CVIndependent

Tue09222020

Last updateMon, 24 Aug 2020 12pm

More critically ill Californians utilized the state’s End of Life Option Act in 2019 than in 2018—but almost all of those who did so were white.

That’s the big takeaway from the California Department of Health’s yearly report, released on June 30, on what is sometimes called the death with dignity law.

Consider: In 2019, some 618 terminally ill adult patients received prescriptions for medical aid in dying, and 405 patients took the medication to end their lives. Of those 405 Californians, 353 of them were white—or 87 percent, even though white people make up just 36.5 percent of the state’s population, according to 2019 U.S. Census estimates. (Full disclosure: My mother-in-law utilized the law in 2016.)

Only 5 Black Californians (1.2 percent), 26 Asian Californians (6.4 percent), and 16 Hispanic Californians (4 percent) utilized the law, although these demographic groups together represent 61.4 percent of the state’s population (Black 6.5 percent; Asian 15.5 percent; Hispanic 39.4 percent).

Compassion and Choices is “the nation’s oldest and largest nonprofit organization working to improve and expand health care options at the end of life,” according to the group’s website. The Independent spoke recently with Brandi Alexander, the national director of constituency at Compassion and Choices, and a Black American.

“I’m not surprised that the African-American community is using (the law) at a lesser rate, because traditionally, we underutilize palliative care overall,” she said. “We’re less likely to complete advance directives, or even have end-of-life conversations. Medical-aid-in-dying is just one of the palliative-care options that are available, along with hospice, and we underutilize hospice as well.

“I think it fits with a pattern in our communities of underutilizing end-of-life care in general. But this is what drives our work as an organization, so that people can be equipped with the information and know what options are available, (as well as) what those options mean to their treatment.”

Are there specific underlying issues that exist in minority communities that contribute to the reticence of people to engage in end-of-life planning?

“I don’t think any group is monolithic,” Alexander said, “but there has been an issue with trust in the medical community overall, so it’s always been a sensitive topic for the (Black) community. Although the law may not fit with (a particular individual’s) personal value system, they do still support it (as an option) for others. So, it makes sense to me that 70 percent (of Black Californians) agree with the option, but that doesn’t mean that they want it for themselves. I do think that personal values have a lot of impact on that number. That’s in addition to the fact that the information is not necessarily available to all patients.”

Patricia González-Portillo is the national Latino media and constituency director for Compassion and Choices.

“I can tell you that Latinos refuse to engage in these conversations,” González-Portillo said. “They’re afraid to talk about death. It’s something that’s known. We dress up for the Day of the Dead, and we wear the outfits, but when it’s time for us to talk about it, we just don’t. We (at Compassion and Choices) want to have people talk to their doctors, to have these conversations that are so important—especially now. This is critical during the pandemic.

“These numbers don’t surprise me, because, again, Latinos unfortunately will wait until death is at our door to start talking about this. That’s including me. My brother died of cancer in 2007, and my mom and I really started focusing on the fact that he was dying just six hours before his death. And it doesn’t work that way. People don’t prepare themselves (and think about), ‘What if I were in this situation?’ We (at Compassion and Choices) are doing everything we can to change that.”

The hope is that a variety of educational-outreach efforts by Compassion and Choices—including public-service announcements, peer-to-peer presentations and clinical presentations where doctors train other doctors about how the End of Life Option Act works—will help increase participation by all segments of the population.

Locally, Eisenhower Medical Center continues to forbid its doctors, staff members and facilities from having anything to do with the End of Life Option Act.

“In the Coachella Valley, we have an action team of volunteers who are trying to get the local hospices and secular health-care systems, like Eisenhower Medical Center, to change their policies to a neutral stance,” said Samantha Trad, California state campaign director for Compassion and Choices. “That means if a doctor wants to support their eligible terminally ill patient in medical-aid-in-dying, they can. In other words, they’d no longer be prohibited.”

Trad said she’s also been busy in Sacramento.

“We meet with legislators. I’ve already met with 75 California legislators this year just to update them on the law and let them know how it’s working,” she said. “The law is working as intended if you can get through all the process. But what we’re hearing is that (some steps) that were meant to be safeguards have turned into barriers and roadblocks. So it’s hard, and it’s a lot of work.”

Kim Callinan, the president and CEO of Compassion and Choices, laid out the challenges ahead for her organization in a June 30 press statement.

