Five times in the last dozen years, bills on medically assisted suicide have risen in the California Assembly, and five times they have failed.
In every instance, a great deal of the credit for their demise goes to a constituency associated with advancing personal choice and civil rights -- namely, the disability rights movement.
The latest attempt, Assembly Bill 374, which its backers called the California Compassionate Choices Act, failed to make it out of committee in June. Modeled on a statute passed by Oregon voters in 1997, it would have allowed mentally competent patients, whom doctors found had less than six months to live, to legally acquire lethal prescription drugs for self-administration.
Many disability rights activists contend that the increasingly cost-conscious healthcare system, especially health maintenance organizations, inevitably would respond to legalized suicide by withholding expensive care from the disabled and terminally ill until they chose to end their lives.
"HMOs are denying access to healthcare and hastening people's deaths already," said Paul Longmore, a history professor at San Francisco State and a pioneer in the historical study of disability. "Our concern is not just how this will affect us. Given the way the U.S. healthcare system is getting increasingly unjust and even savage, I don't think this system could be trusted to implement such a system equitably, or confine it to people who are immediately terminally ill."
Longmore was stricken with polio in 1953, when the Salk vaccine, which would eradicate the disease, was first undergoing clinical tests. Now 60, he has limited use of only one hand and is dependent on a portable ventilator for breathing.
Disabled people, Longmore said, "probably even more than most other citizens, understand the kind of suffering and needless pain that's inflicted on a lot of people and leaves some of them to prefer to die when they can't get the help they need."
Disability rights advocates "have a lot of credibility on this," said Marilyn Golden, a policy analyst for the Berkeley-based Disability Rights Education Defense Fund who lobbied hard against AB 374. "We are on the front lines of this issue as it actually plays out in the medical system."
Los Angeles activist Laura Remson Mitchell, 62, a San Fernando Valley activist with multiple sclerosis, kidney disease and diabetes, added that the federal government is considering cuts in aid "for people who are disabled and trying to live productive lives, and I find it disturbing that at a time like that we're even talking about assisted suicide, which would be a great way to cut costs and leave everybody with a clean conscience."
Remson Mitchell said her own health has "been kind of going downhill" over the last year. "The conditions I have are expensive to treat, and it would be a lot cheaper for the healthcare system to just let my health go to the point where I would want to die."
The activists believe the success they've had in combating assisted suicide legislation stems in part from the fact that they cannot be branded as religious conservatives and thus have more credibility among liberals and moderates.
"We were not part of a moral or religious overlay, but, rather, we were speaking to the public policy," said Ann Guerra, who has multiple sclerosis and is executive director of an independent living center in Grass Valley, Calif.
Disabled rights activists, however, resist being portrayed as the decisive force in the struggle, preferring to depict themselves as part of a broad coalition that includes religious believers and various medical associations.
One of the bill's co-sponsors, Assemblyman Lloyd Levine (D-Van Nuys), said that "we really had two main groups working against us: the Catholic Church and the disability rights folks."
Twenty-one states, including some "blue states" with progressive voting records, have rejected assisted suicide laws. "What has happened in each of these states," Golden said, "is that a cross-constituency has come together that spans left, right and center."
Not all disability rights advocates oppose medically assisted suicide. Public opinion polls indicate rank-and-file disabled people tend to favor the practice, given adequate safeguards, but activists have attacked those polls as misleading.
Alan Toy was 3 when polio struck him, the same year Longmore was afflicted. The disease cost Toy the use of his legs. At 57, he is an accomplished film actor, a member of the board of directors of the American Civil Liberties Union and founder of Living Independently in Los Angeles, an online resource for disabled people.
Toy, who spoke out in favor of AB 374, said his fellow disability rights advocates' opposition to the medically assisted suicide laws "comes out of fear, and I'm tired of living my life from that perspective."