SCOTT SIMON, HOST:
Californians who are terminally ill can now receive a prescription from their doctor for drugs that will end their life. The End Of Life Option Act passed last year went into effect this week. It allows people that two doctors have said have six months or less to live to receive drugs to end their lives as long as they're found to be mentally competent. The person receiving the drug must give it to themselves.
Lonny Shavelson is a physician and author who's been teaching doctors around the state. He's also started a practice devoted to people who want assistance to end their lives. Dr. Shavelson joins us now from Berkeley. Thanks very much for being with us.
LONNY SHAVELSON: It's my pleasure. Thanks for having me.
SIMON: What - and what kind of questions are doctors bringing to you?
SHAVELSON: Well, you know, in general, anytime there's anything new in medicine, there's kind of a level of discomfort with it and certainly when it has to do with dying, which is something that we've tended to be a bit uncomfortable with all of the time.
This is something so new for doctors here that they're all sort of expressing what I call the queasy factor where they will say something like, you know, I'm all for the patient's right to do this, but it makes me feel uncomfortable. I've never done anything to hasten somebody's death. I've always tried to delay it
SIMON: And what do you say?
SHAVELSON: Well, very simply - is that these are people who are dying. It's not that they have a choice of not dying. They're - they have to be terminal in order to even be speaking to the doctor about getting an end-of-life medication, and in that case, it's something that we actually need to be more comfortable with dying. The most significant part of this law is that it opens up a conversation.
When a patient says, you know, Doc, I'd really like to have a medication to end my life now, the first question should be why. And that should open up not a conversation about how to get the medication or what the medication is but, what are you needing as you're dying? What's bothering you, or what are your worries, more than anything else? And what can we do to alleviate those things that make you so frightened of death? How do we alleviate it without giving you this medication?
And what we've found in the other states that are already doing this - already in Washington, Vermont and Montana - is that once you open that conversation, most of the time, and in fact the vast majority of the time, the patients don't need the medication. They just need the conversation.
SIMON: Depression would be understandable and is common among people who are terminally ill, isn't it?
SHAVELSON: Yes, that's right.
SIMON: And would you be concerned about doctors that might write a prescription for this medication rather than think of therapy?
SHAVELSON: Well, you know, sadness certainly and some forms of depression are common at the end of life, and the way the law is written says that if we're at all concerned that the depression is affecting the patient's ability to make a reasonable judgment, to have capacity to make medical decisions, if there's any suggestion that that is true, then we have to get a mental health consult from a psychiatrist and/or a psychologist.
So if there's the question of depression, we need to evaluate that further. In general, though, I'd have to say that the sadness at the end of life is not that difficult to distinguish from severe depression, especially, you know, if a patient has a history of lifelong depression.
SIMON: Can you write these prescriptions, Dr. Shavelson?
SIMON: Can almost any doctor write them?
SHAVELSON: Yes, any doctor can write the prescription, but the patient has to select who is the doctor who is at the end of life, and ideally they should be working through the aspects of this law and all of the aspects of the end of their life with the doctor that usually takes care of them.
SIMON: With respect, you're, I gather, an emergency room physician by training, right?
SIMON: Well, with respect then, would you have the experience to make those judgments that doctors who are practiced oncologists, for example, might have other experience that might be more pertinent?
SHAVELSON: Yeah. You know, I've been dealing with people who were dying for many, many years, and I've been very involved in this question then for more than 20 years now as an advocate for the - what's now called the End Of Life Option Act. And I think general physicians have training, and as long as they're really conscientious about talking to patients and their needs at the end of life and using consultants - I'm going to be working with hospice physicians, palliative care physicians, mental health consultants - and as long as we're working with consultants that can fill in the blanks in our hard-core knowledge, the major job that we have is a really good conversation with the patient to make sure that they understand and we understand what their needs are and that it's appropriate. Mostly, we really work to make sure that they have the best palliative end-of-life care that they possibly can mostly through hospice.
SIMON: Dr. Lonny Shavelson in Berkley, thanks so much for being with us.
SHAVELSON: Thank you for having me.
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