California Hospitals and Lawmakers Clash Over Aid-in-Dying Drugs

Approximately two-thirds of California hospitals restrict physicians’ ability to prescribe aid-in-dying medications, despite a law granting patients with terminal illnesses access to drugs that hasten death. This presents challenges for patients who want to obtain these medications, according to a survey published in JAMA Internal Medicine.

California’s End of Life Option Act (EOLOA) was implemented in June 2016; It allowed adults with terminal illnesses to obtain and self-administer aid-in-dying drugs, but did not require that clinicians or health systems participate.

To examine the prevalence of hospitals and providers opting out of this practice, researchers surveyed 270 California hospitals between September 2017 and March 2018. Eighty-seven percent of hospitals (n=235) had a formal policy that addressed EOLOA.

Of these, 39 percent (n=106) permitted doctors to write prescriptions under EOLOA. However, 61 percent (n=164) forbade physicians from writing prescriptions for aid-in-dying medications. The authors also found that hospitals permitting EOLOA prescriptions were less likely to be religiously affiliated, more likely to be nonprofit, and more likely to offer palliative care, compared with hospitals that forbid this type of prescribing.

“We were surprised by the results,” lead author Cindy Cain, PhD, told Reuters. “A larger number of hospitals were opting out than we thought would.”

Given the unexpectedly high number of hospitals and clinicians choosing not to prescribe aid-in-dying drugs, Dr. Cain suggested that patients in California discuss these and other end-of-life issues earlier with their health-care providers. “Through those conversations, [EOLOA] can come up and then patients can get a sense of what their doctor is willing to do,” she said. “If the doctor is not willing to prescribe, then he can help figure out where the patient can go.”

Source: Reuters, April 8, 2019; Cain CL, Koenig BA, Starks H, et al. Hospital responses to the End of Life Option Act: implementation of aid in dying in California. JAMA Intern Med. 2019 April 8. [Epub ahead of print]

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