Hospitals, Patients May Not Be Prepared For New Aid-In-Dying Law

A week from today, physician-assisted suicide will be legal to perform in California. But researchers have concluded that many providers in the state – along with the families of patients -- are unprepared to make the adjustments required to follow the controversial new law or even provide the required services.

That's the conclusion of researchers at the UCLA Center for Health Policy Research, who in a new policy brief have recommended providing more data and information to both providers and their families in the coming months and years.

Among the recommendations:

• California should collect data on physician-assisted suicide in the state, including the number of requests for life-ending medications, the number of prescriptions that are dispensed, the number of patients who take their own lives, and specific reasons as to why patients have decided to make this decision.
• The state should also gather more data on decisions for ending all forms of end-of-life care, such as withdrawing ventilation or nourishment. The intent is to better determine how families reach such decisions.
• The state should launch a public service campaign on end-of-life options and the new law.
• Providers and professional organizations should engage in educational outreach on the new law.

• Providers, particularly in the hospice and palliative care settings, should receive some education and training on the law and how to communicate with patients and their families on the topic.

“Many people are unsure what the new law entails...the combined effort of legislators, doctors and the public is needed to ease the final days of what should be the focus of our attention, the critically ill patient,” said Cindy Cain, faculty associate at the UCLA Center for Health Policy Research and author of the brief.

Gov. Jerry Brown signed the bill authorizing physician-assisted suicide for terminally ill patients late last year, saying that his religious-based misgivings about the law were outweighed by the options provided to Californians to determine their own fates. The law follows closely in structure to Oregon's Death With Dignity Act, which was the first such law in the nation when it was passed in 1998. It requires a concurrence of physicians on the medical and mental state of the patient before a decision can be made to dispense them drugs that can end their life.

California is just the fifth state to allow physician-assisted suicide. Oregon, Wash-ington and Vermont passed laws to permit the practice, although only the first two states compile specific data. It is also legal in Montana, but as the result of a legal battle as opposed to legislative fiat. Thirty-eight states have specific laws on their books banning the practice altogether.

The passage of the law and its pending enactment has caused low-level tensions within the state. Officials with one major provider, Huntington Hospital in Pasadena, said they would not provide physician-assisted suicides for its patients, and would strongly discourage medical staff from doing so on their own.

And where states keep records, the actual use of physician-assisted suicide – which is known in many circles these days as aid-in-dying – is relatively sparse.

Oregon and Washington have dispensed less than 200 prescriptions apiece in recent years of drugs that would hasten a terminally ill patient's death. About 100 terminally ill patients have taken their lives in each state in recent years. However, that's still a significant increase in Oregon, which has had an aid-in-dying law on the books since the late 1990s. The number of such deaths in Oregon were consistently below 40 per year as recently as 2005.

Other studies have suggested that patients who decide to take their own lives tend to be better educated and earn higher incomes than those terminally ill individuals who decide to let nature take its course.

Nevertheless, there is still a significant gap between the prescriptions dispensed and the actual patient suicides that are taking place – a phenomenon confirmed by the rigorous compilation of data urged by the UCLA brief. In Oregon in 2014, 105 of the 155 people who were prescribed medication took a lethal dose. In Washington, 126 of the 176 patients who were prescribed medication took it. That's about a 70% compliance rate in Oregon and about 72% in Washington.

      “Having a choice in the matter may itself provide comfort to a terminally ill person,” Cain said. “Having that prescription in hand might give them a feeling of control, whether they ultimately use it or not.”