California's right-to-die law (formally known as End Of Life Option Act) went into effect June 9, 2016. California is the fourth state to legalize medically assisted death at the request of a competent adult with a terminal illness. The other states are Oregon (since 1997), Washington and Vermont. This highly controversial concept, often called "death with dignity," continues to gain momentum; at least 25 states have considered or are considering bills that could result in laws similar to the one in California.

From a legal perspective, it is already broadly accepted that a competent adult has the right to decide whether to receive or to decline life-sustaining treatment. “Life-sustaining treatment” is defined by the American Medical Association as any treatment that serves to prolong life without reversing the underlying medical condition. Life-sustaining treatment may include, but is not limited to, mechanical ventilation, renal dialysis, chemotherapy, antibiotics, and artificial nutrition and hydration. AMA, Code of Medical Ethics, Opinion 2.20. The legal right of a competent patient to refuse or terminate life-sustaining treatment was affirmed by the U.S. Supreme Court in Cruzan v. Missouri Dep’t of Health, 497 U.S. 261 (1990). Most states, including Michigan, also permit a legally competent adult to give a surrogate decision maker (called a “patient advocate” in Michigan) the authority to withhold or withdraw life-sustaining treatment in the event the adult cannot make the decision due to incapacity. Note: There are specific, legal requirements that have to be met in order to effectively designate a patient advocate in Michigan.

It is one thing to artificially prolong life, it is a very different thing to artificially induce death. A medically assisted death requires a patient to perform a deliberate, physical act intended to end his or her life sooner than it would end of natural causes. On the other hand, a death resulting from withholding or withdrawing life-sustaining treatment requires a patient to make a deliberate decision not to apply artificial means to extend his or her life, reflecting a preference to allow his or her life to end of natural causes. Worded another way, it is one thing to artificially induce death and quite another to artificially prolong life.

Whether a person should have the right to pro-actively end their life with medical assistance is a complex subject with practical, moral, ethical, financial, social (I could go on) implications. As our society wrestles with this concept, its citizens should engage in the conversation thoughtfully, civilly and with reasoned arguments. To inspire further thought, here is a link to an article that does a pretty good job of describing the current legal status of, and different philosophical points of view on, the concept of medically assisted death.