Will They Or Won't They? Physician Participation In End Of Life Option Act

Physicians must now decide whether to assist patients asking for an end-of-life drug under the state’s new aid-in-dying law. But how does a doctor decide if they should participate in the practice? 

Dr. Lonny Shavelson has been seeing patients interested in California’s End of Life Option Act for the past four months.

The former emergency medicine doctor of 29 years had taken time away from the medical field to work on a film project. But with the rollout of California’s aid-in-dying law, he decided to enter health care once again to make sure that patients had access to the option.

“Everybody thinks that the law is just about providing an aid-in dying-medication. It’s not. The law is about helping people with many of their choices as to how to die,” he says.

End of life care has always been an important issue for him. In 1995, he wrote a book about assisted suicide.

“My belief is that for this law to be moral and respect the desire of patients is that we first offer optimal medical care in every way we possibly can before we offer an aid-in-dying drug,” Shavelson says.

He says when called by a patient, he tells them that he’s the doctor who comes to talk about their end of life care, not the doctor who simply comes out to write a prescription for an end-of-life drug.

This could lead to conversations about improving their sleep, treating them for anxiety or helping them to better manage their pain. But for some, that’s still not enough.

“If it turns out you need this medication because medical care in other ways isn’t working for you as an individual then that’s one of the options,” Shavelson says.

And he’s OK with that. Dr. Shavelson says about 130 patients have contacted him with interest in the end of life option. He says many of them called because they were unable to find a doctor that would help them, which isn’t surprising compared to states with similar laws.

In 1998, when Oregon’s Death with Dignity Act went into effect, only 14 physicians participated. Last year, there were 106 physicians who wrote prescriptions for end-of-life drugs in Oregon, according to an annual report.

Dr. Daniel Mirda, a Napa oncologist, says many physicians don't want to be known as “Dr. Kevorkian.”

“I think that there are physicians that would have some concern that they wouldn’t want to be stigmatized as physicians that are easily providing this service,” Mirda says.

Mirda says if a patient, who he knows well, comes to him for counseling he’ll make sure that the patient and their family understand all the options available and are making their decision with the right information.

“The idea of ending someone’s life isn’t something that physicians really have faced in an active role in our medical training, in our ethics behind it, in the Hippocratic Oath, which we all take very seriously, is really never to harm someone,” Mirda says.

Medical ethicist Ben Rich says the Hippocratic Oath is overused in modern medicine.

“But it continues to be held up by a segment of the medical community as this canonical oath that everyone has taken and it precludes performing aid in dying,” Rich says.

Rich, an emeritus professor of bioethics at UC Davis School of Medicine, says he realizes that many physicians are wary of the new law.

“They entered the profession to help people, to save their lives, to prolong their lives, to improve their lives and that’s where they want to keep their focus and I understand that,” Rich says.

Compassion and Choices, an advocacy group for end of life, expects an estimated 1,500 Californians to request an end-of-life drug over the next year.