Doctors in California face a choice: Should I help a patient die?

Advocacy groups are stepping up education efforts

With California's "right-to-die" law set to take effect on June 9, provider organizations are developing policies and training to handle patient requests for aid in dying, Harris Meyer reports for Modern Healthcare.

California governor signs 'right-to-die' bill into law

California will become the fifth state to allow physician-assisted death, although providers may choose not to participate. Three other states—Oregon, Washington, and Vermont—have laws allowing physician-assisted death, and courts in New Mexico and Montana have ruled assisted dying legal. Other states bar physician-assisted death in all forms.

Details of California law

The measure will allow some dying patients to end their lives through lethal doses of medication, as long as:

  • The medication is self-administered;
  • The patient is mentally competent;
  • The patient reaffirms his or her consent within 48 hours before taking the lethal dose of medication;
  • Two physicians confirm the prognosis that the patient has six months or less to live; and
  • The patient is at least 18 years of age.

The measure will sunset after a decade, making it effective until Jan. 1, 2026. However, the state legislature could vote to extend the law.

Educating providers

The California Academy of Family Physicians is working to educate doctors about the law and their ethical obligations as medical professionals. Leah Newkirk, VP of health policy for the group, says it is particularly important that the law is implemented effectively. "We're a different, more diverse, much bigger state," she says, "and we're definitely thinking a lot about protecting vulnerable people and making sure no one is acting in a way that devalues lives."

The California Medical Association recently published a set of guidelines for its members, while Compassion & Choices, the group that pushed for the law, is also reaching out to physicians through a doctor-to-doctor phone consultation hotline.

Meanwhile, the Disability Rights Education & Defense Fund is planning to "explore and inform doctors, nurses, and pharmacists that they don't have to participate," says Marilyn Golden, a senior policy analyst with the group.

Making a choice

Some hospitals, including those that are Catholic-owned or -affiliated, will not allow their providers to participate. Thirteen percent of California's hospitals are Catholic-affiliated or "generally follow Catholic doctrine," Modern Healthcare reports.

Lori Dangberg, VP of the Alliance of Catholic Health Care, says staff at Catholic facilities will be able to have a conversation with patients who ask about aid in dying, but they will focus on patients' potential "fears about pain management or that the patient and family won't be supported through the dying process."

Staff will be able to refer patients to their attending physicians to receive counseling about the law, Dangberg says.

How to have the hardest talk in health care: The end-of-life conversation

Kaiser Permanente and Sutter Health, two large California health systems, say their physicians will be allowed to assist terminally ill patients in dying if they choose. "We encourage our patients to have thoughtful conversations with their doctors, families, and other loved ones about their end-of-life wishes," says John Nelson, Kaiser's VP of government relations.

Sutter is still drafting its specific policies and procedures related to the law, but "will support patients who explore making this difficult decision," says Stephen Lockhart, Sutter Health's CMO. He adds that the system is planning "comprehensive" education effort to make sure doctors are prepared for the law.

But some providers, including NorthBay Health Care in Fairfield, remain undecided. Terrell Van Aken, the organization's medical director for hospice and palliative care, plans to make the case for participation to his system's board. "I've thought about the first prescription I'll write; it's anxiety-provoking for sure," he said. "But I've seen the other side, people suffering at the end of life on palliative sedation, and that's why I believe in it and am prepared to do it" (Aliferis, "Shots," NPR/KQED, 3/10; Meyer, Modern Healthcare, 3/11).

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