Death unassisted

A patient’s death can feel like a failure to doctors and nurses. As professionals trained to promote health and prolong lives, many have conflicting feelings about helping a patient die—even when that person is suffering from a progressive disease.

Now, Californians can ask for just that under a new state law. Senate Bill 128, aka the End of Life Option Act, went into effect on June 6. There are several hoops to jump through, but, basically, the law allows terminally ill patients expected to live less than six months to obtain a prescription of lethal medication from a doctor. Choosing that path is entirely up to the patient, and each individual doctor, clinic and hospital can decide whether or not to help.

Faith-based organizations like Feather River Hospital in Paradise, operated by parent company Adventist Health, have deep reservations, explained spokeswoman Maureen Wisener.

“Our mission is to share God’s love by sharing health, wholeness and hope,” she said. “So, enabling or facilitating somebody’s death before their time is counter to our belief that God gave life and it’s not up to us to take it.”

As such, Adventist Health has prohibited its medical staff from taking part in any way. “We respect people’s right to choose,” Wisener said, “but we won’t and cannot actively participate in helping people die.”

Enloe Medical Center has opted out of providing aid-in-dying evaluations or prescriptions as well, but not for religious reasons, said Dr. Marcia Nelson, the hospital’s vice president of medical affairs.

“We really think it’s best for a patient to exercise this right outside of an acute-care hospital setting,” she said. “Enloe doesn’t see a role for itself in this.”

In fact, neither Nelson nor Wisener is aware of any local health care providers, private or otherwise, who plan on helping patients end their lives.

“I can fairly confidently say that patients are not going to get a prescription from a physician in [the Ridge] community,” Wisener said. “But they might.”

It’s not just a local thing. Many hospitals throughout California have recently announced that they won’t participate in the End of Life Options Act.

Since he’s seen all of this play out before, George Eighmey expected widespread resistance early after the law’s implementation. He’s president of the board of directors for the Death with Dignity National Center, an advocacy group based in Portland, Ore. (Oregon, Washington and Vermont already have aid-in-dying laws on the books.) During a phone conversation with the CN&R, he explained that, when Oregon’s Death with Dignity Act became law in 1997, the medical community was slow to get on board.

“In the beginning, very few doctors, pharmacists and hospices participated,” he said. Only a couple dozen doctors would write the prescription at first, he added, but now there are about 1,500 statewide. “It takes everyone some time to come around.”

Whether hospitals prescribe end-of-life medication or allow patients to ingest it on the premises means very little, Eighmey said, because the vast majority of patients choose to die at home. In Oregon, only two people have taken the drug in a hospital.

“They want to take the medication surrounded by family at home,” he said. “They don’t like the idea of doing it in a sterile hospital.”

Death with Dignity has been tracking the numbers in Oregon since 1998. About 1,000 people have taken the lethal medication—though many more have explored the option. Nine out of 10 people who start the process don’t see it through to the end, and only about a quarter of patients who fill the prescription actually take it.

That may be because having the option, should worse come to worst, is a comfort in itself, Nelson said. “It provides an element of control. When we’re faced with the end of our lives, it feels very out of control.”

And it’s not like just anyone can walk into a doctor’s office and walk out with a prescription for lethal drugs. California’s law, especially, has loads of patient safeguards built in, Eighmey said.

First off, a patient must be an adult, deemed mentally competent and have a terminal diagnosis confirmed by two physicians. Then he or she must have a private, one-on-one consultation with a physician to make sure there are no undue influences by, say, greedy relatives waiting for inheritance checks. The patient must make two oral requests for the medication and submit one written request. Then there’s a 15-day waiting period before the prescription can be filled. Finally, the patient must give a 48-hour notice to his or her physician before taking the drug.

“It’s not something you can do very quickly or easily,” Eighmey said. “And it’s not a decision people make lightly.”

For its part, Feather River Hospital encourages patients to consider hospice and palliative-care options rather than the aid-in-dying route, Wisener said.

“Certainly, our hospice program is one of the best options people can consider,” she said. “It allows us to provide so much in the way of comfort, support and care during their last days. But in our community, we’ve seen that people don’t take advantage of hospice until extremely late—almost too late.

“Many patients are in hospice for a week or 10 days, and then they’re gone.”

But even for people who’ve been diagnosed with a terminal illness, the outlook can improve and hope can return. And making people better is always a medical provider’s primary goal, Wisener said.

“Clinical professionals are trained to heal and save lives,” she said. “You don’t go to medical school or nursing school to learn how to help somebody die. You learn how to help somebody live.”

While that’s an admirable attitude, Eighmey said, it’s not always the best approach.

“Physicians believe they can cure it,” he said, “but a terminal diagnosis is, by definition, incurable.”