By Kathryn Locatell -- Special To The Bee
Published 2:15 am PST Sunday, March 27, 2005
I have treated hundreds of patients at the end of their lives, listening to their pleas for relief of their suffering, and to their wishes and hopes for a quiet and peaceful death. Despite all the good intentions, too many Californians - contrary to their previously expressed wishes - die in pain and with great suffering. That's why I support passage of AB 654, the California Compassionate Choice Act.
AB 654 is very different from the advanced health-care directives we all should have. The bill would allow California adults of sound mind with fewer than six months to live to ask for and get life-ending medication. Under this bill, two doctors would have to agree on the prognosis and on the patient's capacity to make health care decisions. The patient would have to make written and verbal requests, wait through two "cooling-off" periods and be able to take medication without assistance.
I have heard opponents of this legislation say that the health care industry, and HMOs in particular, will somehow seek to encourage patients to hasten their deaths in order to make more money. The reality is that the medical industry makes far more money foisting unneeded, painful, invasive and futile drugs and treatments on patients than it would by withholding them.
Few terminally ill patients worry that their deaths might be hastened by surrogates' decisions. In my practice, I see far more often that family members and health care providers try to influence the patient to accept life-prolonging treatments rather than to reject them.
This is just what many dying patients fear the most - that they will be judged incompetent and that others will be making decisions for them. Older persons, in particular, are at risk of having decision-making wrested from them. Far too often, the old or dying patient is assumed not to be competent.
The proper and best course to take with any dying patient is to determine whether the patient has decisional capacity; discuss available treatment options; and, finally, ensure that the patient communicates his or her desires for end-of-life care with family members, loved ones and surrogate decision-makers.
As a physician treating terminally ill patients, my goal is to provide the best possible care - the care my patients want - and to ensure that each of them has access to the full spectrum of available treatments. Above all, it is my goal to ensure that each patient and loved one understands the prognosis and has had all treatment options adequately explained and questions answered.
For my competent terminally ill patients, I would prescribe medication to hasten death if I am legally able to do so - if that is their request. Other physicians and I who are willing to prescribe such medications would be able, with AB 654, to treat each patient and family with the courtesy and dignity they have requested and they deserve.
It is the honor of my profession to do nothing less.
About the writer:
Kathryn Locatell, M.D., has served as chief of elder care services in the Sacramento region for Kaiser and as an assistant clinical professor of medicine at the UC Davis Medical Center. Reach her at kllocatell@msn.com.
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