Doctors have found themselves in the middle of the debate around a bill that would legalize physician-assisted suicide in California, and there are strong opinions on both sides of the issue.
SB 128 would allow a doctor to prescribe life-ending medication to a terminally ill patient with a life expectancy of six months or less.
Doctors for and against the bill point to the Hippocratic Oath and the aphorism "Do no harm."
For those who oppose the bill , such as Orange County palliative specialist Dr. Vincent Nguyen, the oath is at the center of the debate.
"We are here to protect the people who are sick, and we are here to promote health and in the event we cannot cure the person, healing can still continue take place," he asserts. Physician-assisted suicide "really goes against the reason why we take the Hippocratic Oath and why we go into medicine," adds Nguyen.
"Some people need help dying"
Doctors who support assisted suicide also invoke the oath. Dr. Robert Olvera is a physician in Santa Ana whose 25-year-old daughter Emily died of leukemia last year after a 17-year battle with the disease.
His daughter asked him twice to help her end her life, Olvera says. He didn't do anything because assisted suicide is illegal. If it had been legal he says he would have found a physician to help her, because as her father he wouldn't have been able to bring himself to do it.
Olvera is now lobbying state lawmakers on behalf of SB 128.
"There’s people that tell me why are you doing this, you’re supposed to cure, you’re supposed to help this person, my answer to that is some people need help dying," he says. "To prolong a death in some cases is not helpful, it can be counter productive. My objective is that given the Hippocratic Oath, I’m not going against it, I’m helping people, people like my daughter who need help at the end of their lives."
Surveys have found the medical community is far from united on the question of physician-assisted suicide. A 2014 poll by the medical news website Medscape found that a majority of doctors support assisted suicide so long as there are adequate regulations and measures in place to guard against abuse. The New England Journal of Medicine asked its readers in 2013 what they thought of the practice, and roughly two out of three said they were opposed.
Doctors who support SB 128 also argue that patients should have the right to choose assisted suicide. Olvera calls it a "fundamental right."
Dr. Joel Hyatt, who has been a family physician in the San Fernando Valley for nearly 40 years, argues, "If they are competent, the prognosis is poor and there is no doubt and patients want to make their decisions, I think as a physician I need to be able to support that."
"Suicide is really a cry for help"
For some doctors who oppose assisted suicide the question is not so much a matter of choice as it is one of not believing that terminally ill people truly want to end their lives prematurely.
Dr. Aaron Kheriaty, associate professor of psychiatry and a medical ethicist at UC Irvine Medical School, is concerned that there is no mental health evaluation included in the legislation.
"Suicide is really a cry for help, it is not a desire to die," he maintains. "It's a distress signal, where the patients is indicating something on the medical, or psychological or social level...[that] in my psychological condition, something is not being attended to."
Kheriaty argues that if those issues are addressed for the terminally ill, requests to hasten death would disappear. Nguyen, the palliative specialist, says he tells patients who say they want to die that he can’t hasten death, and that once he helps them understand the process and the fears they're experiencing, the requests tend to fall away.
Doctors who oppose SB 128 also worry about potential abuses and a lack of safeguards.
They're concerned about how it will impact vulnerable communities such as the disabled, the mentally ill, the elderly and even the poor - who they believe could be influenced by finances, family or other factors.
"The fear that I have as a physician is we look at our economy where the cost of health care is continuing to rise and it’s getting out of control," Nguyen says. "So the fear that we have is that instead of cutting spending, [some will say] why don’t we cut the spending on the people who are costing the society too much money?"
A need for safeguards
Opponents also worry about how the law might be expanded in the future to allow others - possibly those with chronic diseases or mental illness - to request assisted suicide.
Dr. Kheriaty points to Belgium and the Netherlands where assisted suicide is more widespread, and even to Oregon, which is considering opening the window to those with 12 months or less to live.
The doctors who support the law agree there must be safeguards to prevent abuses and to make sure only the right candidates are being approved for assisted suicide. They say the legislation is going to take care of that and they point to Oregon as a model for how to avoid abuses.
Critics say Oregon has scant data on how the program has been working.
In Sacramento, SB 128 is on hold while the Senate appropriations committee waits for a report about how much it would cost. If the committee approves the bill, it will go to the full Senate for a vote.
Olvera says if the bill does not pass in Sacramento, the organization Compassion and Choices intends to push it as a ballot measure. If it comes to that, he says, he will join the political fight again.
"What spurred me is Emily on two occasions when she was lucid and competent, she asked me to give her enough sleeping pills so that she could go to sleep permanently," he recalls. "She was blind, but in the bed and had to be carried, but her mind was still competent. Had I known it was legal in five other states...and understanding what her wishes were, I would have left in a heartbeat."
Until his experience with his daughter, Olvera says he never thought he could imagine helping someone die. But if SB 128 becomes law and a patient who meets all of the requirements asks him for help dying - and if he is convinced that it is truly what the patient wants - then he says he will accommodate the individual.
Olvera says he understands the reluctance of some of his colleagues to publicly support assisted suicide.
"Physicians are afraid that if their patient base hears this they will get a bad reputation and a certain amount...of their patients won’t want to come back and see them," he says.
Kheriaty, the medical ethicist at UCI, said he believes that SB 128 could damage the patient-doctor relationship, by undermining people's trust in their physician to care for them and to help them navigate illness, treatment and eventually death.
Updated: This story has been updated to reflect Dr. Aaron Kheriaty is an Associate Professor of Psychiatry.