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California doctors, patients adjust to realities of new aid-in-dying law

As a California law allowing the terminally ill to obtain aid-in-dying drugs took effect this week, those involved in educating the public about the End of Life Option Act don’t expect a flood of patients to ask for such drugs.

Some California physicians, though, continue to express some anxiety about the law’s implications, and concerns linger among those who opposed the law.

California is the fifth state to allow physician-assisted aid in dying. The law allows mentally competent adults with less than six months to live to obtain prescriptions for drugs that will hasten their deaths and avoid prolonged suffering.

According to a legislative summary of the new law, the patient would be required to make two spoken requests – spanning 15 days apart at a minimum – as well as a written document signed by two witnesses.

The attending physician and a consulting physician would both need to confirm the patient’s situation prior to the patient receiving the medication. The law also requires that the patient be informed about options for hospice care at home or in a health care facility, as well as choices available to manage pain and symptoms.

Those who opposed the law, including the Coalition of Concerned Medical Professionals in Sacramento, have argued that the law would be bad for California due to inadequate patient protections and that low-income residents with fewer health care resources would be more inclined to opt for a low-cost end-of-life drug.

Another opponent is the Sacramento-based Alliance of Catholic Health Care, which has supported government policies and programs that help those at the end of their lives with special needs.

“In the face of repeated attempts to legalize assisted suicide in California, the Catholic health care ministry must be proactive in promoting positive alternatives to this troubling policy proposal,” the organization said in a statement, adding that the group would continue to advocate for life-sustaining activities such as palliative care.

Another opponent representing the Disability Rights Education and Defense Fund warned that the law does not require psychiatric evaluations of patients and that those suffering from depression might attempt to game the system by going shopping for doctors in order to get one who finally agrees to write a prescription.

“We are looking ahead at measures to protect people from abuse and to explore and inform doctors, nurses and pharmacists that they don’t have to participate,” said Marilyn Golden, the group’s senior policy analyst.

Groups in support of the law, such as Compassion & Choices, a nonprofit national organization that seeks to protect and expand aid-in-dying laws, meanwhile have engaged in public education campaigns throughout the state about the implications of the law.

“There is now a statewide conversation going on about end-of-life care in general,” Matt Whitaker, the California director of Compassion & Choices, told AMI Newswire.

Whitaker, who himself has clinical experience in long-term acute care and geriatrics, said he doesn’t expect physicians to be flooded with patient requests for drugs to end their lives, but patients will now be empowered to begin conversations with their doctors on the issue in a more formal way.

“Based on the experience with similar laws in other states, less than 1 percent of terminally ill Californians will need to utilize medical aid in dying,” Whitaker said.

He indicated that in the year ahead, about 1,500 Californians would likely take steps to obtain the drugs to end their lives, based on the experience in Oregon, which also has an aid-in-dying law.

Despite their concerns about the new law and follow-up legislation, opposing organizations were unsuccessful this year in obtaining enough signatures to put the issue to a vote of the people.

Teresa Favuzzi, executive director of the California Foundation for Independent Living Centers, wrote in a letter published on the group’s website that, “The disability community knows that the notion that death is preferable to living with a disability is still pervasive. We also know that medical diagnoses of terminal conditions are not always accurate, so there is a risk that many people could end their lives prematurely.”

She also challenged the law’s focus on patients with six months or less to live as arbitrary and added that data collected by hospice organizations reveals that about 15 percent of those with a prognosis of six months or less to live actually survive for additional months or years.

Whitaker said he has noticed a level of anxiety among physicians, whose traditional role is to do everything they can to save lives. When it comes to end-of-life care for terminal patients, however, doctors must employ different methods that focus on patient comfort and palliative care, he said.

Physicians will also have to deal with the reality of seeing patients who want to discuss end-of-life issues – and not simply consider the issue as an intellectual matter, Whitaker said.

Of course, he points out that the law is strictly voluntary in that physicians, pharmacists and other medical care professions are not required to take part in the process that culminates in a patient getting aid-in-dying drugs.

Whitaker said that the Oregon experience shows that people opting for end-of-life drugs would not be disproportionately low-income residents. In Oregon, people who opted for medications to end their lives tended to be those who are highly educated and affluent, he said.

The California law was passed by the legislature partly in the memory of California native Brittany Maynard, who moved to Oregon to take advantage of that state’s aid-in-dying law after she was diagnosed with terminal brain cancer.

In the month prior to her death in November 2014, from taking an aid-in-dying drug, Maynard wrote, “Now that I’ve had the prescription filled and it’s in my possession, I have experienced a tremendous sense of relief. ... When my suffering becomes too great, I can say to all those I love, I love you; come be by my side, and come say goodbye as I pass into whatever’s next.”