The past few years in this country have seen a grassroots effort to change the dialogue on end of life care. Brittany Maynard became the poster child for choice, for autonomy, something we Americans love. She chose how and when she wanted to die and her choice to end her life in Oregon, where physician assisted death is legal, helped to spur California’s quest for the same. This past friday, California’s assembly and house passed the Right to Die bill. It now sits on Governor Jerry Brown’s desk awaiting his signature — or not.

I have gotten many excited calls from friends over the past year. “They’re talking about physician assisted death on NPR. Turn it on!” I never know what to say to these friends when they call. They assume that I, as a palliative care physician who values dignity and compassionate care at the end of life, would automatically support this proposal. Yet this is only partially correct.

I am ambivalent. As a layperson, I appreciate this added control to my own medical destiny. Yet as a doctor, I am worried.

While my mother is thankfully healthy, one day I will likely be her surrogate decision maker. She has said several times that if she has unremitting suffering from terminal illness, she is counting on me to make sure that she is taken out her misery. It’s always been a bit of a joke, but now it’s a real legal possibility. And I am thankful for that.

Control over one’s destiny is something I value strongly, for myself, for my mother, for my patients. As a doctor practicing both palliative care and ICU medicine, I do my best to provide my patients with as much truthful information as I can, as well as the array of options available before them. I want my patients to choose their own best paths, as opposed to the default life-prolonging treatments that we typically heap on patients at the end of life.

If disease-focused cure is no longer working, my patients often choose to receive palliative or hospice care, which provide expert and personalized care focused on the management of pain and distress. These approaches are as successful as any in medicine at achieving their goals — palliative care medicine has upwards of 90 percent success rate at managing symptoms that accompany the dying process. And for many conditions, patients with life-limiting disease tend to live longer if they choose hospice than if they continue the default approach.

Only rarely, the tools of the palliative care specialists can not bring relief. And it is in these rare cases where palliative sedation — medications which decrease patient awareness — or physician assisted suicide might be considered. (…) Read Full Article Here

Read Full Article