Will Aid in Dying become Assisted Suicide?
by Timothy Gieseke MD, CMD
Former Chair of Education at CALTCM

As a senior clinician working full time in the LTC setting, I am fully committed to an interprofessional approach that provides high value care to our vulnerable patients.  I am pleased that the Coalition for Compassionate Care of California recently updated the CARE Recommendations (Compassion and Respect at the End of Life) for SNFs.  I welcome their efforts to help my teams provide optimal care for those with serious illness.  Like Atul Gawande in his book, Being Mortal, walking with our patients, families, and colleagues during these troubling times has value not only for them, but also for us as caregivers.  To a large extent, palliative care advances have occurred as we learn from situations and strive to do better.  I realize there are moments in the care of some patients where patients are overly burdened with unrelieved suffering and the future looks grim.  However, with the extra layer of care that palliative care offers, and with time, sometimes unexpectedly, good things happen.

In our state and throughout our country, vocal advocates for choice are encouraging legislative action to permit limited physician assisted dying similar to what has been permissible in Oregon and more recently in 4 other states.  In California this legislation has been reintroduced August 17 as AB X2-15

I am concerned that patients and families may choose this option and miss some of the potential good that occurs with the help of good palliative care.  I’m also concerned that those offered this option may be expanded.  A recent article in the Washington Post cites a published article in the BMJ documenting the Belgium practice that permits lethal injections of thiopental for patients with “refractory” mental illness.  The article ends noting that the problem with the “slippery slope” is that you usually don’t know when you’re on it.

It’s my hope that our legislature will use great caution as they hear testimony about the potential benefits of aid in dying.  The potential unintended consequences are real and potentially serious. 

Our efforts to improve end of life care in our SNFs are worth focused attention.  At CALTCM, we have challenged the LTC community to submit Best Practice Implementation plans for next year’s annual meeting with monetary prizes for the winners.  Applying some of the CARE Recommendations may be a worthy project.