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Wellness Corner January 2016 - California’s End of Life Options Act

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Wellness Corner - January 2016
California’s End of Life Options Act

by Veronica Jordan, MD

Calfornia’s End of Life Options Act

Imagine you are sick, really sick. Actually, you are dying. Things feel out of your control. You are in pain, or extremely weak. Perhaps you feel too ill to enjoy the things you love to do. You want to know your options – you want to know what the rest of your life will look like, but you also want to have some control over your death. Ideally, you’d like to die with dignity.

On Monday, October 5, 2015, California became the fifth state in the nation to legally protect a patient’s right to have a physician assist him/her in dying. The End of Life Options Act, modelled closely after Oregon’s 1997 Death with Dignity Act (DWDA), allows California physicians to provide life-ending prescriptions to patients diagnosed with a terminal illness.

As a primary care physician, it’s important that I understand the details of this new law, and as we all are potential patients, it may also be of interest to you. I want to start with a few interesting facts I found in reviewing Oregon’s 16 years of experience.

1) The number of Oregonians using physician assisted suicide has increased steadily since 1998, though these deaths are still a very small percentage of Oregon deaths. In 1998, there were 16 patients who died with assistance; in 2013, there were 73.  A total of 1,173 patients have received prescriptions, and 752 died with assistance.

2) Most Oregonians who use physician-assisted suicide are over age 65 (in 2013, the range was 42-96 years). 

3) Most have cancer (65% in 2013, 80% in 2012). The second most common diagnosis is chronic lower respiratory disease (e.g. chronic bronchitis and emphysema).

3) 97% died at home.

4) 85% were enrolled in hospice care at the time of death.

5) The three most frequently mentioned end-of-life concerns are: loss of autonomy (93%), decreasing ability to participate in activities that made life enjoyable (88%), and loss of dignity (73%).

To whom does the CA law apply?

Per the new law, patients eligible to receive physician assistance must 1) be at least 18 years of age, 2) be residents of California, 3) be considered mentally competent, and 4) be diagnosed with a terminal illness and six months or less to live.

Patients must also be mentally and physically able to self-administer the aid-in-dying drug. Yes, each patient must be physically well enough to take the medication him/herself. 

If a patient has a diagnosed “mental disorder”, the physician must refer him/her to a mental health specialist (psychologist or psychiatrist), who is responsible for determining the individual’s capacity to make medical decisions.

Which physicians can assist patients?

The process is legally mandated to be facilitated by a physician with “primary responsibility for the health care and treatment of an individual’s terminal disease”. This will include primary care physicians (i.e internists and family medicine physicians like myself) as well as specialists (e.g cancer doctors, heart doctors). In Oregon, by one measure, 64% of prescriptions were provided by primary care physicians.

How does an eligible patient actually get aid-in-dying?

First, a person who meets the above criteria must submit to their physician an oral request two times, at least 15 days apart. These requests must be done in person, face to face (not on email, telephone, etc) and documented by the physician. The physician must consult with patients in private to prevent coercion from family members. 

Second, a “consulting” physician must confirm the patient’s prognosis through a physical exam and review of medical record. 

Third, the patient must submit a written request. The signed request must be witnessed by two people, who must attest the person (a) has capacity; (b) is acting voluntarily; (c) is not being coerced to make or sign the request. Only one witness can be related (blood, marriage, partnership, financial benefit), and only one can work at the healthcare facility where the person is getting treatment.

The patient must communicate with the physician to confirm 48 hours before taking the medications, and he/she must take the medications himself/herself.

The law will not take effect until 90 days after Congress adjourns the special session on healthcare.

Comments:

Dear Editor correction please.

Dr. Jordan,
The CA, OR and WA laws were marketed as self administering the lethal dose was a requirement and flaunted safeguard but do not deliver a means to confirm or track.  They all allow a single heir and a care facility employee to witness the sign up process while not requiring relatives to be contacted.  Then they prohibit any investigation after the lethal dose is ingested (forcibly? who knows).
There are other loopholes but just on the basis of the above flaws all three laws need to be amended to provide the means to do what the promoters market.


This is very dangerous public policy that needs our attention.


Also note that California is the 4th state to pass legislation to legalize assisted suicide and provide immunity for all involved (no investigations one day later) along with OR, WA and VT.   


Your source has done you a disservice.  The promoters of assisted suicide have worn out their thesaurus attempting to imply that it is legal in Montana.  Assisted suicide is a homicide in Montana. Our MT Supreme Court ruled that if a doctor is charged with a homicide they might have a potential defense based on consent. The Court did not address civil liabilities and they vacated the lower court’s claim that it was a constitutional right. Unlike Oregon no one in Montana has immunity from civil or criminal prosecution. Does that sound legal to you? Oregon model bills have been rejected (in the face of record high lobby spending by the proponents) by our legislature in 2011, 2013 and 2015 because of gaping loopholes that allow exploitation of elders and people with disabilities of all ages by predators and predatory corporations.


At your service,
Bradley Williams
President
MTaas.org
Hamilton, MT 59840
406 531 0937
I can supply documentation.