This week, we reflect on two significant anniversaries in the death with dignity movement. It has been four years since California’s End of Life Option Act took effect, and a year since Governor Janet Mills signed the Maine Death with Dignity Act into law. Both assisted dying statutes were results of multi-decade campaigns and personal stories.

California End of Life Option Act: A Quarter Century in the Making

The first attempts at passing a law in California go back more than a quarter-century. In 1992, Americans for Death with Dignity placed the California Death with Dignity Act on the state ballot. Because the law would have legalized euthanasia by lethal injection, voters rejected the measure by an eight-point margin.

Two Decades of Movement-Building

Oregon’s success, in 1994 and 1997, inspired Californians to give death with dignity another go. California Death with Dignity Education Center was founded in 1994, with the goal of promoting a comprehensive and humane system for end-of-life care for terminally ill patients. Legislators also jumped into the fray, introducing a number of bills over the next two decades. None advanced.

Brittany Maynard’s Impact

In 2014, the death with dignity movement nationwide received a new infusion of energy and purpose due to one woman’s story. Brittany Maynard, a 29-year-old Californian dying of terminal brain cancer, decided to move from her home state to Oregon to use its death with dignity law.

Maynard changed the face of the death with dignity movement. Her articulate explanation of why she insisted on having some say in the matter of her impending death, and her calm resolve in the face of a devastating diagnosis captured the hearts of millions who learned about her story through extensive media coverage.

A New Bill

Following Maynard’s death in November 2014, lawmakers in more than half the states introduced aid-in-dying legislation. In January 2015, California State Senators Bill Monning and Lois Wolk introduced the End of Life Option Act.

We worked with the Senators to draft the legislation, and provided expert testimony at legislative hearings at the California State Capitol in Sacramento in support of lawmakers and advocates.

In June 2015 the California Senate passed the bill on a 23-14 vote. Death with Dignity Executive Director Peg Sandeen called the vote “historic…a monumental step toward providing death with dignity as an end-of-life option for qualified Californians.”

When then-Governor Jerry Brown convened an extraordinary legislative session on healthcare in August 2015, the End of Life Option Act was on the docket. After passionate debate from lawmakers and advocates on both sides of the issue, the California Assembly and Senate both approved the bill.

The Law of the Land

Brown signed it into law on October 5, making the Golden State the fourth state to adopt medical aid in dying.

In a deeply personal signing message, Brown, a Catholic, described wrestling with the moral and ethical implications of signing the law—and what ultimately led him to do so:

I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by the bill. And I wouldn’t deny the right to others.—CALIFORNIA GOVERNOR JERRY BROWN

Implementation and a Legal Challenge

The End of Life Option Act went into effect four years ago today, on June 9, 2016.

As has happened after every death with dignity statute has been enacted, opponents mounted a legal challenge almost immediately after implementation began. On May 15, 2018, a district court judge allowed a portion of their suit to proceed. After bringing peace of mind to terminally ill Californians for nearly two years, the End of Life Option Act was invalidated.

We filed an amicus curiae brief in August 2018 in support of the Attorney General’s defense of the law, arguing that the passage of the law during a special session devoted to healthcare was constitutional because death with dignity is a fundamental component of end-of-life care.

Eventually, the Fourth District Court of Appeal overturned the lower court’s decision; the law has remained in effect ever since.

State Law, National Impact

The passage of the California End of Life Option Act was a watershed moment in the death with dignity movement. The Golden State has long been a bellwether for major cultural and policy change; indeed, California’s adoption of an assisted-dying law not only gave more than 40 million people access to death with dignity, it also accelerated the movement nationwide. Since 2015, five additional jurisdictions have passed similar statutes (ColoradoWashington, D.C.HawaiiNew Jersey, and Maine), and lawmakers in every region of the U.S. have introduced bills.

Comfort and Control

California’s annual reports on the End of Life Option Act bear out what we know from other states with aid-in-dying statutes: a small number of people use the law, and many people who receive the medication do not take it, finding great comfort in merely knowing it was available to them.

Brittany Maynard’s mother, Deborah Ziegler, who joined our Board of Directors in 2017, continues to honor her daughter’s legacy through passionate advocacy.

“On June 9, 2016, when after months of meeting with and testifying before California legislators the California End of Life Option Act came into effect, I felt a quickening in my heart as my daughter’s light shone brightly,” Deborah shared with us. “Brittany believed strongly that it was her human right to die as she lived – with dignity, strength and great love for all of humanity. I felt profoundly proud of my daughter who through her advocacy had literally made a difference in the world.”

I am doing exactly what Brittany asked of me: speaking up for those who are terminally ill.

