A patient asks for end-of-life medication; what a doctor should do isn’t black-and-white

To the editor: I appreciate The Times considering California’s new end-of-life law in depth, as it will result in important conversations among many patients and their physicians. I would like to clarify my perspective, featured extensively in this article, about whether physicians should prescribe an aid-in-dying medication. (“As California’s End of Life act goes into effect, some doctors question where to draw the line,” June 6)

For some physicians, this is a black-and-white decision, but for most (and I include myself in this group) the decision about whether to prescribe is quite nuanced.

A physician must explore deeply to discover from where the patient’s request comes. Is there inadequately treated pain, isolation or feelings of abandonment? What is the nature of the suffering and might there be solutions, either from within medicine or from other sources, that one might bring to bear? Are there problems in accessing needed treatment? A physician should never prescribe aid-in-dying medication as the remedy for lack to access to medical care.

If, after all this exploration, a patient has intractable suffering at the end of life, I would be willing to follow the law and prescribe the aid-in-dying drug — and I would hope to be at that patient’s bedside when her or she ingests it, providing comfort.

Neil Wenger, MD, Los Angeles

The writer is director of the UCLA Health Ethics Center.

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