California legislators often express a commitment to leading the nation in health policy, equity and progressive reform — and many Californians value leadership that reflects those goals. To ensure meaningful progress, it is important that policies are ed by clear data and transparent reporting. In matters involving public health and safety, trust in government decisions is strengthened through openness and ability. Authored by state Sen. Catherine Blakespear, D-Encinitas, SB 403 wrongly and unnecessarily demands blind public trust. It does not ensure that policies are grounded in transparent reporting and reliable data.
The bill prematurely seeks to eliminate the 2031 sunset provision of the End of Life Option Act, cutting off legislative oversight promised to Californians when physician-assisted suicide was legalized. The sunset provision was enshrined in the law to create a window of time for the Legislature to evaluate End of Life Option Act implementation so lawmakers could make any necessary and prudent adjustments. SB 403 would abruptly close that window — more than half a decade before the 2031 sunset arrives — making it difficult or impossible to assess and ensure, now or in the future, that end of life decisions are not being badly influenced by potentially coercive dangers, like cost-driven denials of appropriate care by insurers, structural discrimination or bias, predatory conduct, bad actors and more.
Any claim that we can trust what we don’t know dangerously overlooks what we do know. For years, California has suffered the worst rate of hospice fraud in the nation — so bad that state legislators were compelled to pause licensing a few years ago and confess mea culpa for failing to perform their duty of oversight. At the same time Medi-Cal has among the worst provider reimbursement rates in the nation — causing health care professionals to be unable to afford providing basic care, let alone crisis care to terminally ill, low-income residents. These are the circumstances confronting Californians. These are circumstances that make transparent implementation data important and safety evaluations rational.
While the California Department of Public Health is statutorily required to collect and publish data on the use of End of Life Option Act more than a decade after physician-assisted suicide was legalized, major gaps remain. Data submissions from providers are inconsistent and often incomplete, and much of the information promised to the public never sees the light of day.
Sparse, incomplete data reporting is not sufficient, sound or progressive — it unfairly keeps our public in the dark and is irresponsible. Legislators must do better and demand better, especially in matters of life and death.
The Legislature has a responsibility to ensure transparency and prevent discrimination in all areas of health care. Without reliable, publicly available data, we cannot even assess whether people of color, the poor, or those with disabilities are being disproportionately steered toward physician-assisted suicide because of systemic inequities or insufficient care options. California legislators purport a commitment to equity, transparency and patient-centered care, and, to effect that commitment, legislators must ensure that dignity at the end of life does not become a privilege for those who speak English, are affluent, highly educated or racially homogenous.
At a time when California is grappling with well-documented disparities in health care access, particularly for low-income and diverse communities Blakespear’s bill sends the wrong message. The state has not resolved hospice safety. Medi-Cal continues to offer some of the lowest reimbursement rates, driving a shortage of providers even for basic care, let alone palliative or crisis services.
These realities matter because the people most likely to be affected by poor oversight — or worse, by neglect or coercion — are those with the fewest resources and the least access to care. That includes diverse communities, people with disabilities, rural Californians and low-income older adults. These Californians, already facing structural health care barriers, deserve protections, not premature policy rollbacks that remove the tools of ability.
Now is not the time to make physician assisted suicide permanent in California. Now is the time for legislators to responsibly oversee the End of Life Option Act — to assure complete data collection and transparent reporting. The time for legislative oversight and evaluation of implementation should continue and will benefit all Californians.
Sandoval is state director of the California League of United Latin American Citizens (CA LULAC) and lives in Salinas.
