In a move that makes California only the fifth state in the nation to approve physician-assisted suicide, Gov. Jerry Brown on Monday signed legislation making the choice available to nearly 1 in 6 Americans.
In his signing statement, the governor said that the "options afforded by this bill" could be a "comfort" to people in pain.
But passage in the largest state in the nation does not guarantee traction in other legislatures, many observers say. While states such as New York, New Jersey, and Massachusetts are expected to take up similar proposals in upcoming sessions, the issue remains deeply divisive.
In fact, California's new law could mobilize the opposition, especially faith and disability rights groups who say that such measures disproportionately disadvantage the most vulnerable and marginalized in society.
The states that have moved first on assisted suicide, such as Washington, Oregon, and now California, tend to be seen as "out of step with mainstream America and the East Coast," says James Hoefler, a political scientist at Dickinson College in Carlisle, Pa., who specializes in end-of-life issues. California is "just not what people look to as the tipping point in this discussion."
The California law is modeled closely after Oregon's 1997 Death with Dignity Act. By giving patients the opportunity to make choices about their own care that minimize suffering, the new law "begins to approximate legislation in more progressive jurisdictions around the globe," says Christopher Riddle, director of the Applied Ethics Institute at Utica College in Utica, N.Y.
Some 65 percent of Californians support the new law, according to a recent Field Poll.
But critics say that several powerful factors make such laws problematic.
Eugene Rivers, president of the Seymour Institute for Black Church and Policy Studies in Boston, says euthanasia has a disproportionate impact on poor black and brown communities.
“There is a myth that whatever happens in California the country follows,” he writes in an e-mail. "The passage of the assisted-suicide bill can serve to be a wake-up call to people of faith who are committed to protecting the sanctity of human life."
There are longstanding concerns that assisted suicide would be offered in lieu of care, especially for vulnerable populations.
It is telling that the law passed this time as part of a special session called to debate the costs of California’s health-care program, says Fordham University bioethicist Charles Camosy. Similar proposals were defeated in previous California legislatures when subjected to the regular committee procedures. "If it had been presented in regular committees, I don’t believe this law would have passed."
Still, there has been no evidence of abuses in any of the states with assisted suicide laws in place, says Professor Hoefler.
In fact, he says, the opposite has occurred. “Those taking advantage of assisted suicide tend to be white, well insured, well-educated and well cared for. (Some 93 percent of those asking for assisted suicide in Oregon last year were enrolled in hospice.)
In its 2014 annual report, Oregon's Public Health Division finds that "pain and suffering" is not the main reason patients in that state turn to assisted suicide. The top-ranked reasons were "loss of autonomy," "decreasing ability to participate in activities," and "loss of dignity." "Pain and suffering" ranked No. 6.
"These are social and cultural reasons that, in our youth-worshipping culture, I want to challenge," says Professor Camosy, citing the Oregon report. The classic progressive view is that "society should protect the poor and vulnerable," he says. Any decision to support right-to-die legislation represents movement in the wrong direction, he adds.