California Psychological Association publishes aid-in-dying resource for psychologists


California’s End of Life Option Act indicates important roles for psychologists; WSPA to revise guidelines.

By Hannah Calkins

The Council of Representatives recently reaffirmed APA’s neutral stance on physician aid-in-dying. But in states where the practice is legal, psychologists may be asked to assess terminally ill patients pursuing this option, or to counsel patients and their families about it.

California is one such state. This summer, the California Psychological Association (CPA) released a 15-page documentcontaining information and guidance for psychologists who provide, or are considering providing, services related to the state’s End of Life Option Act (ELOA). The law, which went into effect in June 2016, allows terminally ill adults in California to obtain aid-in-dying drugs from physicians if they meet certain requirements and follow specific procedures.

As with similar laws in other jurisdictions, one of the ELOA’s requirements is that patients requesting aid-in-dying drugs have the capacity to make medical decisions and not be suffering from impaired judgment due to a mental disorder. If there are indications of a mental disorder, the patient must be referred to a psychologist or a psychiatrist for an assessment.

However, the law does not offer details on how these assessments should be conducted, nor does it address related services that psychologists may be asked to provide, such as counseling patients and their families about end-of-life options, said Elizabeth Winkelman, JD, PhD, CPA’s director of professional affairs.

“CPA felt it would be useful to develop a guidance document that addresses ethical and professional practice considerations in this area more broadly, in addition to explaining the requirements of the ELOA,” said Winkelman, who also chaired the work group that authored the document.

She noted that the document is designed to be educational and to encourage a thoughtful, thorough approach to end-of-life options, and is not intended to set mandatory guidelines or a standard of care.

Regardless of psychologists’ personal views on physician aid-in-dying, Winkelman said, it’s helpful for them to understand the issues involved in the practice, since they may be asked about it by patients and their families or by colleagues.

“Psychologists can contribute meaningfully in this area as experts in mental health care, psychosocial and cultural issues and assessment,” she said.

Education and sharing across states

California is one of seven jurisdictions in the United States to authorize physician aid-in-dying, including OregonWashington stateVermont (PDF, 34KB), Colorado (PDF, 632KB) and Washington, D.C. (PDF, 9.67MB) (The seventh, Montana, is unique and technical; it authorized physician aid-in-dying through a judicial decision, and there is no law governing the practice there.) The laws are similar, and all identify the same key roles for psychologists and psychiatrists.

The Washington State Psychological Association (WSPA) produced a document similar to CPA’s (PDF, 155KB) in 2009, the same year that the Washington Death with Dignity Act went into effect, said Alison Ward, PhD, the facilitator of WSPA’s Palliative Care and End of Life Special Interest Group.

This document is currently being revised, and WSPA plans to release an updated version later this year. “We hope to educate psychologists and other mental health professionals on palliative and end of life care, and to provide guidance and support to those who are interested in conducting these evaluations,” Ward said.

Winkelman said that WSPA’s 2009 guidelines were a great resource for CPA’s work group, and likewise, she hopes that CPA’s guidance document will be helpful to others.

“Many of the issues psychologists face will be the same, regardless of the state in which they are practicing,” she said. “CPA hopes this guidance will be useful to psychologists outside of California and to other state psychological associations.”