CMA Issues End-Of-Life Guidelines

The California Medical Association issued guidelines this week to its physician members on how to administer drugs to terminally ill patients who wish to end their life.

The guidelines stem from the recent passage of the End of Life Option Act, which went into effect on Jan. 1. It made California the fifth state in the U.S. to sanction physician-assisted suicide of terminally ill patients.

The guidelines appear in some ways to discourage would-be Brittany Maynards. She was the terminally ill California resident who moved to Oregon in 2014 – where physician-assisted suicide has been legal for more than a decade -- in order to end her life under a physician's care.

Those patients who have been diagnosed with an illness by at least two doctors that leaves them with six months or less to live and are in a sound mental state must meet many other criteria. Among them: They must be registered to vote; have a valid state identification; have owned or leased property in California for the past year; and have filed a state tax return in the past year.

Requests to obtain life-ending drugs can only come directly from a patient; healthcare directives or those holding power of attorney cannot apply. Interpreters may be used for patients who have limited English proficiency.

Meanwhile, physicians who dispense life-ending drugs, have the legal obligation to “confirm that all requirements are met and all appropriate steps are carried out in accordance with the law before writing a prescription for an aid-in-dying drug.” And, if the patient has a mental disorder, the physician also has the duty to refer the patient to a mental health specialist. It is up to the physician to determine which drug may best aid the patient in dying.

Physicians who have objections toassisted suicide have great leeway in their communications to the patient. According to the CMA, “a physician with a conscience, morality or ethical objection to physician aid-in-dying has no obligation to participate in the activities...or even to notify a patient whom they diagnose with a terminal illness about aid-in-dying as an end-of-life option.” And physicians with such objections are not subject to any professional or personal sanctions as a result. Organizations that provide healthcare services – such as hospitals -- that also object are exempt from providing assistance to end a patient's life. They may deny practicing privileges to physicians or other employees that violate the organization's official position.