A bill that would legalize aid-in-dying medications for the terminally ill passed the state legislature last week and is awaiting a signature from Governor Jerry Brown. If signed, the bill would allow anyone with less than six months to live to request a prescription and take it in the presence of another person.
In West Marin, the bill’s near-passage has elicited a range of responses, both laudatory and wary, from people who have had to watch friends and family suffer severe physical pain at the end of their lives. Some have hailed the bill as a triumph for those who wish to die with dignity, while others are wrestling with the moral stickiness of the situation, wondering who, exactly, would hold final sway over how and when the sick and dying leave this life.
A few have skirted the law to bring relief to those in agony by advising them on how to end their lives—a form of mercy that approaches assisted suicide, which remains punishable as a felony under California penal code.
After numerous failed runs, the End of Life Option Act cleared the State Assembly last Wednesday, 44-35, and the Senate, 24-13, on Friday. Support grew in March after state lawmakers watched posthumous video testimony from Brittany Maynard, a 29-year-old, terminally-ill brain cancer patient. She took her own life in November after moving from California to Oregon, one of five states where aid-in-dying prescriptions are legal.
Should Gov. Brown—who has not indicated his position—sign the bill, the state’s health and safety code will require at least two doctors to determine a patient to be terminally ill, meaning six months or less to live. A patient must make the request three times, twice orally and once in writing.
In some circumstances, a mental health specialist would have to sign off on the medication, to ensure the person was not coerced into suicide.
In particular, family rights and elderly care advocates are concerned that lower-income family members might pressure sick relatives to request aid-in-dying drugs to avoid steep medical costs. The Catholic Church has opposed the bill on grounds that it would condone suicide.
Doctors have routinely advised terminally ill patients to seek hospice or palliative care rather than continue life-support treatment. Dr. Colin Hamblin, a gerontology specialist at the West Marin Medical Center, explained that he daily writes morphine prescriptions for such patients, as a means to help them feel comfortable—not to put them six feet deep.
“It’s insulting to the patient,” said Dr. Hamblin, the medical director for two nursing homes in Petaluma and San Rafael. “And it’s insulting to the physician. I don’t need this stupid law to continue the great work we’ve been doing with hospice and palliative care. This is one of the main things I do: end-of-life care.”
But many seniors have praised the bill. “It’s a very sensible way of handling death,” said Vaughn Morris, a 71-year-old shrimp importer living in Stinson Beach. “I can’t think of anything worse than being in a hospital and being in pain.”
Mr. Morris opined that the decision should take place between doctor and patient. Others have echoed his view, including Point Reyes Station resident Kathy Hart, who had to watch her mother and sister die long, painful deaths.
“I think it just makes sense,” said Ms. Hart, a 70-year-old Walnut Place tenant. “And I think that we spend a huge amount of money keeping people alive who do not want to be alive. It’s an outrage.”
Ms. Hart—who said she would be “first on the list” if she contracted a terminal illness—recalled a close friend who was diagnosed first with breast cancer, then colon cancer. Doctors removed both of her breasts, her colon and her uterus. Eventually, the pain grew so great that she shot herself.
“I always felt badly because I thought she shouldn’t have had to go alone,” Ms. Hart said. “I would have been there.”
More recently, longtime Marshall resident Donna Sheehan took her own life in April after suffering for many years with painful symptoms brought about by dysautonomia—an umbrella term for a variety of nervous system failures—as well as spinal arthritis and shingles. For about five years, Ms. Sheehan stockpiled morphine prescribed for her pain and for sleeping. Having morphine, according to her partner, Paul Reffell, gave Ms. Sheehan peace of mind once she started losing cognition and the ability to walk unaided.
“She knew she had this medicine saved up. She knew she had a way out,” said Mr. Reffell, of Marshall, who this week was visiting sites such as Navarro in Mendocino that he and Ms. Sheehan loved, scattering her ashes along the way.
One day, Mr. Reffell went into Point Reyes Station to pick up heart medication for Ms. Sheehan. When he returned home he found her unconscious on the bed, having taken a lethal dose of morphine. He sat with her for five hours, listening to Frank Sinatra, until she passed peacefully.
