End-of-Life Care

St. Joseph Health physicians and staff know that this is an overwhelming and difficult time for you and your family. You don’t have to do this alone. We’re here to answer questions, provide support and help you and your family. Providing compassionate hospice and palliative care for people nearing the end of their lives is one of the hallmarks of St. Joseph Health’s care.

The end-of-life process is unique to each person. We encourage you to read the information on the pages provided to understand this process and find out more about how we can support you.

It’s important that family caregivers pay attention to their own needs while being there for their loved ones. Get plenty of rest, eat nutritious food and exercise. Headaches, nausea, heartburn or shortness of breath can be symptoms of stress and fatigue.

END OF LIFE OPTION ACT

The law will give terminally ill adults in California the option to end their lives by swallowing lethal doses of physician-prescribed drugs. For a patient to receive the drug, two doctors must confirm the patient’s prognosis of six months or less to live and determine that the patient is mentally competent to make informed health care decisions. The patient must then make two oral requests 15 days apart, and one written request, to a physician for assisted death, with witnesses to all requests. The new legislation allows for organizations and physicians to ‘opt-out’ of dispensing end-of-life drugs.

St. Joseph Health has “opted-out” of the provisions of California’s new end-of-life law and will not participate in the aid in dying practice on our premises, as allowed by the legislation. This means dispensing end-of-life medications will not take place at St. Joseph Health. We believe physicians have an obligation to openly discuss patient’s concerns, unmet needs, feelings and desires about the dying process. It’s important to learn the meaning behind the patient’s question and attempting to respond to a patient’s concern can be a potent, therapeutic intervention.

In most cases, people wishing to use this option would do so in a home or other setting, and many hospitals in states where physician-assisted suicide is legal have also decided not to participate on their premises. Most patients who initially consider obtaining a lethal dose of medication do not persist with their requests when they feel their concerns are effectively addressed.

End of Life Care FAQs

Can patients talk with their physicians about assisted suicide?

We believe all physicians have a responsibility to discuss end-of-life care with their patients who may be facing choices on their care. We are committed to providing the best care to every person at every stage of life.

We respect the rights of patients and their care team to discuss and explore all treatment options and believe those conversations are important and confidential. As part of a discussion, patient requests for self-administered life-ending medication may occur, but our providers do not participate in any way in assisted suicide.

We provide all other requested end-of-life and palliative care and other services to patients and families.

Do your providers write or fill lethal prescriptions?

No, while we respect the rights of patients and their care team to discuss and explore all treatment options and believe those conversations are important and confidential, our providers do not participate in any way in assisted suicide.

Will patients’ advance directive or POLST documentation be respected?

Yes. We have long believed that everyone deserves the best possible care at every stage of life, particularly in the final years. That’s why we want every American to have the opportunity to plan in advance - in consultation with their physicians - for the type of care they wish to receive through the end of life. Advance directives and POLST documentation for all patients are respected

What does our St. Joseph Health Mission and Values say about physician assisted suicide or “aid in dying?

Practicing within the context of St. Joseph Health (“SJH”) core values of Dignity, Excellence, Service and Justice ensures the provision of respect for each person, accountability, commitment to quality, opportunities to serve each other and a sense of community among all persons. SJH provides end-of-life care that takes care of the physical, emotional, social and spiritual needs of the patient and his or her family. The end-of-life care SJH provides is grounded in the values of respecting the sacredness of life, providing compassionate care to dying and vulnerable persons, and respecting the integrity of health care providers. SJH believes that compassionate, end-of-life care should neither prolong nor hasten the natural dying process.

We are committed to providing full and appropriate support for dying persons and their families through the final stages of life including:

  1. Providing and supporting patient use of advance directives.
  2. Offering palliative care, hospice and other supportive care to patients and their families.
  3. Providing effective pain and symptom management.
  4. Offering a full range of social, spiritual, and pastoral care support services.

What is allowed under the End of Life Option Act in California?

The law will give terminally ill adults in California the option to end their lives by swallowing lethal doses of physician-prescribed drugs. For a patient to receive the drug, two doctors must confirm the patient’s prognosis of six months or less to live and determine that the patient is mentally competent to make informed health care decisions. The patient must then make two oral requests 15 days apart, and one written request, to a physician for assisted death, with witnesses to all requests.

Patients must be able to self-administer the drugs. Under this law, it is a felony to coerce a patient into making a request or to forge such a request. A request can only come from the patient and cannot be made on the patient’s behalf through any means, including power of attorney, advance health care directive, conservator, health care agent, surrogate or any other legally recognized health care decision maker.

Will SJH physicians write or fill lethal prescriptions on SJH premises?

We encourage patients and their care team to discuss and explore all treatment options and we believe those conversations are important and confidential. Our providers will not participate in assisted suicide if they are working on "SJH time" or on SJH premises, which includes within our medical foundation or in our hospitals under a contractual agreement (i.e., anesthesia, radiology, pathology).

A physician who has privileges at one of our hospitals but chooses to be a "prescribing physician" on "non-SJH time" and in their own office space at another medical office building (not SJH premises) can do so because we have no authority/responsibility with them in that separate context.

When will this law go into effect?

It was recently announced that the law will go into effect on June 9.

What palliative and hospice care does St. Joseph Health offer?

Each of our ministries offers strong programs in the care of the dying. These programs are called palliative care and hospice. Palliative care is for anyone with a serious illness. You can have it at any age and any stage of an illness, and you can have it along with curative treatment. It is not dependent on prognosis.

At St. Joseph Health, we believe in treating the whole person - body, mind and spirit. That means tending not just to an individual’s physical condition, but also to their emotional and spiritual needs. Our palliative caregivers provide compassionate care while helping patients manage symptoms associated with chronic or life-threatening illness. The goal is to improve quality of life for both the patient and the family.

Hospice is an important Medicare benefit that provides palliative care for terminally ill patients who may have only months to live. People who receive hospice are also no longer receiving curative treatment for their underlying disease.

At our ministries, palliative care is provided by a specially-trained team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment. Palliative care treats people suffering from serious and chronic illnesses such as cancer, cardiac disease such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), kidney failure, Alzheimer’s, Parkinson’s, Amyotrophic Lateral Sclerosis (ALS) and many more.

Palliative care focuses on symptoms such as pain, shortness of breath, fatigue, constipation, nausea, loss of appetite, difficulty sleeping and depression. It also helps a person gain the strength to carry on with daily life. It improves the ability to tolerate medical treatments. And it helps patients have more control over care by improving their understanding of their choices for treatment.

Are health care systems allowed to prohibit their employees from participating in “aid in dying” on their premises?

Yes. Section 443.15 of the End of Life Options Act states the following: Subject to subdivision (b), notwithstanding any other law, a health care provider may prohibit its employees, independent contractors, or other persons or entities, including other health care providers, from participating in activities under this part while on premises owned or under the management or direct control of that prohibiting health care provider or while acting within the course and scope of any employment by, or contract with, the prohibiting health care provider.

Who monitors and enforces this law?

The California Public Health Department is required to review a sample of records annually and adopt regulations establishing reporting requirements for physicians and pharmacists. The reporting requirements will be designed to collect information about how this law is used while protecting the privacy of patients and their families and medical providers.

Can the patient change his or her mind?

Yes, a patient can rescind a request at any time and in any manner. The physician also will offer the patient an opportunity to rescind his or her request at the end of the 15-day waiting period following the patient’s initial oral request to participate.