111 pa­tients used state’s end-of-life law in 2016

Most were white, col­lege-ed­u­cated can­cer suf­fer­ers older than 60, data for law’s first six months show.

Los Angeles Times - - FRONT PAGE - By Soumya Kar­la­mangla

A to­tal of 111 peo­ple in Cal­i­for­nia took their own lives us­ing lethal pre­scrip­tions dur­ing the first six months of a law that al­lows ter­mi­nally ill peo­ple to re­quest life-end­ing drugs from their doc­tors, ac­cord­ing to data re­leased Tues­day.

A snap­shot of the pa­tients who took ad­van­tage of the law mir­rors what’s been seen in Ore­gon, which was the first state to le­gal­ize the prac­tice nearly two decades ago. Though Cal­i­for­nia is far more di­verse than Ore­gon, the ma­jor­ity of those who have died un­der aid-in-dy­ing laws in both states were white, col­lege-ed­u­cated can­cer pa­tients older than 60.

The End of Life Op­tion Act made Cal­i­for­nia the fifth state in the na­tion to al­low pa­tients with less than six months to live to re­quest end-of-life drugs from their doc­tors.

Ac­cord­ing to data from the Cal­i­for­nia De­part­ment of Public Health, physi­cianas­sisted deaths made up 6 out of ev­ery 10,000 deaths in Cal­i­for­nia from June 9 to Dec. 31, 2016. That’s much lower than the 2016 rate in Ore­gon, where lethal pre­scrip­tions ac­counted for 37 per 10,000 deaths.

But the find­ings have done lit­tle to calm the de­bate over whether al­low­ing doc­tors to pre­scribe lethal med­i­ca­tions is ac­cept­able med­i­cal prac­tice.

Supporters of the law pointed to data show­ing that 191 pre­scrip­tions were writ­ten, but only 111 pa­tients had taken the pills as of the end of De­cem­ber.

Of­ten pa­tients have longheld val­ues and be­liefs about what makes a life worth liv­ing and want the peace of mind of know­ing that if their con­di­tions worsen, their pain in­creases or they be­come more de­pen­dent on oth­ers, they won’t have to en­dure it, said Dr. Tom Strouse, a psy­chi­a­trist and pal­lia­tive care doc­tor at UCLA.

They “want the op­tion of say­ing, ‘That’s not how I’m go­ing to live,’ ” Strouse said. “It’s a con­tin­gency plan­ning ap­proach, re­ally.”

Alexan­dra Snyder, an attorney with Life Le­gal De­fense Foun­da­tion and critic of the law, said Cal­i­for­nia is now ef­fec­tively de­crim­i­nal­iz­ing as­sisted sui­cide. And there’s no way to de­ter­mine whether a pa­tient was co­erced into tak­ing the drug, she said.

“It’s re­ally tragic that doc­tors are now think­ing that the best they can do for a pa­tient is to give them a hand­ful of bar­bi­tu­rates and leave them to their own de­vices,” Snyder said of the num­bers re­leased Tues­day.

Ex­perts say the low us­age num­bers in Cal­i­for­nia last year aren’t sur­pris­ing be­cause pa­tients and physi­cians are still learn­ing about the new law.

In the first year that Ore­gon’s law was in ef­fect, there were only 15 physi­cian-as­sisted deaths, though that num­ber had grown to 133 last year.

“The state’s data show that even dur­ing the early months of the law’s im­ple­men­ta­tion, the law was work­ing well and ter­mi­nally ill Californians were able to take com­fort in know­ing that they had this op­tion to peace­fully end in­tol­er­a­ble suffering,” said Matt Whitaker, who works for Com­pas­sion & Choices, an ad­vo­cacy group that fought for the law’s pas­sage.

The or­ga­ni­za­tion re­leased a re­port this month say­ing it knew of 504 peo­ple who had re­ceived pre­scrip­tions for lethal med­i­ca­tions from June 2016 to June of this year.

Writ­ing the lethal pre­scrip­tions is com­pletely vol­un­tary for doc­tors and med­i­cal fa­cil­i­ties, and some, in­clud­ing all Catholic and church-af­fil­i­ated hos­pi­tals, have not al­lowed their physi­cians to pre­scribe such medicines.

But Whitaker said that even those groups in Cal­i­for­nia are hav­ing an open di­a­logue about the law and that, gen­er­ally, he’s been “pleas­antly sur­prised” by how much more will­ing doc­tors are to talk about the prac­tice than they were in the early years in Ore­gon.

“They have re­ally ap­proached the is­sue head-on, and not just closed their eyes and hoped it would go away,” he said.

Sim­i­lar laws are be­ing con­sid­ered by sev­eral other states. In Novem­ber, Colorado vot­ers le­gal­ized the prac­tice, bring­ing the per­cent­age of Amer­i­cans who live in states where the prac­tice is le­gal to 18%.

Cal­i­for­nia’s law still faces op­po­si­tion from some cor­ners. A judge ruled this month that a suit to over­turn the law will be al­lowed to go to trial.

Snyder, who filed the suit, said that be­cause the deaths are not in­ves­ti­gated, the law “takes away cer­tain le­gal pro­tec­tions that were af­forded peo­ple who were sick and elderly and oth­er­wise vul­ner­a­ble.”

Strouse pointed out that un­der the law, doc­tors can­not ini­ti­ate con­ver­sa­tions about aid in dy­ing with their pa­tients. The pa­tient must ask for the medicines them­selves.

He said that doc­tors who do end up writ­ing such pre­scrip­tions be­lieve that they are pro­vid­ing peo­ple with pro­tec­tions for their per­sonal au­ton­omy.

Some doc­tors are still un­com­fort­able with the prac­tice, and many pa­tients’ fam­i­lies re­ported strug­gling to find a doc­tor who would write such a pre­scrip­tion.

Cal­i­for­nia’s data show that 173 physi­cians wrote the 191 pre­scrip­tions statewide.

Sherry Mi­nor’s hus­band, John, was suffering with a painful ter­mi­nal lung dis­ease last year. The 80-yearold re­tired psy­chol­o­gist had lost 80 pounds and could barely eat or talk.

“He just thought he couldn’t go on,” she said.

But they strug­gled to find a doc­tor who would par­tic­i­pate un­der the law, un­til they switched to Kaiser Per­ma­nente and ul­ti­mately got a pre­scrip­tion.

“It was an enor­mous re­lief,” said Mi­nor, who lives in Man­hat­tan Beach. “He just felt more com­fort­able with that men­tally.”

John Mi­nor, sur­rounded by his fam­ily, took the pills in Septem­ber.

“John did what was right for him,” Mi­nor said. “He died peace­fully, rather than in agony, and he was in con­trol. He didn’t feel afraid or help­less.”

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