Hospital policy, often governed by Catholic doctrine, is getting in the way of a dying patients’ ability to use medical aid in dying to peacefully end their suffering, as authorized by the California End of Life Option Act. A recent survey published in the Journal of the American Medical Association (JAMA) Internal Medicine confirms that virtually all (70 out of 72 or 97 percent of) religious hospitals in California refuse to allow their doctors to participate in medical aid in dying. Many of these hospitals are Catholic.
Unfortunately, Catholic religious directives dictate that when a patient’s pain is uncontrollable, a doctor must help their patients “appreciate the Christian understanding of redemptive suffering” rather than honor the patient’s request for medical aid in dying. These directives are inconsistent with the beliefs of seven out of 10 Catholics, according to public opinion surveys, including a survey conducted by Lifeway Research online, a Christian-based research company.
The impact of the ethical and religious directives for Catholic health care services issued by the United States Conference of Catholic Bishops goes far beyond preventing patients from using medical aid in dying. These directives also limit a patient’s ability to refuse unwanted medical treatment, and they prohibit family members from removing feeding tubes even if the patient is in a persistent vegetative state.
Unfortunately for terminally ill patients who would like a voice and choice in their end-of-life care, Catholic-governed health care is on the rise in California. CommonSpirit Health, a large system of Catholic hospitals, was just approved for a merger that was finalized in February. With this merger, another 30 hospitals have been added to the already long list of 50-plus Catholic Health Systems and Hospitals that prevent physicians from practicing patient-directed care. The University of California, San Francisco, one of the leading teaching hospitals in America, is in negotiations with Dignity Health, a San Francisco-based Catholic hospital chain, about a potential affiliation.
Fortunately, the JAMA Internal Medicine study confirms that secular hospitals are beginning to recognize the importance of respecting the patient’s voice. Although it has been less than three years since the End of Life Option Act was implemented in June 2016, the majority (52 percent) of secular hospitals have already adopted supportive policies.
Fortunately, the vast majority of people who use medical aid in dying do not die in a hospital; they die at home. So while hospital policy may affect a doctor’s ability to participate in the law, religious doctrine does not have as far reaching an impact on a doctor’s ability to practice medical aid in dying as it has with reproductive medical services. And according to the most recent annual report released by the California Department of Public Health, in 2017 alone, 274 unique doctors prescribed medical aid in dying to 577 dying patients. The 2:1 ratio of patient to doctor demonstrates the practice is successfully being integrated into the standard of medical care, despite attempts by hospitals to block provider participation.
The lawmakers in California sent a clear message when they passed the End of Life Option Act: Dying patients, in consultation with their loved ones and doctors, should be the decision-makers in their end-of-life care. Now it’s time to send that same message to non-supportive California hospitals. If you agree that patients should be able to decide how they die, make your position known to your doctors, hospitals and hospices. And if they do not have a supportive policy and will not change, then take your business elsewhere. We know from experience that when consumers speak with their pocket book, secular hospitals change their policies.
Kim Callinan is CEO of Compassion & Choices, which led the grassroots campaign to pass the California End of Life Option Act and is helping the state implement the law.
Opinion: Catholic doctrine should not dictate Californians’ end-of-life care