By: Laura Petrillo, MD @lpetrillz
Governor Jerry Brown signed California bill ABx2-15 into law today. The law will give California doctors the ability to prescribe lethal medication to competent, terminally ill patients so that they may end their lives. California is not the first state to enact such a law (Oregon, Washington and Vermont have laws in place), but it is the first since Brittany Maynard, the 29 year-old California woman with a fatal brain tumor, moved to Oregon last year to use the Death with Dignity Act and re-invigorated the decades-old legalization movement. Other states are likely to follow.
What next? If there is one message that all healthcare providers should hear, it is this: a request for assisted suicide is an opportunity to learn more about the individual’s experience, and to partner with the patient to create a plan that addresses her needs. This should include an evaluation of decision-making capacity, mood, symptoms and psychosocial support, followed by a trial of intensified treatment of reversible causes of suffering, possibly including referral to mental health specialists for additional care, and almost always enlisting palliative care support. Timothy Quill’s Fast Facts #156 and #159 provide an excellent starting point for going through this process. After thorough evaluation and treatment, and learning about other options such as hospice care and withdrawal of life-prolonging therapies, if the patient persists in her request, assisted suicide should be considered as a last resort.
The reason to go through all of this is not to prolong life at all costs, but because the vast majority of people will actually achieve a better quality of life through supportive care, and will not persist in their request for hastened death once their needs are met. If the goal of assisted suicide is truly to relieve suffering, anything that could achieve that goal while someone is still alive should be pursued. In Oregon and Washington, the number of people who use assisted suicide is incredibly low, about 0.3% of all deaths, most likely because there is excellent access to hospice and palliative services in those states (as demonstrated in last week’s CAPC report card), as well as appropriate evaluation of eligible patients.
As palliative care and geriatrics providers, we need to lead the way in spreading the message that every assisted suicide request is an opportunity to help our patients achieve a dignified death, but not necessarily through assisted suicide— it should be a last resort. Whether you plan to prescribe or not, it is important to create your own plan for how to respond, and if you can, educate others about primary palliative care skills (“Tell me more about your suffering”; “What are you worried about?”) and how to find more support for people contemplating assisted suicide.
Photo courtesy of Nancy Lundeberg ©2014