Metropolitan News-Enterprise


Thursday, November 29, 2018


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Court of Appeal Reinstates State’s Assisted-Suicide Law

Opinion Says Doctors Who Challenged Statute Didn’t Adequately Plead Standing


By a MetNews Staff Writer




A group of doctors that won an injunction against enforcement of the state’s recently-enacted law legalizing euthanasia did not allege adequately allege standing to bring their action, the Fourth District Court of Appeal has held, ordering the trial court to vacate its judgment ruling the law unconstitutional.

Div. Two’s majority opinion, filed late Tuesday, was written by Presiding Justice Manuel A. Ramirez and joined by Justice Richard T. Fields, who also penned a separate concurring opinion. Justice Marsha G. Slough wrote a concurring and dissenting opinion.

In 2015, in a special session that was called by Gov. Jerry Brown to deal with health care issues, the Legislature passed the End of Life Option Act (“EOLOA”) which went into effect in June 2016.

Under the act—Health & Safety Code §443 et seq.—physicians are permitted to prescribe lethal drugs to patients determined to have a terminal illness likely to result in death within six months; doctors doing so are immune from any liability provided the patient personally administers the drug; and doctors refusing to take part in euthanasia are similarly immune from legal repercussions.

The act was challenged by a group of doctors—led by Sang-Hoon Ahn and joined by a medical ethics organization—claiming, in part, that the state was passed outside the scope of the special session, in  contravention of a state constitutional provision. Riverside Superior Court Judge Daniel A. Ottolia agreed and granted the doctors judgment on the pleadings, later denying a request to set aside that judgment brought by a group of non-party physicians.

Ramirez’s Opinion

Explaining the issuance of a writ of mandate ordering that the judgment be vacated, Ramirez cited the Court of Appeal’s 2007 opinion in Connerly v. Schwarzenegger which declares (with italics in the original):

“To obtain an injunction, a party must show injury as to himself.”

Under Code of Civil Procedure §1060, he noted, declaratory relief may be sought only where there is an “actual controversy relating to the legal rights and duties of the respective parties.”

The doctors did not adequately allege that they are personally affected by the statute, Ramirez said. While they allege that they diagnose patients as having terminal diseases, “it is simply not true that that diagnosis makes the patient eligible for an aid-in-dying drug, he wrote, saying that the “patient still has to jump through a number of hoops, and the Ahn parties are free to refuse to participate in that process.”

Reluctance to Diagnose

If the law were in effect, the doctors argued, they could be deterred from rendering a diagnosis of a fatal disease for feat the patient would seek assisted suicide through another physician.

“These ‘conjectural’ and ‘hypothetical’ possibilities,” Ramirez responded, “do not give rise to standing.”

Medical ethics, he pointed out, mandate the rendering of an honest diagnosis. He remarked:

“Compliance might make the Ahn parties feel bad, but they cite no authority for the proposition that bad feelings can be sufficient to confer standing.”

The act requires the plaintiffs to allow their employees disseminate information on assisted suicide, the doctors complained. Ramirez said it is not clear that the act does have that effect, but in any event, the complaint “does not allege that the Ahn parties even have any employees, much less that any of their employees are health care providers or that any of their employees want to provide information and referrals against their employers’ wishes.”

‘Third Party Standing’

The doctors also do not have “third party standing” through their patients, Ramirez declared. He expressed agreement with the state in saying in its petition for a writ of mandate:

“If neither the real party physicians nor their patients want aid-in-dying to be a part of their professional relationship, then neither group suffers any injury due to the Act.  Alternatively, if the real party physicians do not want to provide aid-in-dying, but their patients do want aid-in-dying, the physicians’ interests are not aligned with those of their patients and third-party standing would not lie.”

Lack of standing cannot be ignored based on the public intertest being implicated, he said.

“A general ‘public interest’ exception to standing requirements would turn us into a super-legislature, able to overturn a statute enacted by the People’s duly elected representatives, despite the absence of any parties who can show that they are being harmed,” Ramirez wrote.

Procedural Error

Ottolia granted injunctive relief after granting the plaintiffs’ motion for judgment on the pleadings. Ramirez said that was error because the general answer denied all allegations of the complaint which included those relating to standing.

“The trial court had to accept this denial as true,” he observed. “This alone should have precluded judgment on the pleadings.”

Leaving the door open to further proceedings, Ramirez said:

“We have no way of knowing whether, on remand, ]the plaintiffs] will be able to amend their complaint so as to allege standing, whether the trial court will grant them leave to do so, or whether they will be able to prove up their amended allegations. It is possible (though by no means certain) that we will see this case again; if so, however, at least we will be sure that the constitutional issue is properly presented.”

Constitutional Question

Ramirez declined to reach the question as to whether the act was validly adopted. Slough protested:

“In my view, the majority’s approach needlessly ties this case up in a procedural Gordian knot. We can cut the knot by realizing the courts—both trial and appellate— have discretion to dismiss a cause of action on any decisive legal ground. In this case, the fact that plaintiffs’ challenge to EOLOA lacks merit as a matter of law provides an independent basis for us to reverse the trial court judgment finding EOLOA violates article IV, section 3 of the California Constitution and direct the court to enter judgment in favor of the state on plaintiffs’ third cause of action.”

She opined that the plaintiffs had adequately pled both personal and third-party standing to challenge the law, but acknowledged that the state’s general denial had rendered judgment on the pleadings inappropriate.

“Compared to the complex knot of standing issues,” she declared, “the merits of the constitutional challenge are straightforward.”

Brown’s Proclamation

She noted that Gov. Jerry Brown had made a proclamation setting out six subjects for the special session of the Legislature that spawned the act. Five of the subjects were irrelevant to the act, but the sixth, the creation of legislation to “[i]mprove the efficiency and efficacy of the health care system, reduce the cost of providing health care services, and improve the health of Californians,” was at issue; if the assisted-suicide law comes within the scope of that subject, Slough explained, it would not be in excess of the legislature’s power at that session.

She posited that the lawmakers had been reasonable in concluding that the euthanasia law supported effective delivery of healthcare services to Californians.

“Indeed,” she added, “it is hard to imagine taking the contrary view, unless you simply reject the idea that aid-in-dying services can constitute a form of heath care. I don’t believe that view is sustainable.”

Fields’ concurring opinion said that remand was appropriate because it leaves the parties where they were before the lawsuit, with the law currently in place, which “is consistent with and comports with the presumption of constitutionality of laws passed in regular or special session….”

The case is People v. Superior Court (Ahn), 2018 S.O.S. 5557.


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