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
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
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
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.