Know Your Neighbors
My friend in Indian Wells was in his 80s, a retired executive and published author suffering from a recurrence of cancer. He had successfully fought it for several years, even entering an experimental drug program—but it was finally clear the cancer could not be beaten. As his ability to move around freely diminished, he realized he would not be able to write nor to pursue his voracious reading habit much longer.
He called and asked if I would meet with him to talk about his end-of-life choices, because of my long work on such issues; I immediately said I’d be there. He laid out his concerns and had clearly thought through his options—including shortening his own life. He felt the quality of his life quickly ebbing away. With no spouse and no children (though he had other close family connections), he finally did make the choice to end his life—secretly and very much alone.
He’d wished he’d had the strength left to move to Oregon, where there is a death with dignity law in place; I wish he’d have had that option, too. Alas, he didn’t. (A broad article about death with dignity ran at CVIndependent.com last week, and is the cover story in the March Independent print edition.)
First, the bad news: Nobody is getting out of here alive.
Now, the good news: California may finally join five other states—Oregon, Washington, Montana, Vermont, and New Mexico—where doctors will not be held criminally liable if they assist a mentally competent, terminally ill patient who makes a conscious choice to shorten the dying process. Also, the Canadian Supreme Court ruled in February that those with terminal illness who are experiencing suffering have the right to a physician’s assistance.
The Options at End-of-Life Act, Senate Bill 128, was introduced in Sacramento in January; the bill is similar to the laws in Oregon and Washington. There is also a pending California lawsuit to protect physicians who assist a dying patient from the state’s ban on assisted suicide. That lawsuit, brought by a cancer patient and five doctors, would mean that “physicians who provide such assistance are not helping the patient commit suicide but are giving them the option of bringing about a peaceful death.”
Assisted dying became legally available in those five states either through voter support, legislative action or via the courts. The requirements under those laws are that two doctors must certify that a patient is within six months of probable death and is mentally competent for decision-making; the patient must then get a prescription and self-administer it. Safeguards in Washington prevent third-party abuses.
When Californians last considered “Death With Dignity,” it was via Proposition 161 on the 1992 ballot (the product of Americans for Death With Dignity, an organization of which I was then president). In spite of polls showing widespread support for the concept, the initiative garnered only 46 percent of the vote after well-financed opponents scared voters with ads featuring a nefarious-looking doctor heading down a dark hallway, needle in hand, with a voiceover warning that abuses would put the vulnerable at risk. Churches throughout the state preached from the pulpit that parishioners must help defeat the initiative.
The California Medical Association also opposed that 1992 effort, insisting that assisting in a death is a violation of the “do no harm” doctrine. Those who support a right to the choice of a death with dignity assert that extending one’s life artificially once the death process has begun may, in fact, be the real harm. A recent Medscape survey of 21,000 doctors found that 54 percent of doctors nationwide now support an option for assisted dying—and would want that option for themselves.
Compassion and Choices is a national organization that offers end-of-life information and consultation services, where trained individuals provide information and support to guide someone through the process, working with the patient, medical professionals and families. One such volunteer is Dwight Moore, a psychologist from Washington who spends half the year here in the Coachella Valley. Now that SB 128 has been introduced in Sacramento, Moore has been named co-chair of the Coachella Valley Action Team, communicating with and organizing local individuals to support passage of the Options at End-of-Life Act. He has enlisted more than 300 local supporters.
To those involved in death with dignity, the differentiation between “assisted suicide” and “assisted dying” is clear.
“Suicide is a traumatic resolution to a precipitating event,” says Moore. “Assisted dying is about the patient’s autonomy when the process has already begun. In fact, many people who qualify to receive a lethal prescription don’t even use it; the sense of empowerment is often enough for them to feel a sense of control over the process.”
When a request comes in from someone considering exercising their right under the Washington law, Moore’s support team meets with the patient, investigates the appropriate application of the law, gets the participation of the doctors involved, and supports the patient and the family throughout the process. They may even help prepare the medications—but the patient must self-administer.
“Even if we get a liquid prescription because someone has a feeding tube, the patient must inject the drug—we cannot help,” says Moore.
Regarding fears of abuse of these laws: When Washington’s voters approved their law, and the court ruled in Montana in 2008, Oregon already had 11 years of data and “an unblemished record.” Moore’s experience has been overwhelmingly positive. “The difference this can make for individuals and their families is amazing,” he said.
There are unresolved issues—yet the concern of people with disabilities that they may be pressured to end their lives is in direct contradiction to the safeguards written into the laws. People with dementia would not qualify under the laws since they would not be considered mentally competent, even if they had previously given specific directions in an advance directive. People in situations in which they are not able to self-administer would also not be eligible under the safeguards.
I certainly want the option of making the choice of how I die, and I want to be sure I have all options available to me. I want my doctor to not only do everything possible to fix whatever’s wrong, but to be honest and have the ability to support me if there’s no fix—and to assist me if I don’t want to drag out the process.
We don’t talk very openly in our society about death and dying—but nobody is getting out of here alive. We need to have these conversations.
I just wish I could have been there when my friend ended his dying.