Senate Bill 128, the so-called “End of Life Option Act,” was introduced earlier this year by state Sens. Lois Wolk, D-Davis, and Bill Monning, D-Carmel. Modeled on an Oregon law governing physician-assisted suicide, SB128 set out a series of conditions that would legalize but limit the practice.

Retooled after it initially stalled, the bill has now passed through the state Senate appropriations committee. “Backers of the assisted suicide proposal made some changes to the bill to gain more support after it initially met with strong opposition from hospitals, doctors, anti-abortion organizations and disability rights groups,” Reuters reported. “As currently written, it allows hospitals and medical providers to refuse to comply with a patient’s wish for assisted suicide, and also makes it illegal to pressure or manipulate people into ending their lives.”

The bill’s final language required that medication be self-administered by a mentally competent patient diagnosed by two physicians with six months or less to live, according to California Healthline.

Deepening controversy

One key to the bill’s committee clearance, Reuters noted, was the California Medical Association, which “still opposes the concept of assisted suicide” but “removed its formal opposition to the bill.”

Yet this attempt at a compromise position has left many palliative doctors unsatisfied. Among those supportive of assisted suicide, some have argued that all patients should have a right to avoid discomfort at the end of life — an objective even diligent palliative care cannot always meet.

Others, arguing against the practice, insisted that affirmatively ending patients’ lives was an unnecessary and crude response to the discomfort of death and dying. Newport Beach doctor Vincent Nguyen told Southern California Public Radio that patients’ typical fears — “about pain, losing control or being a burden on family — can be managed with spiritual and emotional counseling and pain medications, all of which are part of the palliative care toolkit.”

Dr. Ira Byock, a palliative care physician in Torrance, went further. Contrary to their wishes, he warned, the chronically ill often “spend their last weeks in intensive care units, hooked up to life support,” according to SCPR. “To address this problem, he says that all doctors — from medical students to veteran practitioners — should be required to have training in end of life conversations.”

A moral shift

As SB128 came one step closer to becoming law, analysts began a closer look at how much popular support the bill might attract. As has long been the case on high-profile and hot-button issues, California has been seen as a bellwether in the struggle over how the law treats those who want to die.

Despite gathering momentum to legalize assisted suicide, public opinion has remained split. But in-state and nationwide, data suggested an ongoing shift in mores that benefits how SB128 is perceived. “Nearly seven in 10 Americans (68 percent) say doctors should be legally allowed to assist terminally ill patients in committing suicide, up 10 percentage points from last year,” Gallup reported. “More broadly, support for euthanasia has risen nearly 20 points in the last two years and stands at the highest level in more than a decade.”

The shift has left opponents pivoting to warn that even relatively narrow authorizations of the practice would lead to ever-broader accommodations down the road. “In the Netherlands, after many years, legal assisted suicide for the dying has evolved into death on demand, with six out of 10 doctors admitting to killing a patient who was simply ‘tired of   living,'” wrote  Jacqueline Harvey of Euthanasia Prevention International at National Review. “California is approaching that slippery slope.”

Changing mores among MDs

For disability-rights advocates like Marilyn Golden, senior policy analyst at the Disability Rights Education and Defense Fund, “the marriage of a profit-driven healthcare system and legalized aid in dying sets up dangerous possibilities,” the Los Angeles Times reported. “She warned of a scenario in which insurers might deny or delay life-sustaining treatments and a patient ‘is steered toward assisted suicide.'”

But views among doctors have moved strongly toward accepting illness-driven suicide. A recent nationwide poll conducted by the Medscape Ethics Center showed that 54 percent of respondents agreed that medically-assisted suicide should be permitted — an 8 percent increase in support among American doctors over the past five years.

The numbers showed how sharply and deeply the divide among physicians has become. “Historically, doctors have been some of the most vocal critics of assisted suicide,” The Atlantic recently noted.

“The American Medical Association still says that ‘physician-assisted suicide is fundamentally incompatible with the physician’s role as healer.’ Similarly, the California Medical Association takes the view that helping patients die conflicts with doctors’ commitment to do no harm. ‘It is the physicians’ job to take care of the patient and that is amplified when that patient is most sick,’ said a spokeswoman, Molly Weedn.”

A legislative push

With the shift in medical opinion, political support has also increased. While the doctors’ lawsuit makes its way through the courts, Sacramento Democrats have begun to advance legislation that would go even further. In a letter to state Sens. Lois Wolk, D-Davis, and Bill Monning, D-Carmel, U.S. Sen. Dianne Feinstein, D-Calif., gave her stamp of approval to Senate Bill 128, the so-called California End of Life Option Act:

“The right to die with dignity is an option that should be available for every chronically suffering terminally ill consenting adult in California. I share your concern that terminally ill California residents currently do not have the option to obtain end-of-life medication if their suffering becomes unbearable. As a result they may well experience terrible pain until their illness has taken their life naturally.”

