I’ll be honest. When I started my fellowship in palliative care 4 short months ago, I had not seriously considered the possibility that one day I would have a patient ask me whether I would prescribe them a medication to end their life. Of course I was aware of the Oregon experience, but living in California where I completed both medical school and residency had sufficiently inured me to this idea. But with the signing into law in California last month of the End of Life Option Act, I have started to feel troubled by this question: would I or would I not prescribe?

I recently spoke with my old babysitter who cared for me early on in childhood, a wonderful elderly Honduran woman now living in Maryland who I had not spoken with in over a decade. When I updated her on my career plans in palliative care, assuming she would have no context, I was surprised to hear her quickly respond about a recently watched TV program about doctors helping terminally ill patients die in Europe and Oregon. In clinic last week, when I asked a new patient what his plans would be if his health were to deteriorate from his metastatic cancer, he said, “Oh, that new physician-assisted suicide law.” I have already had 5 patients ask me for information on physician-assisted death in California. Anecdotally, people are talking about this new law and they are associating it with palliative care.

As a new face in palliative care, I have found myself deeply affected by these initial requests for more information about assistance with death. But what I have noticed in the field is that before this law was in place, we were comfortable looking the other way, as there were many issues that were considered a bigger priority. And I have also sensed a real unease with physician-assisted death. As I’ve come to understand, many palliative care practitioners have been afraid that any association with this law would further cement the misconception that palliative care is only about death — even as the field has fought so hard to change its image in the national conscience as a focus on life and living well at any stage of a serious illness. With our aging population and higher burden of chronic diseases, the need for palliative care has never been greater, and yet we have all had patients decline our services because of the death stigma. As one palliative care MD I spoke with put it, “We are already thought of as the death squad. If we start prescribing a lethal pill, will we be?” In Oregon, only 0.3% of people that die are utilizing physician-assisted death. Another worry is that we have expended a significant amount of political will on an end-of-life option for the [less than] 1% when there is still so much need to expand inpatient and outpatient palliative care services for the 99%.

Read More: http://www.geripal.org/2015/12/palcare-fellows-perspective-assisted-death.html