One doctor wants to consult physicians, patients on California’s aid-in-dying law

Lonny Shavelson, MD, an emergency room physician and journalist, has experience in areas of the healthcare field many haven’t seen. As California’s new aid-in-dying law takes effect, Shavelson will operate as a consultant to physicians and terminally ill patients who have questions about how it works, reports Kaiser Health News.

“This is really an amazing opportunity to be part of establishing policy and initiating something in medicine," Shavelson said. "This is a major change … [that] very, very few people know anything about and how to do it.”

Shavelson wrote the 1995 book, “A Chosen Death,” which followed five terminally ill people over two years as they decide whether or not to amass drugs on their own and end their lives. The passing of California’s End of Life Option Act gives terminally ill adults with six months to live the right to request lethal medication to end their lives, sparked in interest further in the topic.

This spring, he announced his practice will focus on consulting not only with physicians whose patients request aid-in-dying, but also with patients themselves, offering care to those patients who choose him as their “attending end-of-life physician.”

“If somebody calls me and says, ‘I want to take the medication, my first question is, Why?" Shavelson said. "Let me talk to you about all the various alternatives and all the ways that we can think about this.'”

One of the concerns Shavelson has is that patients may seek aid-in-dying because they are in pain. He recommends all his patients to be enrolled in hospice care first.

“This can only work when you’re sure that the patients have been given the best end-of-life care, which to me is most guaranteed by being a part of hospice or at least having a good palliative care physician," he said. "Then this is a rational decision. If you’re doing it otherwise, it’s because of lack of good care.”

California is the fifth state to legalize aid-in-dying, joining Oregon, Washington, Vermont and Montana. Even with the passing of the bill in Oregon in 2014, only 155 lethal prescriptions were written and 105 people ultimately took the medicine and died.

The standards of the California law include:

• Two doctors must agree that a patient has six months or less to live.
• The patient must be mentally competent.
• One of the meetings between the patient and his or her doctor must be private, to ensure the patient is acting independently.
• Patients must be able to swallow the medication themselves and must affirm in writing, within the 48 hours before taking the medication, that they will do so.

Shavelson says he has been surprised by some of the reactions by doctors to the law, saying that many physicians are “queasy” about the law and unwilling to prescribe the lethal medication to the patient—even when they think this law may be the right thing to do in some circumstances.

“My response to that is as health care providers, you might have been uncomfortable the first time you drew blood. You might have been uncomfortable the first time you took out somebody’s gall bladder,” he said. “If it’s a medical procedure you believe in and you believe it’s the patient’s right, then it’s your obligation to learn how to do it—and do it correctly.”

“It’s important … that we’re moving forward,” he said. “It’s crucial that we do that because this is part of the rights of patient care to have a certain level of autonomy in how they die. I’m just one of those docs who sees dying as a process, and [the] method of death is less important than making sure it’s a good death.”