In California, physicians--and particularly oncologists--are grappling with a recently passed law that allows them to provide competent, terminally ill patients with a prescription for a lethal dose of medication that the patients can use to end their own lives.
But the legislation has raised ethical questions for physicians, according to a Medscape report. At the heart of the issue is whether it is ever ethically or morally permissible for a physician to help a patient die, even if it is legal. Is it a legitimate part of palliative care or a failure to provide that care? Is there a big difference between withholding life-supporting measures at the end-of-life and sedating patients with drugs or providing them a lethal drug that allows them to die?
California doctors are now faced with the prospect of having a patient ask them to help them die. "This is now the law in the state I live and practice in," Kavitha Ramchandran, M.D., a physician in thoracic oncology and palliative medicine at the Stanford Cancer Institute in California, said during a panel discussion at the Gastrointestinal Cancers Symposium, Medscape reported. While admitting she is not an expert on the topic, "I thought, well, I better become an expert because this is an issue that is facing our patients. And if we're not experts, then who are they going to turn to?" she said.
Since the Death with Dignity Act was voted into law in Washington State in 2008, Lynne P. Taylor, M.D., a neuro-oncologist at Virginia Mason Medical Center in Seattle, has had patients ask her for assistance in dying. However, very few patients have actually opted to end their lives.
She noted that in 2014, 176 patients--76 percent of whom had terminal cancer--were prescribed lethal doses of medication in Washington State, which has a population of seven million people. Of this group, 126 patients died after taking the medication. Fifteen percent who requested the lethal drugs did not end their lives.
Even if doctors don't live in a state that allows physician aid in dying, they can better prepare for end-of-life care decisions by receiving more advanced training and education in palliative care management, Taylor said. Tools and resources to help facilitate these conversations are being developed, as FiercePracticeManagement previously reported. For example, physicians can receive free counseling about discussing end-of-life options with patients by calling Doc2Doc, a toll-free line sponsored by Compassion & Choices, a Denver-based nonprofit group that supports end-of-life planning.
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