Elizabeth Wallner, an educational consultant who lives in Sacramento, Calif., has Stage 4 colon cancer that has metastasized to her liver and lungs. She campaigned for her state's new physician aid-in-dying law, which will take effect in June.
Wallner has talked with her three physicians about obtaining a prescription to end her life if and when she chooses not to continue her cancer treatment. None is willing to help her. “I understand that bumping off your patients isn't why you went to medical school,” she said. “But I believe it falls squarely within the Hippocratic oath because making me drown in bodily fluids is doing more harm than giving me the prescription.”
California patients like her who are 18 or older and want to take advantage of the End of Life Option Act are likely to face challenges in finding cooperative physicians, hospice workers, pharmacists and other healthcare providers, at least initially. Terminally ill patients who live in communities where the sole or dominant provider organizations are Catholic-owned or -affiliated will face even tougher problems because those systems will not allow their physicians and staff to help patients exercise their rights under the law. Patients in more conservative, rural parts of the state also may face hurdles. Unlike in other states, Compassion & Choices, the group that led the effort to pass the law, says it will not steer patients to participating doctors, though it will list participating health systems on its website.
But two giant California systems, Kaiser Permanente and Sutter Health, told Modern Healthcare that they and their physicians and staff will participate in the law, though their individual providers have the right to opt out.
There also are questions about health insurance coverage for aid-in-dying services and drugs. Congress barred Medicare, the Veterans Health Administration and other federal programs from paying for these services, while California's Medicaid program and most private insurers have not yet clarified their payment policies. The drugs alone can cost several hundred to several thousand dollars.
A statewide Field Poll last October found that 65% of Californians surveyed support the law, with 27% opposed and 8% undecided. While California providers disagree about the morality of the law, everyone hopes its existence will spur more and better end-of-life care discussions, and increase the use of palliative and hospice care.
“It shines a light on end-of-life care generally, and it requires physicians to explore all these options with patients who make requests for pain control, comfort care and palliative care,” said Leah Newkirk, vice president of health policy at the California Academy of Family Physicians, which adopted a neutral position on the law.
Four other states allow physician aid in dying, but California's experience will receive heightened scrutiny because of the state's enormous size and diversity, and its history as a national trendsetter. In those other states, a small percentage of terminally ill patients have asked doctors for a lethal prescription, and an even smaller percentage followed through to end their lives.