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Judge strikes down California's aid-in-dying law

California's physician aid-in-dying law was thrown into limbo Tuesday when a state judge overturned it because the Legislature unconstitutionally passed it during a special session limited to healthcare issues.

Two groups and several physicians opposed to physician-assisted suicide for terminally ill patients had filed the suit to block the 2016 law, the California End of Life Option Act. Riverside County Superior Court Judge Daniel Ottolia issued an oral ruling saying the Legislature acted illegally in passing the law.

He gave the state attorney general five days to file an emergency petition to stay his order while the ruling is appealed.

It's likely Attorney General Xavier Becerra will appeal Ottolia's decision. It's also possible that Gov. Jerry Brown and the Democratic-controlled Legislature, which is in session through August, could move to re-pass the law in regular session to settle the procedural objections. Senate Majority Leader Bill Monning's office said Monning is talking with the Becerra's office about options to preserve the law.

California is one of seven states—including Colorado, Hawaii, Montana, Oregon, Vermont, Washington plus the District of Columbia—that allow doctors to prescribe lethal prescriptions for terminally ill patients. Two physicians must independently determine that requesting patients have six months or less to live, are making an informed, voluntary decision, and are mentally competent. Patients must self-administer the prescription.

Last June, Compassion & Choices, a group that supports end-of-life options, estimated that 504 Californians had received a lethal prescription since the law took effect in June 2016. Last July, the California Department of Public Health reported 111 patients had ended their lives under the law during 2016. It's expected that more patients will use the option as it becomes better established.

Alexandra Snyder, executive director of Life Legal Defense Foundation, one of the groups filing the suit, said the California assisted-suicide law violates state equal protection provisions because people who are deemed terminally ill lose critical legal protections. Normally when there is a suspected suicide, authorities investigate the cause of death to see if the person was coerced, she said.

"But that doesn't happen when someone requests aid in dying," Snyder said. "Then everything is considered above board and the doctors were acting in perfect faith. That's simply not true. The law doesn't provide adequate safeguards, and it doesn't require any mental health evaluation."

Sean Crowley, a spokesman for Compassion & Choices, said Judge Ottolia's ruling was "a shock" and that his group thinks the judge misinterpreted the state constitution in holding that the aid-in-dying bill fell outside the parameters of the special legislative session. "The session dealt with Medicaid, and the End of Life Option Act allowed Medicaid to pay for aid-in-dying medication," he said.

California's passage of the law has encouraged other states, including Massachusetts, New Jersey, and New York, to consider aid in dying legislation. Such provisions remain controversial among healthcare providers and religious groups.

The End of Life Options Act allows healthcare organizations and providers to opt against participating in aid-in-dying. Some have done so, while other large organizations such as Kaiser Permanente have chosen to participate.

The law also lets organizations that opt out sanction doctors and staffers who violate their policy. But doctors and employees cannot be disciplined for simply telling patients about their options under the law or referring them to participating providers.

While California providers disagree about the morality of the law, there's widespread hope that its existence will spur more and better end-of-life care discussions, and increase the use of palliative and hospice care, which is what providers in other aid-in-dying states such as Oregon and Washington have reported.

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Original URL: 
http://www.modernhealthcare.com/article/20180515/NEWS/180519943