California, the nation's most populous state, is poised to approve "right-to-die" legislation that would allow terminally ill patients to legally end their lives.
The California Assembly approved a bill on a 43-34 vote Wednesday that would let doctors prescribe life-ending medications to patients expected to die within six months.
That bill now moves to the state Senate, which must approve it by Friday. Gov. Jerry Brown has not yet indicated whether or not he will sign the bill into law.
Supporters believe that California's approval could add momentum to the adoption of right-to-die laws across the country.
Opponents of the bill include religious groups such as the Catholic Church and advocates for the disabled.
California would become the fifth state in which people are allowed to legally end their lives. Oregon, Vermont and Washington already have passed laws allowing the practice, and Montana's courts have authorized it.
"I think lawmakers will be more comfortable voting for aid-in-dying, knowing that a big jurisdiction like California has already done so," said Barbara Coombs Lee, president of Compassion & Choices, a national organization that supports the practice.
"It's hard for lawmakers sometimes to think about being the pioneers in a social change movement. It will be easier for them to feel that they are one more state coming along in the assimilation of a new medical practice."
The California legislation is modeled after the Death With Dignity law passed by Oregon voters in 1994, which made that state the first in the nation to allow some terminally ill patients to choose the time of their own death.
The effort to pass the legislation in California was prompted, in part, by the death last year of Brittany Maynard, a 29-year-old California woman diagnosed with terminal brain cancer.
Maynard moved to Oregon so she could end her own life when the time was right, and became a prominent activist in the "death with dignity" movement through online videos and well-read news articles about her choice.
Under the Oregon law and the California bill, two physicians must see the patient, review the prognosis and agree that the person has an illness that will be fatal in six months, Coombs Lee said.
The doctors also must attest that the patient has no mental illness or mood disorder that impairs judgment, and that the person is not being coerced or forced into the decision, she said.
The person must receive counseling about hospice and palliative care, and be told that they are under no obligation to either fill the prescription for the life-ending drugs or to take them.
"The control resides with the patient, from beginning to end," Coombs Lee said.
The California legislation places additional safeguards on the Oregon model, including a statement that the patient must sign within 48 hours of their self-inflicted death indicating that they are still of sound mind and remain capable of taking the medication on their own, Coombs Lee said.
However, opponents believe the Oregon law is flawed and allows abuses that will also occur in California.
Marilyn Golden, a senior policy analyst with the Disability Rights Education and Defense Fund, said that assisted suicide laws could potentially let insurance companies coerce vulnerable people into a cheap and quick death.
"If insurers deny or even delay a person's life-sustaining treatment, they are being steered toward hastening their death," she said. "Do we really think insurers will do the right thing or the cheapest thing?"
Golden also questioned whether the safeguards cited by Coombs Lee are truly effective, noting that people who are depressed or being pressured to take their own lives can "doctor shop" until they find a physician willing to sign off on their lethal prescription.
"It's common knowledge in Oregon that if your doctor says no, you can call Compassion & Choices to find a doctor who says yes," Golden said.
These are troubling concerns that have kept legislators in other states from acting on assisted suicide legislation, she said.
"No one pays attention to the fact that 12 other states this year have rejected the Oregon model," Golden said. "As the legislators became aware of these problems, they chose not to move forward."
Coombs Lee believes many other states will come around, encouraged by Maynard's story and the example set by California.
"It takes a long time for lawmakers to educate themselves, and to start to feel comfortable voting yes," Coombs Lee said. "It's very unlikely a bill would pass a legislature the first time. California has been considering this in one way or another since 1991, when the first ballot initiative occurred."