Euthanasia with the use of physicians is supported by a majority of California and Hawaii residents, regardless of their ethnicity - as reliable as an Internet survey can be, that is.

Older people were more likely than younger people to feel it is acceptable for physicians, who obey the Hippocratic oath, to prescribe life-ending drugs for terminally ill patients who request them. Even among people who consider themselves spiritual or religious, about 52 percent supported the practice.

The survey results will be published in the Journal of Palliative Medicine to coincide with the date that California's End of Life Option Act takes effect, which was signed into law Oct. 9, 2015. Physician-assisted death is illegal in Hawaii but the issue of physician-assisted death gained momentum in California after Brittany Maynard, a 29-year-old Californian who was terminally ill, decided to move to Oregon in 2014 to end her life rather than suffer the pain and debilitation caused by brain cancer. 

The online survey, conducted from July through October 2015, asked participants to respond, true or false, to whether they believed it is acceptable to allow a physician to prescribe medication, at the request of a terminally-ill patient, in order to end that person's life. Those taking the survey marked their ethnicities as African American, Latino, white, Native Hawaiian/Pacific Islander or Asian. 

"We wanted a broad question that didn't specify what kind of medication, that didn't say oral pills or self-administered, none of that," said VJ Periyakoil, MD, clinical associate professor of medicine at Stanford. Participants were also asked: "How important is your faith/religion/spirituality to you? (Unimportant, somewhat important, important and very important.)" 

Among the 1,095 responses from California and 819 from Hawaii, the majority -- both in California (72.5 percent) and Hawaii (76.5 percent) -- were supportive of euthanasia, what some advocates call Physician Assisted Death to separate it from lingering stigma in the medical community over euthanasia.

"The act of deliberately hastening death is not supported by most religions. ... Thus it is not surprising that in our study participants who reported faith to be most important to them were least in support of PAD," the study said.

Need for cultural sensitivity

Periyakoil, an expert on end-of-life care and director of the Stanford Palliative Care Education and Training Program, stressed that it's important for physicians in California to prepare for the new law. "Just be upfront," she said. "Tell patients, 'Listen, this is a very hard topic for all of us.'"

In particular, primary care physicians will inevitably be faced with questions from patients, she said.

The study asserted that because of the number of complex provisions in the law -- such as the requirement that medication must be self-administered by a mentally competent patient -- it will actually affect only a tiny fraction of seriously ill patients.

"Only a small sliver of the population will be eligible for the End-of-Life Option Act, and of those eligible, only a portion are likely to utilize this option, and no one ethically opposed would likely do so," the study said. "For example, of the 34,160 Oregonians who died in 2014, only 155 received a lethal prescription and 105 utilized it."