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Am J Public Health. 2017 Jun;107(6):883-888. doi: 10.2105/AJPH.2017.303755. Epub 2017 Apr 20.

How California Prepared for Implementation of Physician-Assisted Death: A Primer.

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Laura A. Petrillo is with the Division of Geriatrics, University of California, San Francisco (UCSF), and San Francisco Veterans Affairs. Elizabeth Dzeng is with the Division of Hospital Medicine, UCSF, and UCSF Bioethics. Krista L. Harrison is with the Division of Geriatrics, UCSF. Lindsay Forbes and Barbara A. Koenig are with the Institute for Health and Aging, UCSF, and UCSF Bioethics. Benjamin Scribner is with the School of Nursing, UCSF.


Physician-assisted death is now legal in California, and similar laws are being considered in many other states. The California law includes safeguards, yet health care providers will face practical and ethical issues while implementing physician-assisted death that are not addressed by the law. To help providers and health care facilities in California prepare to provide optimal care to patients who inquire about physician-assisted death, we brought together experts from California, Oregon, and Washington. We convened a conference of 112 stakeholders in December 2015, and herein present their recommendations. Themes of recommendations regarding implementation include (1) institutions should develop and revise physician-assisted death policies; (2) legal physician-assisted death will have implications for California's culturally and socioeconomically diverse population, and for patients from vulnerable groups; (3) conscientious objection and moral distress for health care providers must be considered; and (4) palliative care is essential to the response to the law. The expert conference participants' insights are a valuable guide, both for providers and health care facilities in California planning or revising their response, and for other jurisdictions where physician-assisted death laws are being considered or implemented.

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