Physician-Assisted Dying in California -- First 6 Months

Roxanne Nelson, BSN, RN

June 30, 2017

Data from California, the fifth state to legalize physician-assisted dying,  has now been collected for the first 6 months after the law came into effect, covering the period from June to December 2016.

Under the new law, a total of 111 terminally ill individuals ended their lives using lethal prescriptions during the first 6 months of the law's implementation.

More than 250 people started the process known as  the "end-of-life option process," which requires that the patient make two verbal requests for aid-in-dying drugs, according to a report in the Washington Post.  Of this group, 191 patients proceeded with the process and received prescriptions written by 173 different physicians. Twenty-one patients died of natural causes, and 111 used the prescription to end their own lives; there is no information on what happened to the remaining 59 individuals who received prescriptions.

Most patients (n = 65) had cancer, which is in line with statistics from other states that allow physician-assisted dying. The next largest group (n = 20) had neuromuscular disorders; smaller numbers reported cardiovascular or pulmonary disorders or unspecified conditions.

Also similar to other states were the characteristics of the patients — they were primarily white, college-educated seniors who were receiving hospice or palliative care. Within this group, there were only 6 Asians, 3 blacks, and 3 Hispanics, and nearly all had some type of healthcare coverage.

The bill allowing physician-assisted dying was signed in California by  Governor Jerry Brown on October 5, 2015. At the time, he  stated that "I do not know what I would do if I were dying in prolonged and excruciating pain."

"I am certain, however, that it would be a comfort to be able to consider the options afforded in this bill," he said. "And I wouldn't deny that right to others."

Concerns in California

The California law is modeled after landmark legislation in Oregon, the first US state to allow physician-assisted dying, which passed its law 2 decades ago. It allows a physician to prescribe a lethal drug to a terminally ill patient — defined as someone with less than 6 months to live — who requests it

However, the situation is somewhat different in California. As the most populous state to legalize this practice, the move has dramatically altered the prevailing paradigm, observers said when the law was passed.

With 39 million people living in California, more than 14% of the US population suddenly was given access to this option. California is also far more diverse than any of the other states.

One potential issue was that vulnerable populations, including women, the elderly, and the uninsured,  could become the primary recipients of physician-assisted dying and that there would be the proverbial slippery slope of social inequality in end-of-life decisions.

However, that has not been the case with any of the states where the practice is legal, and early data from California appear to be following that trend.

In fact, in a comparison of California (June to December 2016) with Oregon (January to December 2016), demographics are surprisingly similar, despite the increased diversity of California:

  • In California, 59% had cancer compared to 79% in Oregon;

  • 45% in California were male, and 54% in Oregon;

  • In California, 90% who died were white, 3% were Latino, and 5% were Asian, whereas in Oregon, 96% were white, 1.5% were Latino, and 1.5% were Asian;

  • 57% had Medicare, Medicaid, or another type of government insurance; 31% had private insurance and 4% were uninsured in California vs 70% with Medicare, Medicaid, or another type of government insurance; 30% with private insurance and under 1% without insurance in Oregon; and

  • In California, 58% who died had a bachelor's degree or higher, and fewer than 1% were uninsured.

One difference, however, was the death rate related to physician-assisted dying. It was 6 per 10,000 total deaths in California but much higher in Oregon at 37 per 10,000 total deaths.

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