Hospitals Mulling Opting Out of California’s End of Life Option Act

California's End of Life Option Act is scheduled to take effect June 9, 2016. The Act allows, but does not require, medical professionals in California to assist qualified terminally ill patients to end their lives by providing them with script for certain medications in life-ending doses, which the patients may then self-administer. The Act is quite similar to Oregon's Death With Dignity Act.

Huntington Hospital made the  news a week or so ago for reports of  a medical leadership vote to "opt-out" of the statute, a vote that would need to be ratified by the hospital's board of directors on May 26, 2016 in order to take effect.  This is a position that has garnered considerable attention from the press. Huntington Hospital is a large non-religiously affiliated hospital in Pasadena.  As the Los Angeles Times points out, Huntington has more than 800 active physicians serving residents of the greater San Gabriel Valley and beyond, noting that many local doctors with their own practices might be unwilling to jeopardize their access to Huntington by assisting terminally-ill patients under the terms of the law.

As Oregon DWDA policy analysts have noted:  "Institutional refusal may create conflicts for both patients and health care professionals. An attending physician may wish to provide a prescription for an eligible patient under the Oregon Act but be prohibited from doing so by the institution or system. In such an instance, his/her responsibility to the system conflicts with responsibility to the patient. The physician may also be limited in his/her ability to refer the patient to another physician for continuity of care if the patient’s health care system doesn’t participate in the Oregon Death with Dignity Act or restricts referrals (see Attending Physician and Consulting Physician)."

Health care provider participation in California's End of Life Option Act will also be optional.  Oregon's reported experience with its DWDA tells us that not all Oregon providers make this script writing service available to their patients. The latest statutorily-mandated report on Oregon's DWDA tells us more.  A total of 106  Oregon physicians wrote 218 of these prescriptions during 2015 (1‐27 prescriptions per physician). As even some of the fiercest opponents of Oregon's DWDA note, the Oregon data reveals  a significant number of Oregon's physicians decline this service to long time patients. Patients must then find a new provider if they wish to pursue this service. 

Perhaps the most important fact in all of this is that, in Oregon, no physician was present in 90 percent of the cases when the roughly 50 percent of script recipients actually used the script and died.

Why would  a huge non-religiously affiliated acute care facility feel the need to remove the opt-out decision on ELOA participation from its  individual medical staff entirely and decide the issue for them with an institutional/system-wide opt out?  It is hard to say. There is no press reportage on motive — perhaps the single most interesting aspect of all this.  In fairness, press reportage in Oregon and Washington on non-religiously affiliated systemwide opt out under those statutory schemes was also shallow.

This may be a principled position about the kinds of values required of physicians who practice in a particular institution or are hoping to be affiliated with a particular institution. Or, it may be something else. Acute care hospitals in California are places of dying and end-of-life care on a massive scale already and on a scale that considerably exceeds the American average: end stage fatal diagnosis cancer patients spend less time in hospice, more time in the ICU, and more time visiting physicians in the last six months of their lives than do  Americans with similar diagnoses outside California.  No doubt, a culture shift may also be involved in all of this.

Oregon's policy analysts advised: "Systems that choose not to participate in the Oregon Act should notify patients and health care professionals in advance."  This makes sense. But, just how many of us — in an era of narrow networks — choose our health care practitioners (who, data shows, in turn choose our acute care facility) with a single-minded focus on end of life care and aid-in-dying care?  Even the Consumer Reports-produced admirable guide on how to select a physician doesn't mention this one. I had no luck finding that information available on Physician Compare.  What does that mean for the unsophisticated consumer? 


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