The State of California has implemented the End of Life Option Act which goes live on June 9, 2015. According to this law, any adult with intact decision making capacity, who has a terminal illness and an anticipated lifespan of six months or less has the right to ask her/his attending physician for an aid-in-dying lethal prescription. Two physicians must confirm that the patient has an incurable and irreversible disease and will likely die within six months. The terminally ill patient must make three requests to a physician: two verbal requests 15 days apart and a written request attested by two witnesses. If patients cannot verbalize their request due to inability to speak, it is not clear that they will be eligible for Physician Assisted Death (PAD). Patients with cognitive impairment will not be eligible to request the lethal prescription. If patients are decisional at the time of request but later lose their decisional capacity, they may not be allowed to ingest the medication as it is illegal to receive any assistance to ingest the medication.
Our stance on PAD: We are neither pro nor against PAD. We opt a stance of studied neutrality toward the legal aspects of PAD. However, we are anything but neutral toward the profound distress patients feel at the end of life. We are deeply committed to alleviating suffering and providing maximal support to all patient and families.
Great and growing need for better end of life care: Past experience from the State of Oregon (the Oregon Death With Dignity law was passed in 1996) shows that aid in dying laws may impact only a tiny fraction of seriously ill patients. However, it will most certainly impact clinical practice. As more states pass aid-in-dying laws, many Americans, whether or not they are eligible for it, will likely broach this sensitive topic with their doctors for fear of intractable suffering at the end of life. If doctors and the clinical care-team are not skilled at responding to this sensitive issue, they risk further compounding patient suffering.
How to support patients in distress: When faced with a terminally ill patient who is requesting aid in dying, clinicians must avoid responding in a simplistic binary manner. Instead, it is vitally important that all clinicians become skilled at systematically exploring the multiple facets of suffering, the patient’s specific situation, and the underlying concerns and experiences that have resulted in a request for hastening death. A careful assessment of the patient’s mental health status is important as is assessment of the social support systems and family structure. Aggressive and prophylactic management of distressing symptoms is critical to preventing patients from reaching a depth of suffering at which they feel that PAD is their only recourse. In a diverse state such as California (which is a minority-majority state), we stress that requests from diverse patients have to be approached with great cultural sensitivity. Recent research at Stanford has shown that age and level of spirituality impact attitudes towards PAD.
Free training resource: In order to increase knowledge about how best to respond to and alleviate the suffering of seriously ill patients, we have created a free training module on Physician Assisted Death. We believe that trainings like ours can help clinicians better alleviate suffering of all seriously ill patients and serve as a source of hope and compassion for all patients and families.
For more information on Physician Assisted Death go to : http://tinyurl.com/EOL-PAD
To learn more about and apply for the free training program on Physician Assisted Death click here.