New California law eases aid-in-dying process

During her three-year battle with breast cancer, my wife, Leslie, has mercifully endured several rounds of horribly toxic treatments in order to spend more time with our two young children.

But after 18 months cancer-free, the disease returned with a vengeance in June 2003. It broke her bones and penetrated her spinal canal, bathing her brain in malignancy.

For the record:

13:56 December 3, 2021 An earlier version of this article contained an incorrect reference to intravenous administration of AIDS-on-death drugs. California law does not allow end-of-life drugs to be taken through an IV.

During the last six months, as she lay in constant pain on her home hospice bed, attached 24 hours a day to a morphine drip while she lost her sight and withered to a skeleton, the idea came to end her suffering by ending her life. to make. We can’t even comment on our conversations.

I thought a lot about those bleak days when I studied California’s End of Life Option Act, which allows terminally ill patients with a life expectancy of less than six months to end their lives by taking medications prescribed by a doctor. In October, Governor Gavin Newsom signed a revised version of the law, extending it to January 2031 and easing some restrictions in the 2015 version that proponents say have become a barrier to dying people seeking use of the law.

The original law, which will remain in effect until January 1, contains numerous safeguards designed to ensure that patients are not coerced by family members who see them as a burden or a potential financial benefit.

Under current law, patients who wish to die must submit two verbal requests for the drugs at least 15 days apart. They must also request the drugs in writing and two doctors must agree that the patients are legally eligible. After receiving the drugs, patients must confirm their intention to die by signing a form 48 hours before taking them.

The patients must take the medicines unaided, orally, rectally or through a feeding tube. And doctors can refuse to prescribe the death-causing drugs.

After the law was in effect for a while, its proponents and practitioners concluded that some precautions made the option unavailable to certain patients.

Some patients were so sick that they died during the 15 days they had to wait between their first and second request for the drugs. Others were too weak or disoriented to sign the final statement.

The revised law shortens the waiting period from 15 days to just two days and eliminates the final certificate.

It also requires healthcare facilities to post their death assistance policies online. Physicians who refuse to prescribe the drugs — on principle or because they don’t feel qualified — are required to document the patient’s request and transfer the record to another physician designated by the patient.

The most important part of the new law, according to lawyers, is the reduction of waiting times.

dr. Chandana Banerjee, an assistant clinical professor specializing in palliative medicine at the City of Hope National Medical Center in Duarte, Calif., said she has seen many patients who were afraid to broach the subject of their own death until they got very close to it. were end.

“By the time they made that first request and then had to wait those 15 days, they either became completely indecisive or went into a coma or died,” Banerjee said.

Amanda Villegas, 30, of Ontario, California, became an outspoken advocate for updating the law after watching her husband, Chris Davis, die a painful death in 2019 from metastatic bladder cancer.

When the couple asked about the possibility of a doctor-assisted death, Villegas said, inaccurately told staff at the Seventh-day Adventist Hospital where Davis was being treated that it was illegal. When he finally made a request for death-causing drugs, it was too late: He died before the 15-day waiting period was up.

The new law “will open doors for people who may be experiencing the same roadblocks,” Villegas said. “When you die, the last thing you need is to go through bureaucratic barriers to access peace.”

Medical aid for dying is on the same political cleavage as abortion and has long been opposed by many religious institutions and anti-abortion groups. It has also faced resistance from some disability rights organizations who claim it shortens the lives of those who are physically dependent on others.

“We object to the whole idea of ​​a state providing people with a vehicle to commit suicide,” said Alexandra Snyder, chief executive of the Life Legal Defense Foundation, a nonprofit anti-abortion law firm. The 15-day waiting period, she said, provided an important cooling-off period for patients to think about a decision that is irreversible. “Now all the guarantees that were in the law are gone.”

Proponents of the law say they have seen no evidence that a patient’s decision to take the life-ending drugs was ever anything other than voluntary.

While neither version of the law requires a medical professional to be present when a patient is taking the drugs, medical standards encourage professional participation in the dying process, said Dr. Lonny Shavelson, president of the American Clinicians Academy on Medical Aid in Dying. The drugs should be kept in the pharmacy until the patient is ready to take them, he said — although that doesn’t always happen.

From the time the Death Benefit Act went into effect in June 2016 through December 31, 2020, just under two-thirds of the 2,858 people who received prescriptions actually took the drugs and died, according to the most recent data from the California Department of Health. Public health. The rest died before they could take the drugs or find other ways to cope with their pain and emotional problems.

Most major commercial health plans — including Kaiser Permanente, Anthem Blue Cross, Blue Shield of California, and Health Net — cover AIDS-with-death medications and the related doctor visits, as does Medi-Cal, the government-run health insurance program for people with low levels of health. incomes.

However, more than 60% of those who take the drugs are on Medicare, which doesn’t cover them. Effective combinations of life-ending drugs are available for as little as $400.

If you’re considering assisted dying, here are some resources to learn more about it:

If you are considering a medically assisted death, talk to your doctor as soon as possible, in case you need to seek the help of another doctor. If your doctor agrees to help, the law requires that he or she discuss other end-of-life options with you, including hospice and palliative care.

Whatever choice a patient makes, greater openness about our mortality is important, said Senator Susan Talamantes Eggman (D-Stockton), the author of the revised Death Support Act.

“We should all talk more about life and death and what we do and don’t want and what a peaceful death is,” she said. “We will all die.”

Leslie and I had many of those conversations, until the cancer finally robbed her of her thoughts.

In her final months, she often sank into a semi-conscious state, far out of our reach for days. Then, just when we thought she wasn’t coming back, she suddenly opened her eyes and asked for the kids. She would get into her wheelchair and sit at the table with us.

Those periods, which we called “awakening,” were a source of great comfort to all who loved Leslie—but especially to the children, who were relieved and overjoyed to have their mother back.

While I’ll never know for sure, I suspect Leslie wouldn’t have wanted to shield at such times.

This story was produced by Kaiser Health News, one of the three major operating programs of the Kaiser Family Foundation.

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