Nearly 75% of polled Americans say that if they become terminally ill and are suffering, they want their doctors to be allowed to help them die. That’s now legal in nine states and Washington, D.C., giving 22% of the U.S. population access to medical aid in dying.
But the actual practice in those states, including California, lags far behind the legalization — and the reasons are as varied as the causes of death itself.
First, a small minority of physicians participate in aid in dying. That’s supposedly because of moral objections, but most non-participating physicians explain that it’s lack of training. They are appropriately uncomfortable with care they haven’t been trained to provide.
That scarcity of participating aid-in-dying physicians has led to low use of these laws. Terminal patients already facing emotional times find it extremely challenging to search for doctors to consider their requests.
In California in 2018, only 337 individuals died following their ingestion of aid-in-dying medications. No one knows how many patients considered aid in dying but couldn’t find a doctor to provide it.
There’s also a race and class disparity in medical aid-in-dying requests — understandable considering ethnic and income inequity in quality medical care in general, and the mistrust this engenders.
Finally, patients and clinicians say aggressive palliative care — symptom control especially at the end of life — is much more of an unmet need to remedy than providing medications to end lives.
All the above is accurate and thought-provoking. But for patients approaching death who, should their suffering warrant, crave the option of assisted dying — these arguments are theoretical. For them, dreading the final weeks toward their inevitable end, their plea to end their lives is not merely a request, it is a desire born of suffering and desperation.
On Feb. 14-15, a field of nationally recognized doctors, nurses, end-of-life care providers, mental health professionals, and ethicists will gather on the UC Berkeley campus for the first National Clinicians Conference on Medical Aid in Dying (www.nccmaid.org).
This conference will not be a debate on the appropriateness of California’s aid-in-dying law — that debate ended in 2016 when then-Gov. Jerry Brown signed the End of Life Option Act. Rather, the conference will be the first to offer specific teaching to clinicians who are willing to participate but have yet to find the training.
The conference will open the discussion to include racial and income disparities in end-of-life care, and the difficult ethical dilemmas that can arise at the bedside when a patient, for example, is too weak to take the medications but wants them, nonetheless.
We will also discuss at length the crucial role of hospice care, for all dying patients and even more so for those considering taking medications to die.
At this conference, for the first time, clinicians will learn the practical, bedside implications of aid-in-dying laws so that clinical care will have the chance to match the legal promises of relief for select terminally ill patients — a promise yet to be fulfilled.
Until now.
Dr. Lonny Shavelson, a Berkeley physician, is chairman of the board of the National Clinicians Conference on Medical Aid in Dying.
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February 04, 2020 at 09:10PM
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Opinion: Why terminally ill, suffering patients don’t use aid in dying - East Bay Times
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