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Patients and Doctors Wrestle with California's Assisted Suicide Law


On June 9, California became the fourth state in the nation to legally permit assisted suicide for terminally ill individuals. The state’s lawmakers approved the law last year after the terminally ill California resident Brittany Maynard received widespread attention from her decision to move to Oregon. She made the move in order to take advantage of that state’s assisted-suicide laws, which have allowed the practice since 1997. Yet even as California’s legislation comes into effect, state residents are wrestling with the implications of the new law and what it means for life – and death – in the Golden State.

“The California legislation is strict,” writes Jennifer Medina for The New York Times. Patients requesting physician-assisted suicide are required to make multiple requests for life-ending medication, and they must have a prognosis of less than six months to live. “Many hospitals have not yet released policies for dealing with the law. And no doctor, health system or pharmacy will be required to comply with a patient’s request. Doctors who object to the practice are not even required to refer patients who request the medication to another physician.”

Roman Catholic and other religious health care providers have already indicated that they will not participate. “We are crossing a line — from being a society that cares for those who are aging and sick to a society that kills those whose suffering we can no longer tolerate,” says José H. Gomez, Catholic archbishop of Los Angeles.

The Times article provides four profiles – two of patients and two of physicians – to give a glimpse into how Californians are grappling with this new angle on end-of-life issues in their state. Medina features a 63-year old woman who is terminally ill and looks to the new law to provide a way to avoid becoming a burden to her family. Another man, 88 years old and living with multiple myeloma, “does not know what will push him to the edge to ask for the medication. … [But he] relishes the idea of having the right to choose precisely when and where to die.”

Among the physicians profiled in The New York Times article is Dr. Sunita Puri, a palliative medicine specialist at Keck Medicine of the University of Southern California. She describes how reaction to the new law is unfolding among clinicians there – and why most doctors aren’t comfortable taking part in legal suicide. Some of Puri’s colleagues are uncertain about the details of the medications and how they will affect their patients. Others are uncomfortable with the changing role of physicians in society – from those who prevent death at any cost, to those who in some cases usher it in. Many doctors are concerned about the mental health implications in requests for life-ending drugs. How does one know if a patient really wants to die, or if the patient is suffering from pain that counseling, palliative care, and hospice could alleviate?

Not all doctors are sympathetic to these concerns. Dr. Lonny Shavelon, a private practitioner in Berkeley, is frustrated when doctors speak to him of their discomfort participating in legalized suicide. “What I’ve said to them is, ‘Were you comfortable the first time you did chest surgery? Were you comfortable the first time you drew blood?’ I don’t understand when being uncomfortable became a reason not to do something in medicine.” Dr. Shavelon has opened a practice that will provide care for “those seeking to end their lives.” Shavelone says, “The most important issue is to listen to the patient and hear the choices that they truly want to make for themselves. “We always listen to the patient. We never tell a patient: ‘This is what you have to do. You have no choice.’”

Source: The New York Times, 6/9,