Lacey Peterson
The Union Democrat

"The No. 1 reason the people have chosen the option in the past, not because they are in writhing pain, they are afraid of losing autonomy.”

— Dan Riordan, executive director of Hospice of Amador and Calaveras


The Union Democrat

In a week people with a terminal illness will have the option to seek an aid in dying drug as part of the End of Life Option Act passed in California.

However, the logistics of finding a willing provider and how to pay for the drugs remains vague at best.

According to Dr. Lael Duncan, medical director for the Coalition for Compassionate Care of California, most health networks and medical organizations that contract with doctors haven’t written up policies on their stance on the act.

A provider who is employed by an agency that does not want to participate, can’t assist a patient with the process as an employee. However, if they had their own private practice, they could participate under that practice umbrella.

Similarly, a health care organization that does wish to participate can’t force a doctor or pharmacist to participate if they don’t want to, Duncan said.

Insurance companies haven’t decided yet if they will cover the drugs that will be used, so the cost could be low to prohibitively high, Duncan said.

Furthermore, federally administered insurance programs like Medicare and Veterans Administration, won’t cover the drugs because it’s not a federally accepted legal option.

Duncan said she isn’t sure which drugs will be used in California but that providers will be able to find out what can be used, and pharmacies can order them if it’s not something that’s routinely carried. However, the medications are “available,” Duncan said.

Locally, Dignity Health that operates Mark Twain Medical Center in San Andreas said it does not plan to participate in physician aid-in-dying.

“Though we do not participate in activities intended to hasten the end of life, we respect the personal nature of end of life decisions and make no obligation for patients to begin or continue life-sustaining treatment if it is not their wish to do so. In the event patients decide to forego medical treatment to allow the natural process of dying, we remain fully committed to ensuring their comfort and peace during their final moments,” Dignity Health said via its spokesman Chad Burns in San Francisco.

Adventist Health, which operates Sonora Regional Medical Center, supports the rights of terminally ill patients to make private health-related decisions with doctors.

As an organization, Adventist Health chooses not to participate in Death with Dignity Laws procedures. This decision extends to all Adventist Health facilities including hospital based outpatient services, clinics and pharmacies.

It will likely only be done at home, given the plethora of health care agency regulations, policies, etc., Duncan said.

A patient must have about six months to live or less to be eligible and meet a number of other requirements, which may even include a mental health evaluation, Duncan said.

They have to be able to be cognitively and physically able to take the drugs themselves, without help of anyone else, Duncan said.

Also according to the law, a person will not be considered a “qualified individual” solely because of age or disability.

A request for a prescription for an aid-in-dying drug must be made solely and directly by the individual diagnosed with the terminal disease and cannot be made on behalf of the patient by anyone else, including, but not limited to, through a power of attorney, an advance health care directive, a conservator, health care agent, surrogate, or any other legally recognized health care decision-maker.

If a patient on hospice wants to pursue this option, hospice isn’t going to break up with them or abandon them, said Dan Riordan, executive director of Hospice of Amador and Calaveras.

The patient will be referred to educational materials and their provider for information on it and services will still be provided to the family. Hospice doesn’t participate in end of life option activities, but it still offers families regular services that also include respite, counseling, support, etc.

Riordan said patients facing terminal illnesses have perspectives that range from “I’m going to meet God,” to “I’m going to kill myself.”

The option provides people a way to take back a little more control and some may find relief through it even if they don’t use it.

“The No. 1 reason the people have chosen the option in the past, not because they are in writhing pain, they are afraid of losing autonomy,” Riordan said.

“Just that the option is available is a form of palliative care. Just knowing you have an option can relieve a lot of angst. You may not use it. But it helps allay the desperate feeling,” Riordan said.

Much about the new option is unknown and will remain unknown for some time.

There’s not even a decided way of keeping track of which providers are going to be willing to assist patients in the process, or if an organizational body is even going to keep track of which providers will be willing to participate, Duncan said.

It’s also unknown how many people will actually go through with it, once they are deemed eligible and go through the approval process.

Duncan said that in Oregon, a couple hundred people a year request a prescription, but only 50 to 63 percent actually take it.

However, California’s population is different than Oregon’s so it’s anyone’s guess as to how many people will seek the option and carry it out, she said.

As time goes by, it will be more clear how patients can access the End of Life Option, Duncan said.