Benefield: Some medical providers don’t participate in California’s End of Life Option Act. Here’s why

The End of Life Option Act has been law in California since 2016, but that does not mean every physician or medical group must provide the services and care outlined in the law.

They can opt out.

And scores of providers and physicians in Sonoma County, do, including one of the largest care providers in the county.

Providence, a nonprofit Catholic health system that operates Providence Santa Rosa Memorial, Petaluma Valley and Healdsburg hospitals, does not provide services under the End of Life Option Act.

“(Providence) considers intentionally hastening death to fall outside the scope of legitimate medical practice,” the Providence St. Joseph Health policy reads. “This determination derives from the PSJH mission and values and from the Catholic moral tradition.”

“PSJH prohibits providers and caregivers from encouraging or facilitating provider-hastened death of PSJH patients,” the policy states. “However, providers and caregivers must not actively obstruct eligible patients from discussing, exploring, or pursuing legal avenues to hastening death.”

Providence St. Joseph is the third largest not-for-profit health system in the U.S. In 2021, Providence had 1,685 patients in its home health care program and approximately 1,000 patience in hospice.

But Providence officials say they do not dissuade patients from seeking End of Life Option Act services.

“We don’t keep them from accessing it. They can access it,” said Chris Falley, director of hospice for St. Joseph Health which includes Memorial Hospice, Hospice of Petaluma and North County Hospice.

And Falley said caregivers are forthcoming about a patients’ options, even if they include services that Providence does not provide.

“These conversations have been happening all along as their prognosis is changing, but none of the information is hidden or we don’t say anything,” she said.

But liberal use of the opt-out clause used by Providence and other providers is concerning to some advocates of the End of Life Option Act who worry that patients will be denied or dissuaded from care they are entitled to.

Assembly member Jim Wood, D-Santa Rosa, said the robust protections allowing physicians and providers to opt out of providing end of life medications were key to getting the legislation passed several years ago, especially in the face of opposition from groups like the American Medical Association which calls aid in dying laws “fundamentally inconsistent with the physician’s professional role.”

“It’s difficult,” said Wood, a principal co-author on SB380, which amended California’s End of Life Option Act to reduce the wait time between doctor approvals from 15 days to two starting Jan. 1.

“Especially in the medical community, people are trained to do everything they can to save a person’s life, right? Sometimes it’s a religious challenge, sometimes it’s cultural. It’s really, really tough,” Wood said.

But even the sweeping opposition stances like that of the AMA are decreasing.

The California Medical Association in 2015 ended 30 years of opposition to aid in dying medications, a move that some viewed as critical to the eventual passage of the legislation in the nation’s most populous state.

The key is patients knowing their options and how to access care even if their health care provider does not offer the service, advocates say.

Dr. Gregg VandeKieft, executive medical director of Providence Palliative Practice Group and a leader in creating Providence’s policy on medical aid-in-dying requests, said that a caregiver’s responsibility is to hear and understand a patient’s request.

If policy prevents the request from being fulfilled by that provider, they can support and certainly not stand in the way, of a patient going elsewhere, he said.

And VandeKieft said it’s crucial to understand a patients’ needs and serve them in the way they are asking for, whether that is with palliative and hospice care, or referring them to a physician who will help them with an aid-in-dying prescription. Or both.

“Our approach as an organization is not to try to push an individual one way or another,” he said.

If a patient wants to proceed with a hastened death, Providence will support them, they just won’t actively assist, VandeKieft said.

“We do provide publicly available information on organizations that provide” aid-in-dying services, he said. “It’s a thin margin, but I have never felt prohibited from doing that.”

Pointing to the complexity of the issue, VandeKieft, who is based in Olympia, Washington, where aid in dying has been legal since 2009, said that while professionally he cannot take part in any death hastening prescriptions, he personally supports a patient’s right to choose.

VandeKieft said he knows physicians who voted against the law but now work in support of it in the wake of its passage. And he knows still others who voted for it because they supported patient choice, but do not actively write prescriptions.

“It’s complex and deeply personal,” he said.

Providence, and other providers in Sonoma County, are applauded by at least one aid-in-dying advocate who says the system regularly refers patients to his group that can match them with a participating physician.

“Memorial Hospice is geared up for this,” said Dr. Lonny Shavelson, chair of the American Clinicians Academy on Medical Aid in Dying, which offers a wide array of support including connecting patients with participating doctors. “They are uniquely participatory. It’s not perfect, but it’s probably as good as you are going to get. Kaiser and Memorial are on top of it.”

Further, Shavelson said while he advocates for a robust aid-in-dying support system, he supports the opt-out clause.

“I’m quite for it, the ‘I don’t want to do this,’” he said. “They are within their complete rights to do exactly what they do.”

Where Shavelson has a problem is when providers not only opt out but act as hurdles to patients seeking care.

“They can’t become obstacles by saying no,” he said.

Physicians who work for providers that have opted out can make referrals, connect patients with information, and connect them with operations like Shavelson’s group while stopping short of writing the prescription themselves.

But there are nightmare stories.

He has heard of patients telling doctors they want “a death with dignity” only to have providers ignore the prescription request and offer only palliative care.

“Don’t expect your patients to know all the right words,” he said. “Listen for the language. The patient is not trained.”

But he makes clear: He doesn’t see that happening in Sonoma County.

Referrals come to ACAMAID from Santa Rosa and Sonoma County frequently, Shavelson said.

“We have got Santa Rosa pretty well situated,” he said. “They call us all the time.”

Offering services that work in concert with each other and keeping communication at the fore should be the goal for all end of life care providers, no matter if they support aid in dying medications or not, VandeKieft said.

“I believe the care of the patients to who elect (aid-in-dying medications) should look almost identical” to those that don’t, he said.

You can reach Staff Columnist Kerry Benefield at 707-526-8671 or kerry.benefield@pressdemocrat.com. On Twitter @benefield.