Aid-in-dying law begins June 9

Local medical organizations discuss policies around implementation

California's new End of Life Option Act goes into effect on June 9, offering terminally ill persons who face painful or prolonged deaths the option of ending their own lives with medication.

The act, which was signed into law by Gov. Jerry Brown on Oct. 5, allows a mentally capable adult with a life expectancy of six months or less to request "aid-in-dying" medication from his or her doctor for self-administration if suffering becomes unbearable. Two physicians must agree that the person is eligible, and one of the doctors must sign the prescription after the patient has made three requests -- two oral ones at least 15 days apart and one written on a specific form -- directly to the doctor.

But finding a physician to take part in the process could prove challenging. Each doctor is free to decide if he or she will write the prescription. And some health care systems may prohibit their employees from participating in medical aid in dying, a panel of medical professionals told about 50 people at Avenidas senior center in Palo Alto on Monday.

For retired Stanford University professor Dick Scott, the quick death of a loved one who chose to take the medication was an eye opener, he said. Scott helped his brother, who had emphysema, to obtain the medication in Oregon while dying. Watching his brother struggle to breathe, Scott emptied the capsules into a glass of water and handed it to his brother, who was able to drink it, he said.

"It was a very quiet death. It took four minutes," said Scott, the panel moderator and chairman of the advisory council of Avenidas Village program.

But while death came quickly, the process did not come easily, he said. It took more than six weeks to mobilize a network that included the medical team and a pharmacy, get all of the paperwork signed and get the prescription filled, he said.

In California, bringing a network together to provide the medication could be equally daunting.

"There will be some physicians who don't want to have anything to do with it," said Dr. Lew Wexler, professor emeritus of radiology at Stanford Clinics.

Some audience members at Avenidas said they have already run into roadblocks. A woman broached the subject with her physician at Menlo Medical Clinic but was flatly told "no." The physician told her that Stanford Health Care, which runs the Menlo clinic, has a policy against medical aid in dying.

But Wexler said that Stanford doesn't have any such policy. The medical organization is currently discussing its policy in light of the new law, but it hasn't reached any conclusions. At Stanford Medical Group, the general feeling is that each physician will make his or her own decision on whether to participate, he added.

Palo Alto Medical Foundation (PAMF) is also in the midst of discussions, and its parent company, Sutter Health, is in the process of implementing a policy for its clinics, said Dr. Dick Maser, retired plastic surgeon at PAMF.

Missy Gallo, a licensed clinical social worker at the PAMF Geriatric and Palliative Care center, said it is likely that each entity under Sutter would make its own decision to opt in or out of the program.

"It does look like we (PAMF) will offer it," she said. But the individual physician would still ultimately choose whether to write the prescription or consult with a patient about the end-of-life option.

Wexler said that patients would likely find the most resistance from physicians who have had little experience with people who are in the terminal phase of life. But doctors and caregivers, pain clinics and palliative care centers that deal with cancer patients and patients with severe pain issues would be more likely to understand a patient's request for aid to end their suffering.

Medical aid in dying is unlikely to occur in the hospital, where patients are given medications and are not allowed to take medicine on their own, Wexler said. Most deaths will likely occur in at-home hospice or palliative care.

According to the law, patients cannot designate another person to administer the drug nor write the wishes into their Advanced Healthcare Directive. And persons with dementia or Alzheimer's disease are not eligible for the act.

Montana, Oregon, Vermont and Washington also have medical-aid-in-dying laws. In Oregon, it has legally been practiced for 18 years, and 1,500 people have opted to obtain the medication. Of those, about one-third to one-half have not taken it, however, according to Stephanie Elkins of the nonprofit group Compassion & Choices.

The best way for patients who want to exercise the option is to have a conversation -- and many conversations -- with their physicians, Gallo said.

"You have to be the best advocate and ask the right questions," she said.

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9 people like this
Posted by PA resident
a resident of Downtown North
on Apr 17, 2016 at 10:22 am

"Though shall not harm" The hippocratic oath has literally become hypocritical.

