While the hospital Emergency Department may not always be as intense and dramatic as it is depicted on TV, there is palpable excitement and tension when critically ill patients arrive in the resuscitation area. And, certainly great satisfaction when the team is able to stabilize them.
Having been an emergency physician for nearly 30 years, there are times when heroic resuscitation efforts may be inappropriate. From early in my career, I have wondered if a “full-court press” with a terminally ill patient or one with end-stage dementia is what the patient and family desired.
As chief medical officer of Community Medical Centers (CMC), this topic was intensely discussed among providers across our system as California became the fifth state in the U.S. to legalize aid-in-dying (AID) with the recently enacted End of Life Option Act.
While this law is clear that AID is meant to occur at home and not in the hospital, CMC respects the right of our patients and providers to make choices based on their beliefs.
For those unfamiliar, the End of Life Option Act permits a series of steps for terminally ill patients to take that ultimately allows physicians to prescribe a medication that leads to death.
Patients must be able to administer the medication themselves. We know from our neighboring states of Oregon and Washington with similar laws, a small number of people complete all of the steps. In fact, in the almost two decades since Oregon past an AID law, 1,500 AID drugs were prescribed to patients, but only 63% of them were ingested.
One likely reason for this gap is that palliative and hospice care can successfully treat the pain, stress and depression patients often associate with end of life.
I highly recommend Dr. Atul Gawande’s book “Being Mortal,” which recounts his medical education and experiences in the context of his physician father dying from brain cancer.
There haven’t been many studies published over the last 20 years, but we do find common themes in research that contribute to successful dying, such as: dignity, pain-free status, quality of life, family, emotional well-being, and religiosity and spirituality.
The key is identifying and understanding what a good death means for you and your loved ones. The only way to know is to talk about it. I urge you to ask and answer the hard questions.
What activities do you value most? Family dinners, reading a book, watching TV or visiting with friends? If you were unable to do this, would you still want aggressive, curative care? What intensity of care would you want if you were no longer able to make decisions?
If you haven’t done so, complete an Advance Directive. This is a legal form that allows you to spell out your decisions about end-of- life care ahead of time. It will help document your wishes or those of your loved one for family, friends and healthcare professionals to avoid confusion later on. Completing this task could be the most loving act a family could do for each other.
While the End of Life Option Act is controversial, it has pushed the “planning for a good death” discussion forward – and that’s a good thing. In an article published in The Sacramento Bee on Aug. 15, I read about a 94-year-old gentleman who worked in insurance, was a private pilot and former Marine. He also was terminally ill and chose to end his life.
His son was quoted upon his passing, “It was very peaceful. He was used to running his own show, but his body was betraying him. The law happened at the right time for us.”
As I write this, pairing the words “successful” and “dying” still seems strange – and yet, very important. It sounds like this is exactly what this father and son achieved. Whether you’re in favor of the End of Life Option Act or not, the real value is the discussion that is happening around this new law.
I’ve seen the anguish a family goes through when they are unsure what to do for their family member. Please fill out an Advanced Directive that helps detail final wishes and leaves your family with peace of mind when the time comes.
Tom Utecht, M.D, is senior vice president and chief medical and quality officer for Community Medical Centers.