The bill “would allow mentally competent California residents with less than six months to live obtain physician-prescribed lethal drugs that they’d administer themselves,” according to the Los Angeles Times. “A patient would need two doctors to confirm the illness was terminal. Also required: two oral requests 15 days apart and a written version witnessed by two people. Physicians, pharmacists and healthcare facilities could opt out. Those participating would be protected against lawsuits. Coercing a patient would be a felony.”

SB128 recently passed through the Senate Health Committee, which viewed a video message prepared by the activist Brittany Maynard, who moved to Oregon from California last year in order to end her life in accordance with that state’s assisted-suicide law.

“Before she died, Maynard recorded testimony in favor of passing such a law in California,” Reuters reported. “I am heartbroken that I had to leave behind my home, my community, and my friends in California, but I am dying and I refuse to lose my dignity,” Maynard said in the video. “I refuse to subject myself and my family to purposeless, prolonged pain and suffering at the hands of an incurable disease.”

A bellwether in the making

The assisted-suicide movement has positioned itself well to exploit a potential success in California. In addition to Oregon, Washington and Vermont also legally permit the practice. “Courts in New Mexico and Montana also have ruled that aid in dying is legal, and a suit was also recently filed in New York,” according to The Atlantic.

Maynard, 29, an assisted-suicide activist living in Oregon, advertised her impending death as a dignified response to the “aggressive” form of terminal brain cancer that left her with a few painful months of natural life. Maynard moved from the San Francisco Bay Area to Oregon to avail herself of the state’s 1997 law authorizing a narrowly tailored right to die at the hands of doctors.

Now legislators in Sacramento have borrowed the language of that law to draft a version that would protect assisted suicide throughout California.

Careful wording

Despite the vogue for so-called “death with dignity” bills, which are now in the works in 14 states nationwide, opposition to legal suicide is strong enough that California legislators opted to stick with the narrow terms laid down in the Oregon statute.

The bill, SB128, stipulates a long list of conditions that must be met for a person’s request to terminate their life to be fulfilled. For instance, only mentally competent adults given six months or less to live, and equipped with an in-state driver’s license and voter registration, may make the request of their attending physician.

The numerous legal hurdles are part of an effort to ensure the bill is not successfully portrayed as greasing a slippery slope toward fuller suicide rights. In 1992, California voters sank the Aid-In-Dying Act, reversing an apparent trend of support for the measure.

And as U-T San Diego reported, similar bills “were defeated last year in New Hampshire, Connecticut and Massachusetts by a coalition of disability rights groups, medical associations, hospital workers and right-to-life groups.”

Those groups included the Catholic Church, which was instrumental in preventing assisted suicide in California and is expected, like other organizations, to mobilize against the current wave of bills.

Critics also point out the experience in the Netherlands, which had 6,000 cases in 2014 out of a population of 17 million, is that limits on euthanasia can be expanded. London’s Daily Mail quoted Dr. Peter Saunders, “What we are seeing in the Netherlands is ‘incremental extension,’ the steady intentional escalation of numbers with a gradual widening of the categories of patients to be included.”

Political posturing

The delicate wording of SB128 nevertheless struck a clear contrast with the political imagery and posturing surrounding the bill’s introduction. Maynard’s husband and mother made the case for the bill at an uncharacteristically raw news conference where nine California legislators announced the legislation.

“She recognized that to stay in California would mean she potentially would face a horrific death,” her husband, Dan Diaz, told reporters. “Brittany was a Californian. We lived in this state and she would have preferred to pass away peacefully in this state.”

State Sen. Lois Wolk, D-Davis, who co-sponsored the bill with state Sen. Bill Monning, D-Carmel, echoed Diaz. “The fact that Brittany Maynard was a Californian suffering from an incurable, irreversible illness who then had to leave the state to ease her suffering was simply appalling, simply unacceptable,” she said.

Likely complications

Although Wolk, Monning and their allies have successfully capitalized on Maynard’s plans to make assisted suicide a fresh issue, they face opposition from political figures who can make or break SB128. Although in 1976, Gov. Jerry Brown approved a legal right for terminally ill patients to end so-called life-sustaining treatment, it’s unclear whether he’s willing to go as far as Wolk and Monning wish. He has yet to make public comment on the matter.

What’s more, SB128 faces big hurdles even before it can land on Brown’s desk. As Time reported, “Wolk expects the bill will make it out of committee and reach the Senate floor, but will have a tough time passing both houses of the Legislature.”

She told the magazine she expects a “heavy lift” in trying to secure passage over the objections of tradition-minded Democrats as well as Republicans.

As critics in the medical profession have observed, legally protected rights to suicide bring legal duties. In Oregon, for instance, the state-sponsored medical plan offered to cover suicide-inducing drugs instead of more costly cancer treatments.