Because the law took effect 90 days after the Legislature adjourned, its special session pushed the start date into summer. “The California law will permit physicians to provide lethal prescriptions to mentally competent adults who have been diagnosed with a terminal illness and face the expectation that they will die within six months,” as the Los Angeles Times reported.

After maintaining a long holding pattern, the patchwork of stakeholders involved in the change have shifted into action. “As the implementation date nears, medical groups, supporters, legislators and others are working to raise awareness of the new right-to-die law and ensure all terminally ill patients will have access to it,” CNN reported. “They are holding webinars, panels and town hall meetings, distributing information and setting up telephone lines.”

Substantial hurdles

Resistance to physician-assisted suicide has remained strong since legislation was first proposed, however. Combined with the relatively narrow tailoring of the law, crafted to achieve passage in Sacramento and adequate support statewide, “it still is unclear how the law will play out in California,” as Ben Rich, a bioethics professor emeritus at the UC Davis School of Medicine, told CNN. “He said he expects some health institutions to be supportive and others to be unsupportive, leading to inconsistency around the state,” the network noted.

As it stands, Californians trying to avail themselves of the new process will have a laborious road ahead. “In January the state published guidelines for how the lethal drugs can be prescribed and administered, establishing a lengthy process to ensure that patients are making informed decisions,” New York Magazine observed. “Any patient wishing to be prescribed lethal dosages have to make two verbal requests, 15 days apart, and one written request. He or she has to be at least 18 years old, and a physician has to rule out mental illness.”

A limited trend

Even with its hurdles, the change has been hailed as yet another of California’s supposed bellwether bills. But states that have followed California’s lead on other issues may not be ready this time. In Maryland, this month, similar legislation went down to defeat, following a broader pattern. “Maryland is one of 25 states, along with the District, that have introduced what advocates call ‘aid-in-dying’ legislation since the highly publicized suicide of Brittany Maynard, a 29-year-old California woman who had terminal brain cancer and moved to Oregon in 2014 to legally end her life,” the Washington Post observed.

Kim Callinan, of assisted suicide group Compassion & Choices, told the Post it often “takes multiple times,” to make legislative headway. “In addition to California and Oregon, aid in dying is permitted, with varying restrictions, in Washington state, Vermont and Montana,” as the paper added.

Much comes down to the personal predilections of each state’s governor. Jerry Brown was seen to grapple with the philosophical precepts at stake in legalizing assisted suicide. “In the end, I was left to reflect on what I would want in the face of my own death,” he revealed in his signing statement, as the Los Angeles Times relayed. “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others.” Despite broad American trends toward a more individualistic view of the meaning of life, few governors, even in states where evangelical Christianity and Catholicism have not often mobilized to sink legislation, share Gov. Brown’s unusually spiritual — but distinctively Californian — outlook.

The move capped a long and sometimes tortuous effort to get legislation through the state Legislature, where opponents of elective death managed to mount a successfully targeted opposition that was eventually overcome.

Initially, the bill’s progress was smoothed when the California Medical Association ceased its opposition, as the Huffington Post noted, leading state Senators to pass it this June. “But before it could be brought to a vote in the Assembly, lawmakers abandoned the bill in committee amid opposition from the Catholic church as well as disability rights advocacy groups.” That led supporters to rejigger the legislation in special session last month, “adding a sunset provision so that the bill will expire in 10 years unless legislators vote to extend it. The bill passed in committee by a 10-2 vote before going on to the full legislative body for consideration.”

Murky ethics

Brown’s logic for accepting the bill, conveyed in an unusually personal signing statement, hinted at the murky ethical territory into which the assisted-suicide movement has plunged officials in multiple states. While advocates characteristically consider at least some terminally ill patients to possess a human right to end their own lives, Brown seemed intent on sidestepping that question in favor of a more agnostic view.

“In the end, I was left to reflect on what I would want in the face of my own death,” he wrote, CNN noted. “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill.”

As ABC News reported, Brown “said he consulted a Catholic bishop, two of his own doctors and friends ‘who take varied, contradictory and nuanced positions.'” Traditionally, elective suicide has been seen as a moral problem for patients as well as doctors, famously sworn to “first, do no harm.”