18 people like this
Posted by Carol Gilbert
a resident of University South
on Apr 18, 2016 at 11:16 am

To have an option such as this is a tremendous breakthrough. It should never be forced on anyone, but modern medicine only knows how to attempt to prolong life even when it can be harmful, expensive, and not provide a gentle end. To have options is always good.

4 people like this
Posted by Bob March
a resident of Greendell/Walnut Grove
on Apr 18, 2016 at 1:07 pm

Once this law becomes effective, pressure on the elderly to die quickly will inevitably follow. I know its proponents are trying to do a good thing—alleviate suffering—but the experience of other countries with assisted suicide suggests that along with the intended good will come many many unintended evils. Odd, in a way, that our ancestors, who suffered far more pain than we do both in living and in dying, [portion removed], never embraced this.

Like this comment
Posted by R Wray
a resident of Palo Verde
on Apr 18, 2016 at 1:14 pm

Way too many hurdles.
Those sanctimonious fools in Sacramento should butt out of the Doctor/patient relationship.

13 people like this
Posted by Life of Pain
a resident of Old Palo Alto
on Apr 18, 2016 at 2:19 pm

Life of Pain is a registered user.

Well said, Carol. As someone with two chronic, life-diminishing diseases, I am greatly relieved that I now have that choice.

Expensive medications can only go so far-- slowing down, but not stopping the progression of disease. While pain killers do dull the pain, they tend to have nasty side effects ( like dulling appetite) and make a person unable to drive, read, care for children or pets, cook, etc.

Again, when life becomes too painful, too miserable, organs are damaged beyond repair, and all the joy is gone, I take comfort in knowing I have the choice of letting nature take its course, or ending what could be months of suffering

5 people like this
Posted by Compassion
a resident of Charleston Gardens
on Apr 18, 2016 at 9:43 pm

It always baffles me, when people are so passionate against ones choice to end suffering. It seems they must either never have witnessed such endless suffering, especially when needlessly prolonged by modern medicine (talking about do no harm...) or just not being able to feel empathy.
But please explain this to me: Why is it widely accepted as the right thing to do, to put our beloved pets out of their misery when they are suffering at the end of their lifes, yet we deny the same choice to be made by our fellow human beings. Why is that? Why do people get so righteous about this? Or is it fear? I just don't understand why it is OK to deny someone the freedom to end their suffering. I know that I would want that choice for myself., and I want my loved ones to be able to choose too. Have compassion and trust people to do what is right for them, not just for you! Allow yourself to trust and to love.

1 person likes this
Posted by Painful
a resident of Another Palo Alto neighborhood
on Apr 19, 2016 at 8:25 pm

I really don't think opposition is for lack of compassion for the sick but an acknowledgment of the realities of life. Humans, including doctors, are fallible. People with pain can be an annoyance to others, and be shuffled into something like this. Please respect my opinion as someone whose life was almost entirely formed by terrible chronic pain (and whose only relief came from off-label use of unrelated medication by a really smart but rare physician). One of Kevorkian's victims had similar, and I know that patient was never offered what ultimately helped me. I wasn't out of pain but able to bear it enough to make life worth it. If I had listened to countless other doctirs before that one, life wouldn't have been worth living. I just think there are too many things we need to do better before we consider this. I'm sorry for people's suffering, but there is also the suffering of people who really want to live and won't get the help they need because it's already so difficult. There are no easy or clearcut answers and I do think the downsides to this are worse.

Like this comment
Posted by Joan S
a resident of University South
on Apr 28, 2016 at 8:27 pm

Both Kaiser and Sutter support physicians choice in whether to participate. Stanford has not been at all transparent either with its physicians or patients. Polls show over 80% of Californians support Medical Aid in Dying (regardless of age, gender, or party) and over 50%of doctors do so the 2 large physician groups in the state are neutral so physicians can choose for themselves. Let your Stanford or UHA docs know you want the physicians to decide, not a minority.

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