Death with Dignity: Lack of Access Biggest Issue

Refusal to participate leaves patients without access to end-of-life options

Twenty years ago, the state of Oregon implemented the nation’s first Death with Dignity Act. This state legislation provided a physician-prescribed, end of life option for terminally ill individuals. In the 20 years following, five other states and the District of Columbia passed their own voter-approved aid in dying legislation.

The names of each state’s medical aid in dying legislation differ slightly (Oregon’s Death with Dignity, California’s End of Life Option, and so on), but the message is the same. Each law allows terminally ill, adult residents to obtain and use lethal medications prescribed by their physician for self-administered treatment. Yet, terminally-ill patients are experiencing a big obstacle when seeking end of life assistance —  few doctors are willing to help.

Person staring out of a window alone, contemplating death with dignity

Death with Dignity is Not Guaranteed

Doctors, hospitals, and health systems are not required to participate in their state’s death with dignity legislation. Resistance to take part comes from both faith-based medical systems and individual doctors. Some doctors see medical aid in dying as a practice that goes against their training to extend and preserve life. As Dr. David Stevens, CEO of Christian Medical & Dental Associations, commented, “People consider it a breaking of professional integrity.”

But when so many doctors and medical systems opt-out, they leave terminally ill patients  without access to this voter-approved, end of life treatment. Also, non-participating medical firms prohibit doctors from assisting, even if they want to. In addition, doctors who opt-out don’t have to discuss death with dignity options with patients, or even refer them to colleagues who will.

Close up of elderly woman's hands who desires death with dignity

Letting Death with Dignity into the Conversation

Advocates say that without access to aid-in-dying options or information, we leave large swaths of the terminally ill vulnerable. As a result, dying individuals may experience a diminished quality of life, or as seen in the case of one Washington man, choose a violent death. Advocates want doctors to at least be able to discuss death with dignity options with interested patients. This will allow the terminally ill to access the care they want for the end of life experience they desire.

According to Dr. Jay W. Lee, former president of the California Academy of Family Physicians, the issue of lack of care seems to be, at its core, “the taboo against talking about death openly in the medical community.” A 2015 Kaiser Poll showed that 89 percent of respondents think health care providers should discuss end of life care issues with their patients. In practice, though, only 17 percent had had such a conversation with their doctor.

Advocates believe as providers and the public become more familiar with the laws and its requirements, more providers will participate. Anne Coscarelli, UCLA clinical psychologist, added, “There’s a lot of need for talk, and talk is something that’s bigger and broader than the actual aid-in-dying itself.”

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2 Responses to Death with Dignity: Lack of Access Biggest Issue

  1. avatar Sue M. says:

    Discussing end-of-life issues is a good thing. For people who find the concept shortening their lives in any way abhorrent, it allows them to be frank with their health care providers, as well as those who favor this option. For the former, this gives them the to opportunity to say, “If you offer me a POLST or a MOLST, have all boxes for every life-sustaining option checked. Don’t you ever, ever, ever ask me about medical assistance in dying. By the way, do you participate in this practice? If you do, good bye. I want a new doctor.”

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  2. avatar Kathleen Clohessy (Blog Writer, SevenPonds) says:

    Hi Sue,

    Most doctors are very reluctant to discuss end of life issues, even when it’s clear that a person is on a downhill slide. And a lot of research suggests that patients often have unrealistic expectations about their prognosis and life expectancy because of this. So any discussion between doctor and patient is a good thing, even when the conversation is hard.Of course, in the end it is always the patient’s decision whether to opt for life-sustaining treatments or not. But it’s critical that they make that decision with all the facts.

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