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SACRAMENTO - In a landmark victory for supporters of assisted suicide, the California State Legislature on Friday gave its final approval to a bill that would allow doctors to help terminally ill people end their lives.
Four states - Oregon, Washington, Montana and Vermont - already allow physicians to prescribe life-ending medication to some patients. The California bill, which passed Friday in the State Senate by a vote of 23 to 14, will now go to Gov. Jerry Brown, who will roughly triple access to doctor-assisted suicide across the country if he signs it. Mr. Brown has given little indication of his intentions.
The California bill is modeled on the law in Oregon, with several notable changes. The California law would expire after 10 years and have to be reapproved, and doctors would have to consult in private with the patient desiring to die, as part of an effort to ensure that no one would be coerced to end his or her life - a primary concern for opponents of the law.
Leaders of the "death with dignity" movement said they hoped the passage of the California law could be a turning point.
"It allows for individual liberty and freedom, freedom of choice," said Mark Leno, a Democrat from San Francisco who compared the issue to gay marriage.
Since Oregon approved the country's first assisted-suicide law in 1997, supporters have struggled to expand their reach, amid opposition from religious groups, some medical organizations and lawmakers whose skepticism crosses party lines.
"I'm not going to push the old or the weak out of this world," Senator Ted Gaines, a Republican, said on the floor. "I think that could be the unintended consequence of this legislation."
More than half the states, plus Washington, DC, have put forward bills this year to legalize some kind of assisted suicide, according to the Death With Dignity National Center, which is based in Portland, Ore. So far, none of them have become law.
"If it becomes the law in California, that's going to be very, very significant nationally," said George Eighmey, vice president of Death With Dignity and a former state legislator in Oregon.
In spite of the bill's provision about coercion, Dr. Aaron Kheriaty, director of the medical ethics program at the University of California, Irvine, School of Medicine, said that low-income and underinsured patients would inevitably feel pressure from family members to end their own lives in some cases, when the cost of continued treatment would be astronomical compared with the cost of a few lethal pills.
He pointed to a case in Oregon involving Barbara Wagner, a cancer patient who said that her insurance plan had refused to cover an expensive treatment but did offer to pay for "physician aid in dying."
"As soon as this is introduced, it immediately becomes the cheapest and most expedient way to deal with complicated end-of-life situations," Dr. Kheriaty said. "You're seeing the push for assisted suicide from generally white, upper-middle-class people, who are least likely to be pressured. You're not seeing support from the underinsured and economically marginalized. Those people want access to better health care. "
Mr. Eighmey said that the argument about pressure from families had the issue backward: "It's always the loved ones who want the dying person to try one more round of chemo, one more treatment down in Mexico."
Until after a Supreme Court ruling in 2006 threw out a Justice Department effort to block Oregon's law, no other state permitted assisted suicide. Washington adopted its measure in 2008. Several northern European countries, including the Netherlands, Belgium and Sweden, also allow assisted suicide. The British Parliament on Friday voted down a measure that would have permitted physicians to help terminally ill people end their lives.
Previous bills to legalize assisted suicide have failed in California, including one this year, when pressure from the Roman Catholic Church helped stall a similar measure in the Assembly. (The bill was resurrected for a special session, where it could bypass Assembly committees.)
But this year in California, the aid-in-dying movement, as advocates prefer to call it, had a public face: Brittany Maynard, a Bay Area woman who received a diagnosis of terminal brain cancer and moved with her family to Oregon last year so she could end her life on her own terms. Ms. Maynard, who died in November at 29, drew nationwide news media attention for her crusade to die legally under conditions of her own choosing. Her family has since been involved in lobbying for the California bill.
Opinion within the medical community here has also begun to shift. After decades of opposing physician-assisted suicide, the California Medical Association switched its position this year, adopting a neutral stance and stressing that the decision was a personal one for doctors and patients to make.
On the Senate floor on Friday, members told one personal story after another of watching loved ones die, as they argued both for and against assisted suicide.
Senator Hannah-Beth Jackson, a Democrat, told of her mother's two requests while suffering from leukemia: Not to die alone, and to maintain her dignity. "We are talking about giving people a choice," she said. "They want to be able to transition out of this life with their dignity."
Though Mr. Brown has been silent about his position on the bill, he has been critical of the decision to bring assisted suicide forward in a special session, where the legislative process is curtailed.
But backers of the bill have discussed bringing the issue to the voters through a ballot measure if Mr. Brown vetoes it. A Gallup poll this year found that nearly 70 percent of Americans support physician-assisted suicide, up 10 percentage points from last year.
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