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Robin Bernhoft, M.D.: Death law would turn family doctors into hit men

4:50 PM, Apr 25, 2015

As a retired liver and pancreatic cancer surgeon, I am appalled that California Senate Bill 128 is advancing. There are so many reasons we voted this idea down (as Proposition 161) back in 1992.

I call SB 128 "Personal Choice Meets Malpractice at the End of Life." Here are some problems, starting with choice.

Many studies show that patients follow their doctor's advice. Their quality of choice is only as good as their doctor's knowledge, and most doctors are simply not competent at treating pain or depression, which are the two big reasons terminally ill people want to die.

Sloan Kettering's Palliative Care Unit, for example, has had 100 percent success at giving back to terminal people their desire to live, by effectively managing their issues. In my experience, and in many studies, most well-intentioned family docs simply don't know how to do that. Follow their advice and you die because they don't know how to help. Garbage in, garbage out, as they say in computers.

So let's imagine two terminally ill people.

Patient No. 1 goes to Sloan Kettering or a palliative care specialist, regains the desire to live by having pain, depression and other problems managed effectively, and enjoys another six months, year or two years with his or her family. (The "six months left to live" bit is fiction, by the way; we have no idea how long a patient will live.)

Patient No. 2 sees a couple of family docs who are nice people but untrained in end-of-life care, and takes their recommended overdose. No time with family.

I have a big problem with disparities of that sort. Patient happiness is a huge value for me. If we can provide quality life we should do so, not deprive people of that option due to well-intentioned physician ignorance.

There's also the money issue. What is the cheapest form of end-of-life care? Death. Did you know the chief author and spokeswoman for the Oregon measure was vice president of a health insurance company? Why do you suppose an insurance company would be interested in this issue? Because they love humanity?

Does the potential for using death to ration care bother you? It does me. Many forms of managed care offer financial incentives to doctors to cut costs. You don't have to postulate monsters here, just doctors ignorant of effective options for supporting dying people's quality of life having financial incentives to give out death pills.

Regarding Oregon, since reporting of death cases is entirely voluntary, we have no idea how well the system is working up there. Nor will we in Washington, for the same reason. If there is abuse, it's not going to be reported without mandatory requirements, which, given medical secrecy, would not be enforceable.

We do know that in the Netherlands, from the attorney general's report, that over 20 percent of total deaths in that country are involuntary, caused by doctors without patient consent, despite very tight safeguards promising patient autonomy. Give docs the power to kill and some of us get a bit too enthusiastic.

There's also the family issue. Most people need to forgive, or be forgiven, by family members. It's part of the dying process. But in the Netherlands, it often doesn't happen and leaves the survivors with a burden the Dutch call the Post Euthanasia Syndrome.

Finally, back in the 1960s Margaret Mead, the anthropologist, did a study of doctor-assisted death. In every country where it was tried over the past centuries, it destroyed doctor-patient trust.

Let's not implement a bad idea here, a bad idea that will deprive a lot of people of quality life, and turn doctors into low-key hit men.

Californians voted down doctor-assisted death in 1992. We got it right back then.


Robin A. Bernhoft, M.D., of Ojai, is board certified in surgery and emergency medicine.

Published in Blog

The California Disability Alliance, which advocates for the health, independence, and community inclusion of persons with disabilities, opposes SB 128.

Published in Blog

The National Council on Independent Living (NCIL), the longest running national cross-disability, grassroots organization run by and for people with disabilities, respectfully opposes Senate Bill 128.

Published in Blog

As Expected, Assisted Suicide Bill Passes Committee

But list of bill opponents grows - Silicon Valley Independent Living Center and Communities United in Defense of Olmstead say no to Assisted Suicide

(Sacramento, CA) – Today, the Senate Judiciary Committee passed the controversial Senate Bill 128 (Monning, Wolk), the bill to legalize assisted suicide in California. Opposition testimony was delivered by Marilyn Golden, Senior Policy Analyst for the Disability Rights Education and Defense Fund, Tom Driscoll - a Stockton-based attorney who specializes in elder abuse and family law and a representative from the Association of Northern California Oncologists and Medical Oncology Association of Southern California.

