Proposition 161

Without entering the people vs. pets debate regarding the Death With Dignity Initiative (Proposition 161), a response to Dr. Melvin Kirschner’s (co-chairman of the Los Angeles County Medical Assn. Committee on Biomedical Ethics) letter attacking the initiative (Aug. 21) is appropriate.

Kirschner addresses few specifics, but generalizes about the following:

1. Terminally ill, i.e., six months or less to live, is a clinical judgment that most doctors can make, and if in a particular case they cannot, they do not.

2. Patient must be of sound mind, i.e., competent. Competency evaluations are made daily when doctors obtain legally required “informed consent” for all medical procedures. Psychiatric consultation is not required by statute or case law if an adult, competent patient decides to forgo a respirator, dialysis, or other life-prolonging treatment.

3. No requirement for witnesses. Witnesses are required in signing the voluntary directive to physicians under Prop. 161. The time and place of death shall be “in my sole discretion” is provided in the directive. To require witnesses at the time of death would be a clear violation of one’s constitutional right to privacy.

4. No cooling-off period (whatever that means). The law requires that the request be “an enduring” one, whereas no such requirement exists for removal of life support systems. Physician assistance in dying is a medical procedure; therefore, informed consent requires a physician to carefully evaluate the legitimacy of the request and to discuss alternatives with the patient.

5. Patient’s name not reported. Again, this would be a violation of one’s right to privacy.

Kirschner refers twice to the patient receiving “the lethal injection,” a term not mentioned in Prop. 161. The directive merely states “the manner of my death shall be determined jointly by my attending physician and myself.” Prop. 161 is totally voluntary for both patient and physician.

GRIFFITH D. THOMAS MD, JD, Member, Joint L.A. County Bar/Medical Assn. Committee on Biomedical Ethics, Sherman Oaks