Though upset, Mr. Reffell was not surprised: they had talked about the end of Ms. Sheehan’s life over the years, and even held a pseudo-wake with friends in the mid-90s when Ms. Sheehan underwent an experimental heart procedure. Mr. Reffell’s only regret was that Ms. Sheehan ended her life alone, for fear of incriminating him.
“If she’d had the option of having friends and family to be there, she would have done it,” Mr. Reffell said. “For sure. But that was not to be.”
Even so, he wondered whether the bill would have had any effect in Ms. Sheehan’s case, since she was not diagnosed with a terminal illness. “I’m not sure how it’s going to work, if people are in unbearable pain,” Mr. Reffell said “How will they be allowed to act?”
Not everyone in West Marin sees the issue as a clear-cut case of reprieve from a slow, painful death. Some say it is difficult to figure out whether factors such as mental illness or economic pressure have played a role.
“It seems like the potential for abuse is quite high,” said Raven Gray, of Inverness. “It seems like a slippery slope to me.”
In January, Ms. Gray’s father died of a morphine overdose after enduring years of prostate cancer, and since she was not present at the hospital when he died, she’s not certain if his death was voluntary. He had called Ms. Gray days before his death and told her that he was “frightened, scared.” The call sparked Ms. Gray’s suspicions that her father was reaching out for help, for unknown reasons, but it was too late—soon afterwards, he was dead.
Toward the end of his life, Ms. Gray said, her father often worried about the burden on his family to pay for medical expenses. As California law currently stands, sick patients can refuse treatment and seek palliative care. Research into more effective palliative care should be further explored, she said.
But Ms. Gray also emphasized that the real way to address death and suffering might require a shift in values.
“We don’t deal with death very well in this culture, do we?” Ms. Gray pondered. “We live in a culture that honors youth and beauty and physical fitness. I think our culture needs to honor the aging process.”
Aside from the moral quandary of how, when and why some would choose to end their lives with powerful drugs, there’s also the legal question. In the face of serious legal risks, one Inverness resident has helped people die for over a decade.
Fifteen years ago, Mark Dowie travelled to Mexico to retrieve a pentobarbital called Nembutal—a Schedule II controlled substance—for a friend who was dying of pancreatic cancer. Since then, he’s advised a couple of friends on how to self-administer a lethal amount of helium by running a tube hooked to a helium canister into an oven bag sealed around the person’s head. It’s tough to watch, Mr. Dowie said, but ultimately painless and quick.
“There’s a certain point at which some kinds of cancer are beyond palliative care,” Mr. Dowie said. ”I’ve wanted to [help] in as legal a way as possible.”
Under current law, Mr. Dowie’s actions could be considered assisted suicide, a felony, though he has yet to obtain a firm legal opinion from three attorneys general, including former attorney general Jerry Brown. But with passage of the aid-in-dying bill, another person could be in the same room as the person self-administering the drug—a critical component of the legislation that would let loved ones be a comforting presence at the moment of death.
And it would allow Mr. Dowie to retire, so to speak.
“I won’t have to do it if this is passed,” Mr. Dowie said. “Every time I’ve had to do it and help people, it’s because they haven’t been able to get assistance from their doctors.”
But while many see the bill as a human rights victory, others are wary of the bill’s lax language. Since 1997, over 40 percent of patients in Oregon—the state from which California has modeled its legislation—have received but not self-administered the drugs, according to that state’s Public Health Division.
Though Mr. Dowie could not foresee any illegal activity resulting from the bill’s vagaries, he did agree that the language could be clearer. But he added that a person bent on killing him or herself would, he believed, do so regardless of whether the drug is legal.
It’s exactly this suicide component that has riled the Catholic Church. “It is God who gives life, and it is God who can take it away,” said Father Rafael Antonio de Avila y Romero, the pastor of Olema’s Sacred Heart Church. “That’s what the Church has said so far.”
But moral dilemmas, religious stances and legalities aside, it’s the manner by which one passes from life into death that has spurred the debate over this legislation. Ultimately, everyone will die, regardless of young or old age, whether it comes quickly or drawn out over time, peacefully or painfully. That fact, according to Ms. Hart, need not trouble us.
“We’re not afraid of being on the other side, whatever the other side is,” Ms. Hart said. “Most of us have a sense that it’s peaceful, quiet. We don’t have to have dental floss anymore.”