While the bill passed its second committee, the list of those opposing assisted suicide continues to grow with the Silicon Valley Independent Living Center and Communities United in Defense of Olmstead joining disability rights organizations like The Arc CA, United Cerebral Palsy, Autism Self-Advocacy Network, California Foundation of Independent Living Centers and others opposing SB 128. 

In her testimony Marilyn Golden gave an example for why the very basic premise of a six-month "terminal" diagnosis makes SB 128 bad public policy. She testified that her colleague, "was diagnosed with ALS at age 18 and given 3-5 years to live. Six years later, the progression of his disease suddenly stopped and he is alive at age 77, with a wife, children, and retired from a successful career. He told me that if assisted suicide had been legal at the time, he would have used it, but is so happy to be alive."

Similar pieces of legislation have failed or been tabled this year in states like Connecticut, Colorado and Maryland. 


Published in Blog


We Oppose Assisted Suicide

  • Access to Independence – San Diego
  • American Disabled for Attendant Programs Today – Northern California (ADAPT)
  • American Disabled for Attendant Programs Today – Southern California (ADAPT)
  • Alliance of Catholic Healthcare
  • American Academy of Medical Ethics (AAME)
  • American College of Physicians – American Society of Internal Medicine
  • American College of Pediatricians
  • American Medical Association
  • American Nursing Association
  • Association of Northern California Oncologists (ANCO)
  • Association of Programs for Rural Independent Living (APRIL)
  • Autistic Self Advocacy Network (ASAN)
  • Berkeley Commission on Disability
  • California Catholic Conference
  • California Chapter of TASH (CalTASH)
  • California Disability Alliance (CDA)
  • California Family Alliance
  • California Family Council
  • California Foundation for Independent Living Centers (CFILC)
  • California Latino Medical Association
  • California Nurses for Ethical Standards (CNES)
  • California ProLife Council
  • California Right to Life Education Fund
  • California State Council on Developmental Disabilities
  • Californians for Disability Rights (CDR)
  • Catholics for the Common Good
  • Center for Independence of Individuals with Disabilities (CID)
  • Christian Medical and Dental Association
  • Coalition for Concerned Medical Professionals
  • Communities Actively Living Independents and Free (CALIF)
  • Crusade for Life
  • De La Salle Institute
  • Disability Rights Center
  • Disability Rights Education & Defense Fund (DREDF)
  • Disability Rights Enforcement Education Services (DREES)
  • Disability Section of the American Public Health Association
  • FREED, Center for Independent Living
  • Hispanics for Life
  • Independent Living Center of Southern California (ILCSC)
  • Independent Living Resource Center San Francisco (ILRCSF)
  • Independent Living Services of Northern California (ILSNC)
  • International Life Services
  • Joni and Friends
  • Justice for All (JFA)
  • La Raza Roundtable of Santa Clara County
  • League of United Latin American Citizens (LULAC)
  • Life Priority Network
  • Life Legal Defense Foundation
  • Medical Oncology Association of Southern California (MOASC)
  • National Council on Disability
  • National Council on Independent Living (NCIL)
  • National Spinal Cord Injury Association
  • Not Dead Yet – California Chapter
  • Not Dead Yet (NDY)
  • Oakland Mayors Commission on Human Relations
  • Patients Rights Council
  • Physicians for Compassionate Care
  • Placer Independent Resource Services, Inc.
  • Pro-Life America
  • Right to Life League of Southern California
  • San Mateo County, CA
  • Scholl Institute of Bioethics
  • Second Thoughts, People Living with Disabilities Opposing Assisted Suicide
  • Southern California Cancer Pain Initiative
  • TASH
  • The Arc of California
  • The California Catholic Conference
  • The Center for Bioethics and Culture Network (CBC Network)
  • The Oaks Group
  • West Coast Pro Life
  • Western Service Workers Association
  • World Association of Persons with Disabilities (WAPD)