Dave K
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I do not come out on either side of the suicide or physician-assisted suicide issue, but I do staunchly support the right of PALS to be fully informed about their prognosis and treatment options. Indeed, in every debate concerning physician assisted suicide, all sides agree that the patient must be fully informed. Unfortunately, the “physician checklists” required under the recently enacted “aid in dying” laws in California and Colorado are minimalist and fail to ensure that people with ALS are fully informed, which is leading to tragic results.
Assisting the terminally ill who wish to hasten their deaths has long been a common, though hidden, practice of compassionate physicians. See Julia Pugliese, Note, Don't Ask--Don't Tell: The Secret Practice of Physician-Assisted Suicide, 44 Hastings L.J. 1291, 1295 (1993). Many patients suffering from incurable conditions have their deaths eased at home by the ministrations of opiates by family members. No one is being prosecuted for these acts of compassion, so the issue is: what do the new laws really change?
As a CALS, these issues are very personal, and very immediate. However, as an attorney I am shocked at how poorly these new "aid in dying" laws are being written, and how easy the new laws make it for the managed care industry to withhold care and equipment to such an extent that it makes suicide seem like the best option. The new laws state that the patients must be "fully informed" by their doctors, but the new laws do not require a record of the actual information that is provided to the patient, and from what I've seen, many PALS are not fully informed by their physicians about their end of life options. The vast majority of PALS die peacefully in their sleep, but many PALS are so poorly informed by their doctors about their prognosis, that they have an unwarranted fear of choking to death. The law requires a hospice to provide ALS patients with around the clock in-home care if necessary, but due to current funding structures, virtually all hospice physicians tell ALS patients that only a few hours per week of nursing will be provided. An honest physician will disclose any financial interest in a proposed course of treatment, but it would be exceptional for a doctor who is paid on a capitation or per diem basis to tell a PALS that omitting in-home shift care from the patient's care plan serves to increase the doctor's financial bottom line.
By failing to provide for any accountability for actually "fully informing" PALS about their options, the new "aid in dying" laws make it incredibly easy for HMOs and hospices to paint suicide as the most desirable option for a PALS in order to get these super-expensive patients off of their books. There are a lot of uninformed/misinformed PALS who are at risk of because of how poorly these laws have been written.
So the bottom line is, an "aid in dying" act with an unenforceable "full information" provision probably hurts PALS more than it helps them. To prevent PALS from being short-changed when they are given their care options, we should all be urging our lawmakers to put some teeth into the "full information" parts of these "aid in dying" laws.
Assisting the terminally ill who wish to hasten their deaths has long been a common, though hidden, practice of compassionate physicians. See Julia Pugliese, Note, Don't Ask--Don't Tell: The Secret Practice of Physician-Assisted Suicide, 44 Hastings L.J. 1291, 1295 (1993). Many patients suffering from incurable conditions have their deaths eased at home by the ministrations of opiates by family members. No one is being prosecuted for these acts of compassion, so the issue is: what do the new laws really change?
As a CALS, these issues are very personal, and very immediate. However, as an attorney I am shocked at how poorly these new "aid in dying" laws are being written, and how easy the new laws make it for the managed care industry to withhold care and equipment to such an extent that it makes suicide seem like the best option. The new laws state that the patients must be "fully informed" by their doctors, but the new laws do not require a record of the actual information that is provided to the patient, and from what I've seen, many PALS are not fully informed by their physicians about their end of life options. The vast majority of PALS die peacefully in their sleep, but many PALS are so poorly informed by their doctors about their prognosis, that they have an unwarranted fear of choking to death. The law requires a hospice to provide ALS patients with around the clock in-home care if necessary, but due to current funding structures, virtually all hospice physicians tell ALS patients that only a few hours per week of nursing will be provided. An honest physician will disclose any financial interest in a proposed course of treatment, but it would be exceptional for a doctor who is paid on a capitation or per diem basis to tell a PALS that omitting in-home shift care from the patient's care plan serves to increase the doctor's financial bottom line.
By failing to provide for any accountability for actually "fully informing" PALS about their options, the new "aid in dying" laws make it incredibly easy for HMOs and hospices to paint suicide as the most desirable option for a PALS in order to get these super-expensive patients off of their books. There are a lot of uninformed/misinformed PALS who are at risk of because of how poorly these laws have been written.
So the bottom line is, an "aid in dying" act with an unenforceable "full information" provision probably hurts PALS more than it helps them. To prevent PALS from being short-changed when they are given their care options, we should all be urging our lawmakers to put some teeth into the "full information" parts of these "aid in dying" laws.