Life Matters Media
Quality of life at the end of life

California Doctors Do Not Have to Participate in ‘Death With Dignity’ Program



California physicians must learn how to best address the concerns of people seeking physician-assisted suicide.

This week, the Golden State’s controversial “Death with Dignity” law went into effect, allowing terminally ill adults with a life-expectancy of six months or less to request drugs to end life.

The End of Life Option Act requires patients to submit two oral requests (a minimum of 15 days apart) and one written request to his or her attending physician. The written request must be signed in front of two witnesses, who verify that the patient is not being coerced. Individuals who are not terminally ill, or who have a mental disability, are not eligible.

The Coalition for Compassionate Care of California is working to help educate physicians about best practices and rights of providers.

Dr. Lael Duncan

Dr. Lael Duncan

Dr. Lael Duncan, medical director of consulting services with the nonpartisan nonprofit, said a doctor’s participation is completely voluntary.

Physicians who do not wish to participate in the program for religious or ethical reasons may decline to write a prescription and not be subjected to civil, criminal or professional discipline or penalties.

Health care systems with moral or ethical objections, including Roman Catholic hospitals, can opt out and bar their doctors from issuing prescriptions for barbiturates, she said. If turned down, patients may ask for a referral to another doctor more willing to cooperate.

“Physicians really need to know what the policy is of the organization where they are employed,” Duncan told Life Matters Media. “That policy may or may not put limits on the ways they can interact with patients regarding the End of Life Option Act.”

However, it is not enough for doctors to only rely on their organization’s policy. They must also explore their own “moral compass” and figure out where they stand on the practice, which is illegal in most of the U.S. and discouraged by the overwhelming majority of medical organizations.

“From their own perspective and culture, how do they feel about this option?” she said. “When they are presented with a question or inquiry from a patient, they can then respond in a way that is very supportive and compassionate toward the patient, regardless of their own feelings or judgements. If they don’t consider their perspective, they might be caught off guard by their own visceral or emotional response.”

Duncan said she hopes doctors “rehearse” their responses and remember that most patients asking about their end of life options are not seeking suicide.

“Be sure you know what the patient is asking for,” she advised. “Patients who talk about end of life or stopping treatments and things often are not necessarily asking about the End of Life Option Act. Have the patient really clarify what they are asking about. Be aware of all these things so they can respond appropriately.”

Unfortunately, not all state hospital systems have policy regarding the End of Life Option Act, which was signed into law by Gov. Jerry Brown last fall.

“Health care organizations across the state, hospice organizations, home care organizations, hospitals, clinics are in the process of writing policy,” Duncan added. “They will be required to provide that information to all of their employees.”

The tone among California doctors regarding the practice is mixed. Most physicians caring for aged or seriously ill patients, Duncan said, are just now beginning to come to terms with the new law.

“People are just now figuring it out, and they may not be ready to shepherd a patient as early as this week”

Once a year, the state Department of Public Health is required to issue a report stating the number of lethal prescriptions issued and how many patients died. The first report is not expected before next summer.