch

Meanwhile, Dr. Nguyen is keeping a close eye on the progress of Sen. Blakespear’s bill. 

But his primary concern remains with patients who require his medical expertise and compassionate accompaniment, especially if family members are not present. 

He acknowledged that patients facing the final chapter of their lives feared the “unknown”: loss of autonomy and becoming a burden to others, as well as inadequate pain control.

But rather than presenting assisted suicide as a remedy for these patients, he said, “We should do more to strengthen palliative care and hospice.”

“We talk about diversity, inclusivity and equity,” he concluded, “but there is this perverse advocacy for death in the absence of equal access to health care.”

 

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