“We must all do a better job of ensuring equitable access to this peaceful dying option, so no terminally ill Californian has to needlessly suffer,” Callinan said.

She offered a suggestion for a roadmap that could lead to simpler and quicker patient access: “Oregon recently enacted an amendment to the 1994 Oregon Death with Dignity Act. It allows doctors to waive the waiting period requirements for medical aid in dying if the patient is not expected to live long enough to complete them. This has set a precedent for California and other states to make the same compassionate adjustment to their laws.”

Published in Local Issues

California will soon have a tougher new legal standard for the use of deadly force by police, under legislation Gov. Gavin Newsom signed yesterday, Aug, 19, that was inspired by last year’s fatal shooting of a young, unarmed man in Sacramento.

Newsom signed the legislation amid unusual fanfare, convening numerous legislators, family members of people who have died in police shootings and advocates including civil-rights leader Dolores Huerta in a courtyard at the Secretary of State’s building—used in the past for inaugurations and other formal events.

The governor contends that with Assembly Bill 392 in place, police will turn increasingly to de-escalation techniques, including verbal persuasion, weapons other than guns and other crisis-intervention methods.

“It is remarkable to get to this moment on a bill that is this controversial. But it means nothing unless we make this moment meaningful,” Newsom said after signing the legislation.

He made a point of praising law enforcement, saying the “overwhelming majority are extraordinary and honorable people.” He is planning to attend the funeral today of California Highway Patrol Officer Andre Moye Jr., who was killed by an ex-felon last week in Riverside.

Newsom also noted that the state’s current budget includes an additional $35 million for more police training, including training on ways to better handle severely mentally ill people. He said as many as a third of people shot to death by police are diagnosed with schizophrenia, bipolar disorder or some other serious illness.

“That is a tough assignment for law enforcement,” the governor said. “What’s happening on the streets of California is challenging, and law enforcement is increasingly being called to do social work.”

Kori McCoy, who attended the bill signing, was among various family members of people shot to death by police. His brother, Willie McCoy, was shot Feb. 9 while he slept at a Taco Bell in Vallejo. Six officers fired 55 rounds, hitting him more than 20 times.

“I don’t think this is going to totally change everything, but it definitely is a piece, and we’ll take it,” McCoy said about the legislation.

The law reflects a compromise between civil-rights advocates who want to limit when police can shoot, and law-enforcement groups who said earlier versions of the bill would have put officers in danger.

Under the new law, which takes effect Jan. 1, police may use deadly force only when “necessary in defense of human life.”

That’s a steeper standard than prosecutors apply now, which says officers can shoot when doing so is “reasonable.” One of the most significant changes will allow prosecutors to consider officers’ actions leading up to a shooting when deciding whether deadly force is justified.

“This will make a difference not only in California, but we know it will make a difference around the world,” said Assemblywoman Shirley Weber, the San Diego Democrat who carried the legislation.

The law doesn’t go as far as civil libertarians originally proposed, and courts will need to define what a “necessary” use of force is in future cases. The negotiations led a few early supporters, including the group Black Lives Matter, to drop their support, and major statewide law-enforcement organizations to drop their opposition. After a year of contentious testimony over how to reduce police shootings, the final version of the bill sailed through the Legislature with bipartisan support. 

Newsom’s staff helped broker the compromise, and his signature was not a surprise. In March—after Sacramento’s district attorney cleared the officers who killed Stephon Clark on March 18, 2018, in his grandparents’ backyard after mistaking the cell phone he was holding for a gun—Newsom signaled support for police reforms that “reinforce the sanctity of human life.” And in June, he said he would sign the bill as he praised advocates for “working across their differences” to forge a compromise.

“The bill is watered down; everybody knows that,” Stevante Clark, brother of Stephon Clark, told the Los Angeles Times. “But at least we are getting something done. At least we are having the conversation now.”

California police kill more than 100 people a year—at a rate higher than the national average and highest among states with populations of 8 million or more. Most of the people police kill are armed with a gun or a knife.

But when California police kill people who are not armed, the impact falls disproportionately on Latinos and African Americans. Together, those groups make up 66 percent of the unarmed people California police killed between 2016 and 2018, but about 46 percent of the state’s population.

For more on California’s attempt to reduce police shootings, please listen to CalMatters’ Force of Law podcast. It’s available here on Apple Podcasts or here on other podcasting platforms. To read the Independent’s ongoing coverage of police shootings, go hereCalMatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.

Published in Politics