A consultation with Dr. Shavelson or Dr. Spangler is commonly initiated when a patient who has less than six months to live is considering all possible options for their death, including physician aid in dying. This consultation can be initiated by the patient or, with the patient’s permission, by the doctor or a family member. The most common first contact is by email (info@BayAreaEndOfLifeOptions.Com) or telephone with our nurse manager, Thalia DeWolf, R.N. She will send you (email, fax or snail mail) a short Patient Intake Form.
Once we have your basic information on a Patient Intake Form, Dr. Shavelson or Dr. Spangler will contact you by phone to consider a “first verbal request” for aid-in-dying.
There is no charge for this initial contact and evaluation by Dr. Shavelson or Dr. Spangler. There is also no charge for our doctors to talk with the patient’s doctors if they are in need of information about the End of Life Option Act.
Please note that Dr. Shavelson and Dr. Spangler will encourage you and help you not only to continue care with your regular physicians, but to make every attempt to have your own doctors talk with you and evaluate all of your end-of-life needs and choices.
If the initial contact shows that it is appropriate to continue, Dr. Shavelson or Dr. Spangler will review your medical records and then arrange a first-visit home evaluation. This consists of a home visit with the patient (with family or caregivers present, if desired). The doctor will review all the relevant medical information, examine the patient, and discuss at length all potential options available to the patient as death approaches.
The goal of the first visit is to evaluate the patient’s end-of-life care and help maximize that care. As such, it is highly recommended that all patients requesting an end-of-life consultation are also enrolled in a hospice program or receive care from a palliative care physician (a specialist in symptom management). Another part of the initial evaluation is to ascertain whether, among many choices that will be described, physician aid-in-dying is appropriate and legal for the patient and their circumstances.
The fee for this first in-home evaluation is $450.
(plus $0.60/mile if travel from Berkeley is greater than 50 miles round trip)
- If as a result of this first visit Dr. Shavelson or Dr. Spangler and the patient agree that no further care on their part is necessary or appropriate, the $450 is the only fee and no further care is provided. The doctor will, however, follow through on specific recommendations such as referral for hospice care or talking with the patient’s doctors and health providers.
- If as a result of this first visit Dr. Shavelson or Dr. Spangler and the patient agree that it is appropriate for them to continue as the attending physician for the patient’s terminal illness (to supervise end-of-life care, possibly including an aid-in-dying medication), the fee for that continuous care is a one-time comprehensive care payment of $2,150 — in addition to the 1st-visit $450 — to include all continued aspects of end-of-life care (described below). This $2,150 is due at the time of the home visit if the patient desires to continue end of life care with us.
(plus $0.60/mile for each home visit if travel from Berkeley is greater than 50 miles round trip).
Please note that once comprehensive end-of-life care begins, this fee is independent of outcome. There is no refund if the patient dies without taking aid-in-dying medications. The total end-of-life-care fee, including presence at the death bed if aid in dying is appropriate, is $2,600. This is payable at the time of the initial home visit.
Comprehensive end-of-life care with Dr. Shavelson or Dr. Spangler as the attending physician responsible for the patient’s terminal illness:
Dr. Shavelson or Dr. Spangler will consult with the patient, the family, the patient’s doctors and hospice staff. They will guide communication to educate and advocate for the best end-of-life care for that individual patient’s needs and desires. They will maintain communication with the patient and caregivers by phone, email and, when suitable, home visits. When appropriate, our doctors will prescribe needed aid-in-dying medications. A member of our practice, most likely the doctor you are most familiar with, will be present at the bedside when the medications are taken.
This can occur only if:
- The patient is no longer participating in any curative or life-prolonging treatment of their underlying terminal disease, but rather has chosen to receive intensive treatment of symptoms as death approaches. This signifies that the patient understands and agrees that their end-of-life care no longer requires their specialist’s treatment of the underlying disease, but rather treatment of the symptoms of dying.
- The patient has an appropriate and persistent desire to consider the possibility of ending their life with an aid-in-dying medication, and the patient’s usual physicians will not or cannot provide physician-aid-in-dying.
- The patient agrees, if at all possible, to be in a hospice program.
- The patient understands that, by transferring their end-of-life care to Dr. Shavelson or Dr. Spangler, they will guide, provide and manage that care, assuring that palliative care (symptom control) is maximized and that all options toward death are discussed, considered and understood, including physician aid-in-dying as one possible option among many. Please note carefully that being a patient of Dr. Shavelson or Dr. Spangler does not imply or guarantee that they will provide an aid-in-dying medication, but that they will help you through many choices, and this may or may not include an aid-in-dying medication.
If the patient does take an aid-in-dying medication, Dr. Shavelson and/or Dr. Spangler will write the prescription for that medication, supervise the process and, if the patient wishes, a member of our practice will be present at the bedside to manage the taking of medications and counsel the patient and family on the day of the patient’s death.
(NOTE 1: If the patient does work with Dr. Shavelson or Dr. Spangler as the attending physician for the End of Life Option Act, they must have a second opinion from another doctor, a “consulting physician.” That consulting doctor may or may not charge an additional fee. Finally, the cost of the aid-in-dying medication — usually about $650 — is not included in Dr. Shavelson’s or Dr. Spangler’s fees.)
(NOTE 2: All of the above applies only if Dr. Shavelson or Dr. Spangler is the Attending Physician for the End of Life Option Act. Some patients already have an Attending Physician and have asked Dr. Shavelson to be the 2nd or Consulting Physician — to review the medical records and examine the patient to confirm the diagnosis and prognosis and mental capacity of the patient. If Dr. Shavelson or Dr. Spangler only provides this service as Consulting Physician, there is a one-time fee of $500.)
PLEASE NOTE that patients with difficulties in meeting the above fees should feel free to discuss this with Bay Area End of Life Options. Our goal is that no patient should be denied treatment because of inadequate funds.