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Stanford physician reflects on aid-in-dying law in practice

As Stanford physician Catherine Sonquist Forest, MD, went through her medical training, she hadn't considered the possibility that she would someday provide aid in dying to her terminally ill patients. But when she was in medical school, she watched as her grandmother (a physician herself) suffered a stroke and aspiration pneumonia and was put on a breathing machine against her wishes. And as Forest became a practicing family medicine physician, she had many patients ask her to help them die more quickly.

Now, following the 2015 passage of California's End of Life Option Act, aid-in-dying is legal. In a recent Vox essay, Forest explains how she's committed to providing the best care possible for her patients, which sometimes includes working with them to advance their death.

She also clarifies several misperceptions in the piece:

It is important to know that most people who request aid-in-dying medication do not use it. Fewer than one in 20 who request it end up ingesting the prescription for compounded medication for aid in dying. While the request must go in at least 16 days before a prescription can be written, it is not filled until within 48 hours of planned ingestion of the lethal medication. Much like the late referrals to hospice, many people do not know they are terminal until it is too late to have alternatives.

Most requesters go on to choose other options that the discussion opens up for them, such as palliative care (relief of symptoms for quality of serious illness or end of life that is neither life-prolonging or life-shortening) and hospice care (just caring, not curing, at end of life). Others simply die before crucial conversations have occurred; many people do not know they are terminal until it is too late to use aid in dying.

And it was her mother, as well as other patients, who have taught her one of the most important benefits of the aid-in-dying law: "To have the option of medical aid in dying among all options provides unimaginable peace of mind and empowerment."

The entire piece is well worth a read.

Previously: Talk about death -- before a health crisis, says Stanford's Philip Pizzo, On life, death and David Bowie: A palliative care physician shares words of wisdom and New tools to improve end-of-life communication available
Photo by Andrew Ruiz

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