Deborah Ziegler
Maine Death with Dignity Act: An East Coast Success

Maine, too, has a multi-decade history of activism and attempts to pass death with dignity legislation. Lawmakers first introduced a bill the same year California’s first proposal appeared on that state’s ballot. Following the Oregon Death with Dignity Act’s passage in 1994, Maine legislators introduced bills in three consecutive legislative sessions (1995-97), with no success.

Question 1

The first significant citizen-led campaign took shape in early 1999, when our predecessor organization partnered with a dedicated group of Maine residents on placing Question 1, an Oregon-style ballot initiative, on the November 2000 ballot. Despite Mainers’ support for the measure, a last-minute flood of opposition advertising ultimately led to Question 1’s narrow defeat, 51 to 49 percent, with the vote difference statewide just 6,000.

A Legislative Push for Death with Dignity

In 2015, Maine state lawmakers introduced a bill modeled on Vermont‘s Act 39. We worked with grassroots advocate, Valerie Lovelace, to complement legislative efforts with grassroots advocacy. The House approved the bill on a 76-70 vote; the Senate defeated it by a single vote, 18-17.

In the 2017 session, Val and a growing number of advocates redoubled their efforts, and we assisted in developing a sound advocacy strategy to push for a re-introduced bill. We provided expert testimony at a legislative hearing on the bill, and commissioned a poll demonstrating strong support among voters for the bill. This time around, it was the Senate that approved the bill and the House that defeated it.

“Come hell or high water, we’re going to get legislation passed,” Val said in response. Over the next two years, we worked with her to form a political action committee, Maine Death with Dignity, that led a successful signature-gathering effort to place an assisted-dying measure on the 2019 ballot. In parallel, we pursued a legislative strategy, working with State Representative Patricia Hymanson on drafting and moving a bill, LD1313.

The groundswell of support for the Maine Death with Dignity Act catalyzed by Val and Maine Death with Dignity manifested at an April 2019 legislative hearing, where numerous advocates shared powerful personal stories and urged lawmakers to pass the bill.

Those stories struck a chord with many legislators, and built further momentum for the bill.

Above: Cyndie Rogers, a Maine advocate with terminal cancer, testified in favor of LD1313 at the April 10, 2019 hearing before the Maine State Legislature’s Committee on Health and Human Services.

On June 3, 2019, in a nail-biter of a vote, the House approved LD1313 on a 73-72 vote; the following day, the Senate approved it 19-16.

The Ninth Jurisdiction

On June 12, 2019, Maine Governor Janet Mills signed the Death with Dignity Act into law, making Maine the ninth jurisdiction in the U.S. with an aid-in-dying statute.

From left: Val Lovelace, of Maine Death with Dignity, with steadfast advocate Eva Thompson (1957-2017).

“I am so proud and grateful to finally be heard by our lawmakers and our Governor on this issue,” Val said just after the bill signing. “This is an exceptionally historic day for Maine.”

Val was quick to point out that the victory in Maine was the culmination of efforts by many people. Mainers’ and others’ generous contributions, letters and phone calls to legislators, Facebook posts and tweets, signatures on the ballot initiative petition, conversations with loved ones, and crossed fingers as we waited for victory in Maine made it happen.

In September 2019, the Maine law went into effect. That same month, Val joined Death with Dignity as our State Leadership Incubator manager, where she helps advocates gain the knowledge and resources they need to lead successful campaigns as she did in Maine. She also leads our efforts to ensure implementation in Maine goes smoothly.

Maine Implementation

Since implementation began, two residents have used the law to die peacefully and on their own terms. Val looks forward to working with more Maine residents to help them access the law, and to educating the public and healthcare providers about how the law works and why it is an important end-of-life care option for those with a terminal illness.

Ripple Effects

The adoption of a death with dignity law in Maine had ripple effects across the Northeast. In September 2019, a fledgling group of advocates in a neighboring state launched New Hampshire Death with Dignity, a grassroots group to pass an aid-in-dying law in the Granite State. In Massachusetts, where we have worked for nearly a decade, legislators in June 2020 advanced a bill out of committee for the first time in history.

A Roadmap for Victory

On the surface, California and Maine would seem to have little in common. On opposite coasts, with very different population demographics, they’re rarely spoken of in the same breath.

Yet there are commonalities. Both are known for the independent-spiritedness of their citizens, and a willingness to go against the grain. These characteristics inform the widespread support for death with dignity and the belief that everyone should be able to decide how they die.

We are proud to have supported advocates and lawmakers in these two states as they led successful campaigns for end-of-life policy reform. California and Maine provide inspiration and a roadmap for success in states across the country whose citizens seek to make death with dignity a reality where they live.