Medical leaders at Huntington Hospital in Pasadena voted behind closed doors this week for the facility's hundreds of doctors and affiliated personnel to opt out of California's assisted suicide law, which goes into effect June 9.
If the proposed amendment to the hospital's medical rules is approved by the board of directors this month, Huntington will become one of the largest non-religious medical institutions statewide to turn its back on a law that Gov. Jerry Brown called "a comfort" to anyone "dying in prolonged and excruciating pain."
The End of Life Option Act allows doctors, medical groups and hospitals to opt out of the law's guidelines for assisting the terminally ill achieve a dignified end. Most, if not all, religious hospitals are expected to reject the law.
It's unclear at this point if Huntington is an outlier among secular facilities or representative of a wave of opt-outs to be revealed by month's end. The California Hospital Assn. was unable to provide an estimate for the number of institutions considering a similar move.
However, spokespeople for some of California's biggest medical facilities — including Kaiser Permanente, Sutter Health and UCLA — told me they will comply with the law on an institutional basis, while respecting the right of individual doctors to opt out.
Prior to this week's vote, Huntington's executive committee of department heads circulated its proposed amendment among the facility's doctors for their feedback. They were given until April 23 to make their feelings known.
The amendment received by doctors says that "Huntington Hospital has chosen not to participate in the Act, and therefore no Huntington Hospital employees, independent contractors, or other persons or entities that work at or with Huntington Hospital may participate in activities under the Act while on the premises of Huntington Hospital, or while acting within the scope of any employment or contractual relationship with Huntington Hospital."
However, the amendment says Huntington will permit doctors "to furnish patients with information about the Act and/or to provide referrals to healthcare providers who may participate in activities authorized by the Act outside of Huntington Hospital, in response to patient requests for such information."
Derek Clark, a spokesman for the hospital, declined to go into detail about the executive committee's deliberations or the rationale for opting out of the new law.
"Our hospital respects the rights of patients and their families to make decisions regarding end-of-life care," he said in a statement. "We also respect the rights of independent physicians and pharmacists to decide whether they will participate in the process. While a final decision has not been made, we are currently evaluating whether the inpatient setting is the appropriate location for end-of-life care to be delivered.
"In order to maintain the integrity of our hospital's decision making process, discussions during interim steps are not publicly disclosed," he said. "A final decision on this issue will be made by our board of directors at a later date."
The board's next scheduled meeting is May 26.
The End of Life Option Act, which is modeled on Oregon's Death with Dignity Act, allows physicians to prescribe medication to hasten the death of competent adults who have been diagnosed with terminal illness and have six months or less to live. The patient must be able to self-administer the medication.
For religious hospitals, the new law is as contentious as birth control. Providence Health & Services, which operates six medical centers in Southern California, said it would be opting out because assisted suicide is incompatible with the system's Catholic beliefs.
"We at Providence believe intentionally ending a person's life is not consistent with core principles of the professions of medicine and nursing," said Patricia Aidem, a Providence spokeswoman. "We are committed to providing appropriate support for dying persons and their families through the final stages of life.
"We will not be present if a patient chooses to ingest life-ending drugs, but we will work with the patient and loved ones to discuss the plan of care," she said.
Huntington's thinking is less clear. The amendment shown to doctors offers no reason for opting out of the law. What is clear, however, is that the move, if approved, would have potentially far-reaching consequences for the surrounding community.
The hospital says it has a medical staff of "more than 800 active physicians serving residents of the greater San Gabriel Valley and beyond." Many local doctors with their own practices might be unwilling to jeopardize their access to Huntington by assisting terminally-ill patients under the terms of the law.
"That strikes me as a crossing of the line by the hospital," said Anthony Wright, executive director of the advocacy group Health Access California. "It limits what doctors can do even in their own office."
Although California's law is changing, the controversial nature of assisted suicide hasn't diminished.
"Let's call this for what it really is: It's not death with dignity," state Sen. Bob Huff (R-San Dimas) said after the End of Life Option Act was signed into law in October. "This is state-assisted death, physician-assisted death and relative-assisted death."
Brown views it differently. "The crux of the matter is whether the state of California should continue to make it a crime for a dying person to end his life, no matter how great his pain or suffering," he said upon signing the law.
Many secular hospitals are taking a patient-first position, respecting that some terminally ill people desire this choice.
"Sutter Health is supportive of helping our patients explore all of their end-of-life options, which can include palliative care, home health and hospice, and our Advanced Illness Management program," said Dr. Stephen Lockhart, Sutter's chief medical officer.
"For qualified terminally ill patients, the End of Life Option Act provides an additional choice, and our organization supports an open dialogue with these patients as they make end-of-life decisions," he said.
Insiders at Huntington say many doctors opposed the hospital's end-of-life amendment. However, such opposition wasn't enough to change the executive committee's thinking.
Maybe the committee should hear as well from David Eisen. He and I spoke this week, and he was dismayed to learn that Huntington is on the verge of opting out of the law.
Eisen, 60, lives in Manhattan Beach. But he was a resident of La Canada Flintridge for more than 20 years and Huntington was always his hospital of choice. In July 2007, Eisen's fiancee, Debbie White, was diagnosed with glioblastoma, an incurable brain cancer.
White had surgery at Huntington and was treated there for more than two years, Eisen said, adding that the quality of care was excellent. Her final weeks were spent at home receiving hospice treatment under the supervision of a Huntington oncologist.
"What she expressed while she was still relatively healthy was that she didn't want to be in pain," Eisen recalled. "She didn't want to be in a position where she could no longer take care of herself."
Once the pain grew in intensity and White's life was defined by ever-increasing doses of morphine, the couple pleaded with her doctor for help in putting an end to the suffering.
"The doctor said no," Eisen said. "She said there was nothing she could do." White died in the summer of 2009.
As of next month, most California doctors will no longer have their hands tied.
Amy J. Thoma, Kaiser's director of public advocacy and public affairs, said the health maintenance organization is "working to ensure the best implementation" of the law.
"Each patient wanting to participate in the program will be paired with a coordinator who will then guide them through the process," she said. "If a physician does not wish to participate, he or she may refer the patient to the coordinator, who will connect the patient with a physician who does participate."
That seems reasonable — and a good deal more humane than Huntington's blanket ban on any staffer or affiliate fulfilling patients' end-of-life requests.
Eisen said that if the End of Life Option Act had been around when White was experiencing her ordeal, "she would have been able to choose the point where she could end it, on her terms."
Huntington's stance, he said, "seems inconsistent with what you'd expect from a physician."
David Lazarus' column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5 and followed on Twitter @Davidlaz. Send your tips or feedback to firstname.lastname@example.org.
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