PAS in California: the first 6 months

In a 2016 data report, the California Department of Public Health says that in the first 6 months after California enacted the “End of Life Option Act,” 111 people committed suicide with the help of a doctor’s intentionally lethal prescription, as permitted under the terms of the law.  The time period reviewed was the last 6 months of 2016.

The people in question are understood to all have been terminally ill, as the law intends.  The majority of these 111 were white and college-educated.  The median age was 73.  They had a variety of diseases; a few more than half of the 111 had cancer. 

The report says 258 people asked their doctors about PAS.  Of these, 191 got prescriptions, and 111 took the drugs (orally) and died.  Another 21 did not take the drugs.  What happened to the remaining 59 of the 191 is not known.  The law calls for prescribing physicians to report outcomes after prescription, when known.

In the time period PAS accounted for 6 of every 10,000 deaths in California.  By comparison, the Associated Press reported that the figure for 2016 in Oregon was 37 of every 10,000.

84% had been enrolled in hospice or palliative care, suggesting to me the acceptance of PAS as a standard of care by specialists in palliative care.   Or perhaps the patients decided palliative care had failed them.  Details of the mindsets of the 111 are not part of the report.

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Michael Knower, MD, HMDC
Michael Knower, MD, HMDC
4 years ago

Jon, I have yet to hear assisted suicide described as “standard of care,” but I have heard it described as part of the “continuum of care” for several years now. The folks who have taken advantage of the secobarbital while on our hospice have expressed at the time of admission that they are “interested in ‘Death with Dignity,'” would “like to pursue ‘Death with Dignity,'” or have already secured a prescription. I am not aware of any who have subsequently sought out assisted suicide after being “failed” by hospice.

So far as the mindset is concerned, the leading reasons given for pursuing assisted suicide are variations of “I want to be in control.” Measure 16 was sold to the voters of the state of Oregon as a means for limiting uncontrolled pain. I have never seen uncontrolled pain ,or even more general uncontrolled suffering, rated any higher than #3 in studies done by the Oregon Health Division, Portland State University, and others. Proponents argue for honoring the autonomy and wishes of our patients. It is ironic that the ultimate expression of self-determination is self-annihilation.

You have reason to question the accuracy of the bookkeeping. It seems that every subsequent piece of legislation has touted the success of Oregon’s law and its vaunted safeguards. I have not read the California act. In Oregon, there are no penalties for not reporting. Physicians filing electronic death certificates are required to affirm that the death occurred naturally, and specifically that it had nothing to do with poisoning. Given that this amounts to mandatory falsification of a public document, how reliable is the documentation?

Thanks for your post.

Michael Knower, MD, HMDC, FAAHPM
North Team Physician
St. Charles Hospice
Prineville, OR

Jon Holmlund
Jon Holmlund
4 years ago

Dr. Knower,
Thank you for these comments. One of the things that goads me is my experience a couple of years ago at the inaugural ASCO (American Society of Clinical Oncology) palliative care conference. There was a session at which PAS was discussed. A brave physician from Canada (Ontario or Quebec) rose on the floor of the meeting to oppose PAS, and he met some resistance. So I had the temerity to ask the meeting whether palliative care physicians consider PAS or euthanasia outside of the boundaries of professional standards–and they demurred, in favor of “giving the patients what they want.” The usual objections, from attendees from Oregon, were raised–it’s really about choices, more people inquire than receive prescriptions, and still fewer (they think) follow through.

Now, I am not a palliative care doctor, nor am I really a doctor any more–I work in the biopharma industry, haven’t seen patients for over 20 years, and don’t even maintain an active license to practice. So I’m really more of a freelance moralizer. But I’m appalled.

Organized opposition by physician groups per se seems pretty low-profile. Where are the most concerted stands in the medical community against “MAiD”?