Soapbox

Helping their patients die won’t be easy for doctors

Debbie Ziegler, mother of Brittany Maynard, speaks to the media last September after the passage of legislation to allow terminally ill patients to legally end their lives. California’s law takes effect Thursday.
Debbie Ziegler, mother of Brittany Maynard, speaks to the media last September after the passage of legislation to allow terminally ill patients to legally end their lives. California’s law takes effect Thursday. Associated Press file

On Thursday, California’s End of Life Option Act goes into effect, enabling doctors to help terminal patients legally end their lives

It will be a victorious day for advocates of physician-assisted death, who are on the march to have similar laws in place soon in more than half the states. But for California’s already harried physicians, it will be the first of many challenging days ahead.

First, they will have to decide if they are willing to write life-ending prescriptions. Many may feel ill-equipped or disinclined. The promise to help cure patients’ diseases that drove many doctors to study medicine is not the same as the promise to help them end their lives.

Those who have no ethical qualms will face a gauntlet of regulations. At a minimum, physicians must hear two requests from a patient, 15 days apart, and get a written statement that must be signed by that patient and two witnesses. Doctors also must confirm that the patient has the capacity to make a medical decision, can take the drugs without assistance and counsel the patient on alternatives. Doctors have to submit four new forms to the Department of Public Health.

That’s a lot of work for your local primary care physician whose day is already packed. When general practitioners do not have time or relevant experience, they routinely refer patients to specialists. California is large enough that it could support specialty death medical services, unlike Oregon and the three other small states where aid in dying is legal.

Such a specialty practice would mean a lot of visits to homes and hospice centers. But it also would have advantages of scale. It could be a one-stop shop, with forms, consultations and pharmacies at the ready. It could bargain for lower-priced death prescriptions, which are now retailing for more than $4,000. It would be convenient for referring doctors, and probably ease the concern of patients and their families that they be guided by experienced hands at a critical moment.

It seems inevitable that some doctors will handle more of these cases than others. As their expertise grows, they also may be called on to take regulatory positions. As has happened in Europe, physicians attracted to assisted suicide may crowd out others who provide an ethical balance.

The advocates for medical aid in dying in the United States are sincere in seeking to mitigate suffering and promote much wider discussions involving end-of-life issues. But as the practice grows and consolidates, it also could invite unethical decisions in cases where patients may be more distressed than they are terminal.

Is California ready for a specialist death practice? We may be about to find out.

Jason Doctor is director of health informatics at the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California. He can be contacted at jdoctor@usc.edu.

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