Now that California has legalized physician-assisted suicide, advocacy groups are planning statewide education campaigns so doctors know what to do when patients ask for lethal medication to end their lives.

One of the first stops for doctors new to the practice is a doctor-to-doctor toll-free helpline. It’s staffed by physicians from states where the practice is legal, who have experience writing prescriptions for lethal medication.

“We try to answer any doctor’s phone call within 24 hours,” says David Grube, a retired family doctor in Oregon who accepts calls. “I might answer questions about the dose of medicine, the timing of the giving of the medicine, things to avoid, certain kinds of foods.”

Grube recommends prescribing a specific dose of sleeping pills, along with anti-nausea medication. People usually fall asleep within five minutes after taking the drug, and usually pass away within an hour.

This kind of information will also be shared in training sessions, online, and at hospitals and medical schools throughout the state before and after the law takes effect in 2016. (The precise date is not set; it will take effect 90 days after the end of the ongoing special legislative session.)

“Health care systems should start preparing now for their patients who are going to be requesting, and demanding, information about the End of Life Option Act,” says Kat West, policy director for Compassion & Choices, the advocacy group that led the charge for legalization in California and is spearheading the education campaign.

She says a few health care systems in California have called their counterparts in Oregon, where the practice has been legal since 1997, to find out how they have implemented the law there. For example, Kaiser Permanente in Oregon and Seattle Cancer Care in Washington hired patient advocates specifically to respond to requests for aid-in-dying medication and to guide patients and doctors through the process.

Medically-assisted suicide is also legal in Vermont and Montana. But West says California has some key differences that will influence implementation here.

“The challenge, of course, is California is so big,” West says. But, “in some ways, California is in a better position to start implementing aid-in-dying, because the infrastructure is already good and in place.”

Opponents have vowed to try to block the law from taking effect. A group calling itself Seniors Against Suicide filed paperwork this week to put a referendum before voters in November 2016, asking them to overturn the new law. The group needs to collect 365,880 signatures by January to qualify for the ballot, though it’s unclear if they have enough money to run a statewide campaign.

In Oregon, the law was delayed from taking effect for three years because of a lawsuit filed by the federal government. But West says that was 20 years ago, and is unlikely to happen in California.

Californians Against Assisted Suicide, a coalition of religious groups and disability rights advocates who fought the law through the legislative process, says it has not yet decided whether it will sue to stop the new law from going into effect.

California’s department of public health will be required to collect and store data about who requests the lethal drugs, and who takes them.

  • Bradley Williams

    Your source has done you a disservice. The promoters of assisted suicide have worn
    out their thesaurus attempting to imply that it is legal in Montana. Assisted suicide is a homicide in Montana. Our
    MT Supreme Court ruled that if a doctor is charged with a homicide they might
    have a potential defense based on consent. The Court did not address civil
    liabilities. No one in Montana has immunity from civil or criminal prosecution.
    Does that sound legal to you? Oregon model bills have been rejected by our
    legislature in 2011, 2013 and 2015 because of gaping loopholes that allow
    exploitation of elders and people with disabilities of all ages by predators
    and predatory corporations.

    The loopholes and more work with each other to expand the
    scope of exploitation by predators and predatory corporations.

    By all these OR model laws all family members are not
    required to be contacted, hold that thought.
    A single predatory heir is allowed to steer the sign up and then execute
    the lethal process without a witness.

    A witness is not required to confirm that the dose was so
    called “self administered” (you remember this was one of their lead selling
    points).

    Even as the law provides immunity for all involved and
    demands the falsification of the death certificate (impossible to track trends
    for good public policy) it actually prohibits a public inquiry of any kind
    (remember the family members who were not contacted).

    These loopholes and more are in the OR, WA, and CA’s laws and expand the
    scope of exploitation by predators. However, it serves the
    health insurance corporations very well.

    There is the Oregon Tami Sawyer Thomas Middleton case of
    abuse for assets.

    Oregon and Washington should amend their initiative-sound-bite driven
    dangerous laws. California’s should be
    vetoed.

    Also note how the promoters of assisted suicide cling
    to their verbally engineered polls that claim a majority is in favor. I polled thousands of Montanans one-on-one as
    I served 60 days at fair booths across the state. Once folks knew about the loopholes in all of
    the Oregon model bills, 95% were not for them.
    So much for their verbally engineered polls.

  • Robert Liner, M.D.

    Examination of the majority rulings in Baxter v. Montana makes it clear that Montana Supreme Court found aid in
    dying a medical option protected under existing Montana statutes pertaining to autonomous rights of the
    terminally ill. The Court also decried use of the term “suicide” in this context — as has the American Psychological Association.
    As for anxiety over the potential machinations of unscrupulous family members and the lack of a requirement that “all family members” be contacted, the same concerns could apply to drafting of a will or an advance health care directive. It would be ridiculously burdensome
    as well as wrong-headed to impose such a requirement. Evidence-based medicine should be based on evidence, not
    fear and speculation. The evidence from eighteen years of experience in Oregon is that no credible instances of coercion or other abuse have surfaced. There is no “falsification” of death certificates under the laws protecting aid in dying. The cause of death is recorded with reference to the underlying disease process, as is appropriate. What does Mr. Williams imagine the death certificate states as the cause of death for patients who request and are legally granted withdrawal of life support or whose suffering is abbreviated by palliative sedation? As with aid in dying, the appropriate attribution is the underlying disease. Robert Liner, M.D.

Author

April Dembosky

April Dembosky is the health reporter for The California Report and KQED News. She covers health policy and public health, and has reported extensively on the economics of health care, the roll-out of the Affordable Care Act in California, mental health and end-of-life issues.

Her work is regularly rebroadcast on NPR and has been recognized with awards from the Society for Professional Journalists (for sports reporting), and the Association of Health Care Journalists (for a story about pediatric hospice). Her hour-long radio documentary about home funerals won the Best New Artist award from the Third Coast International Audio Festival in 2009.

April occasionally moonlights on the arts beat, covering music and dance. Her story about the first symphony orchestra at Burning Man won the award for Best Use of Sound from the Public Radio News Directors Inc.

Before joining KQED in 2013, April covered technology and Silicon Valley for The Financial Times, and freelanced for Marketplace and The New York Times. She is a graduate of the University of California at Berkeley Graduate School of Journalism and Smith College.

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