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By: Laura Petrillo, @lpetrillz

The End of Life Option Act has been in effect in California for almost three months.  How is it going so far?

In the news, there have been a few publicized cases. First, the death of a young woman with ALS in Ojai, California fit perfectly with the romanticized image of an intimate goodbye among friends and family, followed by the sip of a potion and a long, gentle sleep.  The most common sentiment I heard from people was “You have to admit that was lovely,” yet the media coverage led me to wonder whether the rules of reporting on suicide (avoiding sensationalism to deter copycats) apply here— apparently not.

Other stories were less rosy. Another woman with ALS in southern California struggled to find anyone to write a prescription, and when she finally obtained the medication, her death was a frenzy that involved an urgent ferry from the pharmacy via Uber and a rushed crushing of pills in a race against her symptoms. The woman’s niece wrote, “It didn’t exactly match the serene scenario I’d pictured—with appropriate music, Bible readings, and meaningful conversation… My aunt was surrounded with love, but the day was fraught and frightening.”

Healthcare systems around the state that have chosen to participate in the law are having varied experiences. The Compassion and Choices director Matt Whitaker praisedCalifornia’s response so far, saying, “California is ahead of the pace, in terms of access. Many of the struggles Oregon had have not materialized, because health systems have stepped up to make sure their physicians are educated and there are structures in place for patients.”  He may have been talking about Kaiser Permanente, which did extensive training in advance of the law in order to operate like a well-oiled machine from day one. Kaiser spokeswoman Amy Thoma said, “With every person who wishes to exercise their right, we will have a patient coordinator to guide the patient through every step.”

Many healthcare systems are still scrambling to create policies, though, and in some cases, dealing with dissent among the ranks. Physicians at Huntington Hospital, in Pasadena, decided “behind closed doors” to opt out of the law at first, but their decision was overruled by the hospital board, who decided to allow physician aid in dying in the hospital. Physicians will still have the right to opt out individually, as guaranteed by the law.

The other big news item is that a group of physicians and the American Academy of Medical Ethics has filed a lawsuit seeking to overturn the law. A Riverside County judged ruled against an injunction to suspend the law until the case was decided, but allowed the case to move forward.

So Geripal readers in California, I’m curious. How’s it going where you practice?  Please feel free to use the anonymous feature on the comments section to sound off!

This Post Has 4 Comments

  1. It's the End of Life Option Act, not "Options." I've heard of some cases around San Diego County, in my dealings with other hospice medical directors and HPM docs, but my hospice has not been involved with a case yet.

  2. Out here in the hinterlands of rural Far Northern California, it's been challenging. ResolutionCare Network has decided to provide support and education to people under our care without taking an active role.

    We are receiving a steady stream of inquiries from folks seeking aid-in-dying rather than comprehensive palliative care support. That's a bit troubling but exactly the reason ResolutionCare Network declines to function actively in prescribing or consultative role.

    Two folks in the practice have made requests and are eligible, so we are loving them well and offering what we know as they and their families explore this pathway. The challenge of the cost, medication access and absent local docs actively participating will certainly create a divide between rural and urban exercise of this strange new right afforded very ill folks.

    We will continue our efforts to create value, meaning, and purpose for all those that seek it in any way possible.

  3. Thanks for your comments. Michael. You bring up a point that I have anecdotally been hearing about a lot– the contrast between the collective expectation that this is a "right" (or feeling that it should be) and the reality of the law, which actually doesn't create or guarantee a right of access for patients at all. Perhaps it's a function of the law being written by legislators who understandably are not intimately familiar with medicine, and had the power to make this not-illegal-anymore in response to the public interest but (thankfully) did not have the power to dictate how physicians provide care. Sadly I really did get the sense in the lead-up to this law that many people had been brainwashed into thinking that physician aid in dying is a solution in itself to suffering at the end of life, and actually could replace comprehensive supportive care. I felt that the advocacy group Compassion and Choices went too far in making the case that palliative care is not enough, so that what might have just been a last resort for exceptional cases is now the de facto choice for anyone who wants control (and who doesn't want control?)

    As always, I appreciate you and the work you do very much!

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