But that once-sturdy consensus has begun to collapse, perhaps especially in socially libertarian states like California. “Roughly two-thirds of U.S. adults (68 percent) say doctors should be allowed by law to assist patients who are terminally ill and living in severe pain to commit suicide,” Pew observed. “That’s an increase of 10 percentage points in just one year, and 17 points over two years.” Meanwhile, “a new Field Poll released Monday found two-thirds of California registered voters supported a proposal to give patients the right to obtain life-ending drugs, with support cutting across most religious and political party lines,” according to the San Jose Mercury News.

Legal wrangling

Yet California’s version of legalized assisted suicide did not reach as broadly as the majority public opinion may wish. “The new law requires two doctors to determine that a patient has six months or less to live before the lethal drugs can be prescribed. Patients also must be physically able to swallow the medication themselves and must have the mental capacity to make medical decisions,” NPR noted. “One of the meetings must be private, with only the patient and the physician present. […] Patients must also reaffirm in writing that they intend to take the medication within 48 hours.”

Opponents have warned that those safeguards aren’t enough to prevent abuse. “Tim Rosales, spokesman for the Californians Against Assisted Suicide Coalition, said opponents of the law aren’t giving up their fight,” the Mercury News reported. “They vowed Monday to explore their options, including a referendum or legal action to repeal the law.”

Rosales and his allies were bolstered by the trouble assisted suicide has encountered in the courts. “It was permitted in New Mexico until August, when an appeals court in the state reversed a lower court ruling that had established physician-assisted suicide as a right,” NPR added. “The New Mexico Supreme Court is now hearing that case.”

Unanticipated opposition

“The state Assembly Health Committee on Tuesday postponed a key vote on legislation that would allow adults with a terminal illness to seek medication from a doctor to end their lives,” the San Jose Mercury News reported, “raising doubts about the fate of the hotly contested bill.”

“Democrats representing the Bay Area who sit on the committee are expected to support the End of Life Option Act, but several Democratic members from Southern California remain undecided. And they’re facing intense pressure from the Roman Catholic Archdiocese of Los Angeles to vote no.”

In the wake of East Bay resident Brittany Maynard’s decision last year to end her life in Oregon, where assisted suicide is legal, SB128 was introduced by state Sens. Lois Wolk, D-Davis, and Bill Monning, D-Monterey. Northern California Democrats quickly lined up in support of the bill, although Gov. Jerry Brown’s signature is not guaranteed. “Gov. Jerry Brown has not yet said whether he would sign the bill,” the Washington Post noted, adding that SB128 “would make California the most populous state to allow physicians to write lethal prescriptions for dying patients.”

Catholic clout

The about-face indicated that Christian voters, including Democrats, possess more power to influence legislators than many observers and policymakers assumed. “The California Medical Association dropped its opposition to SB128, but the Catholic Church and other religious groups are still fighting it,” the Associated Press observed.

Apparently, however, one voice in particular had an outsized impact on key members of the health committee — that of Los Angeles Archbishop José Gomez, who sent out a letter insisting that SB128 must be opposed. Citing “dangerous implications for our state, especially the poor and the most vulnerable,” he urged legislators not to “allow California to become a place where we respond to human suffering by simply making it easier for people to kill themselves.”

At a requiem mass for the aborted conducted in January, Gomez struck a similar tone. “Only God, who is the Lord of our beginning and the Lord of our ending, can make the determination of the beginning and end of life,” he said. “If the child in the womb has no right to be born, if the sick and the old have no right to be taken care of, then there is no solid foundation to defend anyone’s human rights.”

Homing in on the same targets as Gomez, right-to-die advocates recently singled out several legislators who they hope to flip in their favor. According to the Pasadena Star-News, the Compassion & Choices organization “visited the offices of three Latino Catholic Assemblymen: Jimmy Gomez, D-Los Angeles; Roger Hernandez, D-West Covina; and Freddie Rodriguez, D-Chino. About 30 people stood outside the West Covina district office Tuesday chanting ‘SB128! We can’t wait!’ and ‘Si se puede.’ Some held up signs saying, ‘It is my life. It is my death. Please respect my choice.'”

“Patricia Gonzalez-Portillo, spokeswoman for Compassion & Choices, cited an independent survey released last week that said 7 out of 10 Californians support the proposed legislation, including 70 percent of Latinos and 60 percent of Catholics.”

A second try

Meanwhile, Assembly Republicans nursed hopes of succeeding where their colleagues had failed. SB128 had passed the Senate over the objections of critics like state Sen. Jeff Stone, R-Temecula, who raised the specter of an influx of so-called death tourists. “What is going to be the new theme of the state of California?” he asked, according to CBS Sacramento. “Come play, live and die in California.”