End of Life Option Act requires rigorous physician review

By Dr. Vincent Nguyen

Categories: Featured News
On June 9, California's End of Life Option Act went into effect, allowing terminally ill patients with a prognosis of six months or less to request a doctor's prescription for lethal medications intended to end their lives.

The End of Life Act itself is hardly "the easy way out." One of the most rigorous in the nation, California's law requires two doctors to confirm a patient's diagnosis, prognosis and ability to make medical decisions. The patient must then make multiple requests for the prescription, both orally and in writing in front of witnesses, and has to have the physical ability to self-administer the aid-in-dying drugs.

Regardless of one's personal beliefs on this law, I am hopeful that it will ultimately serve an important role in beginning a critical conversation about death, dying and what it means to retain autonomy over the final days of our lives.

One conversation, in particular, that must begin is the discussion about a person's end-of-life wishes. Many patients facing terminal illness quietly make decisions about which life-sustaining treatment they would tolerate, and which they wish to forgo, but they don't always communicate those decisions to their doctors or their loved ones.

I hope this new law motivates doctors and patients to work together to create both an Advance Directive and a Physician Order for Life-Sustaining Treatment (POLST). An Advance Directive is a legal document that tells your doctor and your loved ones what kind of care you would like to have if you become unable to make medical decisions. A POLST provides a framework for patients and their doctors to discuss and develop plans that reflect a person's wishes regarding life-sustaining treatment.

As medical director of the CARES palliative care program at Hoag Memorial Presbyterian Hospital, I know that palliative care is not designed to hasten death, nor does it prolong suffering. We help relieve pain, attend to psychosocial issues, address spiritual matters and allow patients to safeguard what is important to them. We are an extra layer of support for providers, patients and families.

For years, palliative medicine has been silently succeeding in assisting people to live fully and die a natural death with dignity. Now the entire country is turning its attention to palliative care. I believe this is a reflection of the fact that people aren't accustomed to talking about death.

Everyone wants a way to face the inevitable with dignity and without pain, but our society lacks the vocabulary to begin this discussion. I hope this renewed attention to end-of-life care helps remove the taboos associated with death.

I know firsthand the pain families suffer when terminal patients leave no care instructions. It is imperative that we as a society continue to educate ourselves about end-of-life care and have important conversations with family and physicians. By making your wishes known in an advance directive you are providing a road map for your love ones to follow and it keeps you in charge when it comes to decisions about your medical treatment. This road map is the biggest gift you can give to yourself, family and friends.

Dr. VINCENT NGUYEN is program director, Hoag CARES/Palliative Care Program.