California Medical Association Sets Guidelines For Physician Aid In Dying Act
I Maureen Cavanaugh it's Monday, January 25. First in the news now that California has an aid in dying law about to take affect what are the obligations and responsibilities for doctors under the new law? That's what the California medical Association is addressing in a new set of guidelines for doctors who help their terminally ill patients and their lives. Joining me a San Diego physician Dr. Ted Mazur he is this week are for the house of delegates. Why would the CMA publish these guidelines? Is there a lot of confusion within the medical community about the end of life option model? I wouldn't call it confusion. We are trying to lay out both the doctors and the public what this new law is and what the requirements are to participate or not participate from both the physician standpoint and the public standpoint. This is more of a public service that we are providing for an end-of-life care. When a terminally ill patient tells his doctor that they are thinking about ending their life, apparently a whole chain of events begins. What is the doctors initial obligation? The initial obligation is whether or not the doctor wants to participate. There were protections built into the law because some physicians feel they may not want to participate. Once the patient asked the question the physician must make sure that the patient understands and has the capacity to understand asking for a drug to end their life and then there's a process that they have to fill out forms that are made by the state. There needs to be a second consultant who agrees with the original diagnosis and that the patient is terminal and that they have the capacity to make this decision. A series of steps all built together to make sure that nobody is coerced it is not used in property -- properly. And from reading what has been published it seems to me that a lot of this responsibility falls on the doctor shoulders. To make sure that these particular requirements are met. I think a great deal guys, but what we're trying to do by documents such as these and trying to make the language understandable to make sure the doctor knows how to play that role. Make sure the doctor in good faith if he misses a step that he is not prosecuted for missing that step. One argument is is it the role of the doctor? It is the role of the doctor to participate with the patient. The doctor should make take on some responsibility to make the patient understands the process. Do we know, Dr. Mazer, how many doctors are still against this in California and maybe across the country? The latest polls and there's some great information in last week's Journal of American Medical Association, the physicians in the majority are in the support of having this available to patients. The public surveys were about 70% or higher that the public thinks this is something they want. I don't have specific numbers for California, but at the medical Association when we made the decision, we did find it it is a substantial minority of physicians that don't agree. The doctor does not have to bring this up. The doctor has to make sure the patient understands what this process looks like to them and that the patient has responsibilities as well. 48 hours before they wish to take this medication. They need to sign a form saying I've made my decision. Whether that actually plays out remains to be seen. The doctor does have to educate the patient as to why you seeing your another doctor why you feel the patient may need a psychological consult. There may seem -- there seem to be a lot of forms. Part of the protection is as there's not an abuse. It might be used improperly and we fought very hard to make sure there is every protection. The insurance company can't bring it up. The fact that doctors have to fill out forms, it's kind of lousy for us as physicians but it's part of our life these days. There also seems to be a formality when it comes to prescribing the drug. It comes to delivering the prescription to the pharmacy and so forth. Can you explain and white is that exist? I don't want them to get into the weeds as to how that plays out. It's not as simple as a doctor writing a prescription. We got to be more careful. We are talking about lethal medications. We don't want to see Scripps given to the wrong parties. There is a protective way that making sure the position has direct contact with the pharmacy. Dr. you told me in the beginning that these are not in the California medical Association's guidelines they are based on the legislation that came down from the California legislature, but has the legislature been able to give doctors this kind of a line by line recitation of what it is that you need to do in order to comply? It's in the law. If you think it's difficult to read through the 15 pages, try reading through the law. This is a digested law repetition. These are in the regulation and remember laws are passed in than the regulators right the regulations and we have to deal with the regulations. This on-call document is a more simplified way of dealing with what the law says has to be done. To protect the patient from abuse. Does the CMA consider adding to these guidelines, adding more protections for doctors and even the law requires? At this time we are not talking about that thinking about the law that is passed incorporating the concerns of the patients in protecting the physicians. This law has a ten-year sunset. It will go away are have to be modified and repast. It was done through the legislative process, it is much easier to clean up. When does it go into effect? It goes into effect after the close of the special session I was called by the governor last year. That session is still open. It can and tomorrow or as late as November. It's up to the governor to address the issues. I've been speaking with San Diego physician Dr. Ted major speaker for the house of delegates in California.
Dr. Theodore Mazer, a San Diego physician and speaker for the CMA's House of Delegates, said doctors want to be able to come to the CMA to find out how the law impacts their practice and how to communicate about the law with their patients.
"The patients have complete control and that was very important to us in the CMA to make sure that they did have protections against abuse," Mazer said. "They could pull back from it, and the physicians had the option to opt in or out of physician aid in dying."
The California End of Life Option Act will go into effect 90 days after the end of the special legislative session.
“There is a series of steps all built together to make sure nobody is coerced into it,” said Mazer.
“Once a patient asks the question, the doctor has to go through a process of making sure the patient understands what the law is, make sure they meet the requirements of the law, which is to have the capacity to actually understand what they’re doing.”
Patients have to be diagnosed with a terminal disease putting their life expectancy at six months or less. That diagnosis also needs to be confirmed by a second consultant.
Mazer said the process ensures “the patient is protected, and likewise the physician has protections about their participation or non-participation.”