Law Advocates Who Sought to Intervene in Case Celebrate Ruling As Win for Dying Californians

Compassion & Choices, which filed a motion on behalf of three California patients with disabilities and two doctors requesting to intervene in a federal lawsuit claiming the state’s revised End of Life Option Act (EOLOA) discriminates against people with disabilities, praised the court for dismissing the case Wednesday. The advocates filed the intervention motion and a proposed motion to dismiss the case last September.

The state defendants filed two separate motions last July to dismiss the case. The individual and group plaintiffs in the lawsuit, United Spinal, et al. v. State of California, et al., claimed that the updated California medical aid-in-dying law, which took effect in 2022, discriminates against people with disabilities. The law allows mentally capable, terminally ill adults the option to obtain prescription medication they can decide to take to peacefully end unbearable suffering.

On Wednesday, United States District Judge Fernando L. Aenlle-Rocha issued an order to “dismiss the claims with prejudice,” so the plaintiffs cannot refile the same claim again in that court, rendering Compassion & Choices’ intervention motion moot:

“The Individual Plaintiffs’ interpretation of the statute is inconsistent with the plain text of the EOLOA, which defines ‘terminal disease’ for purposes of eligibility as ‘an incurable and irreversible disease that has been medically confirmed and will within reasonable medical judgment, result in death within six months’ …

Fatal to Plaintiffs’ claims, however, is that a terminally ill patient’s decision to request aid-in-dying medication—and accordingly, to not participate in or seek the benefits of other public health services—is voluntary … Because Plaintiffs do not (and cannot) plead that terminally ill patients are affirmatively denied the option to avail themselves of behavioral health services and the protection of criminal law enforcement, their claims for relief under the ADA [American with Disabilities Act] and [ADA] Section 504 fail as a matter of law.”

“On behalf of terminally ill California patients who desperately need this peaceful dying option to end unbearable suffering and the physicians who provide it, we praise the ruling for correctly interpreting the law,’” said Kevin Díaz, chief legal advocacy officer for Compassion & Choices. “The court specified the plaintiffs fail to meet the law’s requirement of a medical prognosis of six months or less to live, so they would not qualify to use the law and it does not impact them.”

“This ruling rejects the plaintiff’s claims of coercion because it specifies that the law explicitly requires attending physicians to discuss with patients the feasible alternatives or additional treatment options, including comfort care, hospice care, palliative care, and pain control,” said John Kappos, a partner in the O’Melveny law firm who is outside counsel for Compassion & Choices on this case.  “The court also noted that the law further prevents coercion by requiring the attending physician to inform the individual that they may withdraw or rescind the request for an aid-in-dying drug at any time and in any manner. The decision to request aid-in-dying medication is entirely voluntary, which undermines any claim that the EOLOA violates due process.”

“At the end of my husband Will’s life, as he began to choke and gasp, despite being 100% mentally aware, medical aid in dying was literally the only option available to alleviate his suffering,” said Dr. Catherine S. Forest, a clinical associate professor of family and community medicine and a public health specialist in the Monterey Bay and one of the two Californian physicians who sought to intervene in the case. “Without medical aid in dying, Will would have suffered immeasurably as he would have died a difficult death.”

“I have cardiac amyloidosis, also known as stiff heart syndrome, with symptoms that mimic congestive heart failure,” said Pleasanton resident Lambert (Burt) Bassler, 87, one of the three Californian patients with disabilities who sought to intervene in the case. “I am doing everything I can to fight amyloidosis. If and when I qualify for medical aid in dying, I would likely fill (but not necessarily take) the prescription to relieve the anxiety that comes from the progression of my disease. Just knowing that option is available helps me cope with the prospect of dying.”

“The particular kind of ovarian cancer that I was diagnosed with has a poor prognosis, is highly resistant to chemotherapy, and generally recurs within two years after removal and chemotherapy,“ said Berkeley resident Judith Coburn, 79, one of the three Californian patients with disabilities who was diagnosed with a rare, aggressive form of ovarian cancer called ovarian clear cell carcinoma in 2019. “Knowing that I have the option to die in a peaceful manner relieves so much of the anxiety about whether my cancer will recur or how painful it could be.”

“I have congenital spinal malformations with arachnoiditis and severe neuropathy, for which I have undergone numerous surgeries over the years,” said Berkeley resident Peter Sussman, 82, one of the three Californian patients with disabilities. “I have participated in physical therapy repeatedly over the years with no substantial change in my condition. I am lucky to live a very happy and meaningful life, and I hope to continue doing so for as long as possible. While I do not currently have a terminal condition, if I ever become diagnosed with a terminal illness and reach a point where I am suffering unbearable pain, I would want the option of medical aid in dying.”

Peter Sussman of Berkeley, CA

“In my experience, most patients feel a loss of autonomy upon receiving a terminal prognosis, especially in the context of a rapidly progressing terminal disease,” said Dr. Chandana Banerjee, a hospice and palliative care physician and associate professor at the City of Hope National Medical Center in Duarte, and one of the two Californian physicians who sought to intervene in the case. “I am grateful that the court did not grant the plaintiffs’ request to issue an injunction on the End of Life Option Act, or I would have been unable to offer my patients a critical end-of-life care option. The quality of care my patients receive would have suffered as a result.”

Polling shows that three out of four Californians (75%) support medical aid in dying as an option for terminally ill adults and 79% of Americans who say they live with a disability support medical aid in dying, according to a 2023 national poll. California is one of 10 states, along with Washington, D.C., that have authorized medical aid in dying. The other nine states are Colorado, Hawaii, Maine, Montana (via a state Supreme Court ruling), New Jersey, New Mexico, Oregon, Vermont, and Washington.

In addition, the retired longtime executive director of Disability Rights Oregon (DRO) from 1991-2019, which has federal authority to act as a watchdog for people with disabilities and request confidential records, confirmed in a 2019 letter: “In the years since passage of the [1994] Oregon Death with Dignity Act (the Act) … DRO has never to my knowledge received a complaint that a person with disabilities was coerced or being coerced to make use of the Act.” [Bold font added to original copy]

Finally, a 2007 Journal of Medical Ethics study about the Oregon Death with Dignity Act concluded:

“Rates of assisted dying in Oregon…showed no evidence of heightened risk for the elderly, women, the uninsured…people with low educational status, the poor, the physically disabled or chronically ill…people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations.” [Bold font added to original copy]

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