Guest column: Why physician-assisted dying proposals won’t die |

Guest column: Why physician-assisted dying proposals won’t die

Dr. Matt Wynia
Guest column

For the second year in a row, Colorado legislators have debated a proposal to allow physician assistance in dying.

House Bill 16-1054, the Colorado End of Life Options Act, was voted down in the Senate’s State, Veterans and Military Affairs Committee, 3-2, along party lines earlier this year, with Democrats in favor and Republicans opposed. While the House version of the bill passed out of the House Judiciary Committee — also on a party-line vote — it was pulled from consideration by the full House when it became apparent to the bill’s sponsors that it was not going to pass.

But the sponsors haven’t given up, and it seems likely that Colorado voters will eventually be asked to weigh in on this issue, perhaps through a ballot measure.

Why can’t opponents put the idea of physician-assisted dying on ice once and for all?

One reason is that a fair number of Coloradans support the idea of allowing a physician to write a prescription to help a terminally ill individual end their own life. According to a January poll by Talmey-Drake, 68 percent of Coloradans supported the bill that went before the Legislature this year.

But that level of support didn’t come from nowhere. It’s a symptom of a larger problem — put simply, the American health care system is not yet doing a good enough job addressing the needs of dying patients.

I say this with some trepidation. After all, I’m a doctor. And as an AIDS specialist for many years, I have cared for my share of dying patients.

I also know that things are getting better but not nearly quickly enough.

For example, about 90 percent of Americans say they would prefer to die at home, and more than 80 percent say they’d like to avoid being in an intensive care unit when they are dying. The good news is that recent studies show more of us are dying at home than in the past, but still about one-third of Americans end up dying in a hospital, and 1 in 5 will die in a nursing home.

And almost half of Americans who die in hospitals spend time in an intensive care unit toward the end of their lives.

Either a lot of people are changing their minds at the last moment, or doctors aren’t doing what some of our patients prefer.

I worry it’s the latter. In one older but very large study of patients with living wills, more than a quarter of their doctors didn’t even know about their living wills. In another famous study, even when doctors knew about patients’ end-of-life preferences, they had no effect on medical decision-making. More recent studies show that when doctors talk to patients about their end-of-life care preferences, they can make a difference, but such conversations remain too rare.

Here’s another good-news, bad-news example. Use of hospice care at the end of life is increasing — almost half of Americans now receive hospice care before they die, a dramatic increase over the past decade — but many patients receive hospice care for a week or even less.

This means doctors are referring too many patients to hospice only at the last possible moment.

Yet we now have evidence that care focused on comfort and dignity, rather than focusing on prolonging life at all costs, both improves and actually extends life for some dying patients, especially those with terminal cancer.

Finally, here’s the good-news, bad-news example that’s most concerning to me: In a national survey in March, more than 90 percent of doctors said it’s important to have conversations with patients about end-of-life issues, and 3 of 4 also agreed it’s their responsibility to start these conversations.

But almost half said they are “sometimes” or “frequently” unsure what to say when they have these conversations. And only 14 percent have ever billed Medicare for having such a conversation with a patient — an option that finally became available this year.

As physicians, we need to have these conversations — and when we do, we need to listen and pay attention.

For those who support physician-assisted dying, more honest conversations about end-of-life preferences will be welcome.

For those who oppose physician-assisted dying, having more of these conversations and providing better care at the end of life are the only hope.

Dr. Matt Wynia is director of the University of Colorado’s Center for Bioethics and Humanities, located on the Anschutz Medical Campus in Aurora. On Thursday from 5 to 7 p.m., he will participate in a public conversation, along with Ira Bedzow of New York Medical College and Sean Jeung, a board-certified chaplain at the Calaway Young Cancer Center, about Colorado’s Terminally Ill Individuals End-of-Life Decisions Act at the Aspen Jewish Community Center at 435 W. Main St. in Aspen.