Insights from mainstream media

By Robert Brody, MD

People Magazine is an unusual source for a blog such as this - we are more likely to comment on articles in more academic journals.  But I believe the following from People.com about a young woman, a UCSF patient, who had to leave California for another state to get the care she wanted, and especially the video in which she tells the story herself, is a powerful reminder about work that still needs to be done to make patient-centered end of life care in the form of death with dignity legal and accessible in this state.

http://www.people.com/article/Brittany-Maynard-death-with-dignity-compassion-choices

What would I do if one of my patients in the San Francisco General Hospital General Medical Clinic were terminally ill and made such a request of me?  Would it be right to say to her that my hands are tied by current state law; go to Portland?  Our patients lack the resources to move their families to Oregon or Washington, Montana, Vermont, or New Mexico: the states where aid in dying is legal.  I would certainly make sure she had the best possible palliative and hospice care.  But more than 75% of the people who use the Oregon law are in hospice care when they hasten their death.  I would try to understand the answer to the question "why now?", that is, what exactly is it that is driving the patient's desire to die earlier than she otherwise would?  Is there some issue I can realistically address to assure her that she does not need to take this action?  As part of this evaluation, I would assure myself that this request came from her long held values, and that she had the mental capacity to make this decision, and that those around her were not pressuring her.

Once, many years ago, I met a patient much like the young woman in the video, who answered all my questions in a way that convinced me that her request for aid in dying was appropriate for her.  Together, within the law, we were able to finagle a way that her goals were met.  But perhaps the time has come for California to join these other states to put safeguards in place and allowing physicians and patients to make these important decisions together.