The End of Life Option Act: Important Considerations for Pharmacists as California Implements Physician Aid in Dying

Topic: Risk, prevention and care in population studies

The law has safeguards intended to ensure that patients are acting autonomously, including a 15-day waiting period between two requests, the requirement that patients meet privately with their physicians to confirm they are acting on their own, and the requirement that patients sign a form within 48 hours of taking the aid-in-dying drug to indicate that it is their choice. In Oregon, individuals who have used physician aid in dying were most often white (96.6%), older adults (median age 71) with a cancer diagnosis (77%).2 Patients most commonly cited concerns about “losing autonomy” (91.6%) and “being less able to participate in activities that make life enjoyable” (89.7%) as motivation for their interest in physician aid in dying, according to data collected via physician report.2One positive outcome of the Death with Dignity Act in Oregon is that 91% of people who received a physician aid in dying prescription between 1998 and 2015 were enrolled in hospice at the time of death,3 which is double the national frequency of hospice enrollment.4 This achievement is a testament to the efforts of the Oregon healthcare community to improve end-of-life care generally in response to the legalization of physician aid in dying.5 One area of concern is the low frequency of psychiatric evaluations (5.3% over 1998–2015) for Oregon residents who received a lethal prescription through the Death with Dignity Act, despite the finding that depression is relatively common among requesters (26% of patients who made a request for physician aid in dying met criteria for clinical depression in one study).6Data from the Seattle Cancer Care Alliance indicate that about five-fold more patients inquire about physician aid in dying than use it.7 There are a variety of reasons for this difference: patients are unable to make it through the process due to illness progression, they do not qualify, they change their mind, or they find relief from their suffering from alternatives like pain control or hospice.7–9 Comprehensive attention to patients' end of life needs by healthcare providers go a long way, not only to support patients and families10 but also, in some cases, to change patients' minds about pursuing physician aid in dying.6Given the similarities between California's End of Life Option Act and the Oregon and Washington laws, California's experience with implementation of physician aid in dying is likely to resemble the other states' in some ways. An opinion poll done in Augus

@article{petrillo2017-dedbf80c,
  author  = {Petrillo, Laura A.},
  title   = {{The End of Life Option Act: Important Considerations for Pharmacists as California Implements Physician Aid in Dying}},
  journal = {Journal of Contemporary Pharmacy Practice},
  year    = {2017},
  doi     = {10.37901/jcphp16-00029},
  url     = {https://doi.org/10.37901/jcphp16-00029}
}

Key findings

• The law has safeguards intended to ensure that patients are acting autonomously, including a 15-day waiting period between two requests, the requirement that patients meet privately with their physicians to confirm they are acting on their own, and the requirement that patients sign a form within 48 hours of taking the aid-in-dying drug to indicate that it is their choice.
• In Oregon, individuals who have used physician aid in dying were most often white (96.6%), older adults (median age 71) with a cancer diagnosis (77%).2 Patients most commonly cited concerns about “losing autonomy” (91.6%) and “being less able to participate in activities that make life enjoyable” (8
• An opinion poll done in August 2015 indicated that 76% of Californians support physician aid in dying, but support was higher among white, Asian-American and Latino adults (all ≥75%) than among African-Americans (52.3%).11It is reasonable to expect that as in Oregon and Washington, many more patients will inquire about physician aid in dying than will use it in California.
• Already, since the End of Life Option Act has gone into effect, reporters have raised concern of a shortage of willing physicians in rural counties like Humboldt.13Several institutions have added requirements in addition to the law's safeguards in order to further protect patients from harm, such as mandatory palliative care or mental health evaluations, or credentialing for physicians who participate.(14) These requirements are intended to reduce the risk of patients receiving a prescription as a result of coercion or insufficient evaluation for reversible causes of suffering, but may make it more difficult for patients to obtain a prescription.As described above, participation in the End of Life Option Act is voluntary.
• Bereaved family members in particular are at increased risk of suicide in the period after the patient's death.

Why it matters

This article discusses considerations for pharmacists as California implements its physician aid-in-dying law. It contains no information about treating, curing, or preventing Alzheimer's disease.

Study details

• Effect size96.6%; 91.6%; 89.7%
• Evidence strengthLow

Read the original

• DOI: 10.37901/jcphp16-00029
• Original source →
• Free full text: Journal of Contemporary Pharmacy Practice →

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