by Chris Fruitrich, Volunteer Storyteller / Client Advisor
Often when people are ready to die, it’s hard to find a doctor.
Though that may appear unexpected and contradictory, it is sorrowful for many dying patients. Increasingly, people with terminal conditions are interested in the option of medical-aid-in-dying (MAiD) – taking a doctor-prescribed lethal medication to die with peace and autonomy.
Unfortunately, too few doctors in Washington State are willing or able to write those prescriptions.
The scarcity of physicians continues to challenge and generate angst in the death with dignity community, which helped Washington’s law get passed more than 13 years ago.
More than 20,000 physicians provide direct patient care in the state, yet patients in 70% of death-with-dignity cases could not rely on their own doctors to prescribe their medical-aid-in-dying medication.
Doctors have many reasons for opting out of MAiD cases.
Physicians working in religious health care systems and hospice organizations are forbidden by contract from helping death with dignity patients, as are physicians working for the federal government.
The process of patient meetings and mandated state paperwork is very time-consuming.
Some don’t know about or understand the Death with Dignity Law and how it works.
Other physicians feel that the original Hippocratic Oath would be violated, or openly working with MAiD patients could violate federal HIPAA rules.
Dr. Bob Wood is a longtime Seattle physician, former head of the HIV/AIDS Program in King County, and supporter of the right for terminal patients to hasten their own deaths. As an End of Life Washington volunteer, Dr. Wood is frequently tasked with finding one or two supportive doctors when a patient wants to use Washington’s law, but their doctors refuse to help.
“Doctors are often overextended,” says Dr. Bob Wood, “Then the MAiD work becomes one more burden for them.”
Dr. Roy Graves, a retired emergency room physician, often helps MAiD patients and is open about why some can’t help. “Some doctors are just trying to make a living,” Graves says. “In primary care, it’s challenging just to keep the lights on.”
Dr. Carol Parrot is a retired anesthesiologist who maintained her licenses to help with MAiD cases. Over the past ten years, she has aided hundreds of patients. She has mixed feelings about physicians who opt out.
“Between the meetings and phone calls and writing the prescription and getting them to the pharmacy plus taking calls from family members and working with volunteers, we can spend between 3 and 10 hours per patient,” Parrot says.
She goes on to say, however, that sometimes arguments against participating ring a bit hollow. She asks, “how does this compromise HIPAA? And for those who don’t understand the law, are they uninterested in learning it? Or do they think it is too complicated or what? They can easily get information from the state or End of Life Washington.”
Parrot and Graves agree that the time commitment can become particularly burdensome. Volunteer doctors sometimes search through volumes of records to confirm a patient’s eligibility for the law. “This is not something a doctor can simply integrate into an office visit,” Parrot says.
So, what can be done?
Parrot says the way forward may not be easy. Education – at every level – is a key element in recruiting more doctors.
“I actually think it needs to come from the hospitals and residencies,” Parrot says. “I don’t think this is a quick fix. It needs to be part of a curriculum so [medical students] know this is a different branch of medicine. We also need to approach hospitals and see if they can add MAiD to physician medical continuing education.”
Medical Providers
Interested in more information about strengthening and expanding access to aid-in-dying across Washington?
Reach out to providers@endoflifewa.org for information on how to get involved.