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New life sought for right-to-die law

A portrait of the late Brittany Maynard, who advocated for California's right-to-die law, is seen at a 2015 hearing of the Senate Health Committee. A Superior Court judge rejected the law as unconstitutional. (Photo: Rich Pedroncelli/AP)

Deborah Kratter sat in her Half Moon Bay home, explaining her decision to move to Washington state to live, and then die with life-ending medication alongside family members when her terminal pancreatic cancer worsens.

“My gosh, when the time comes and you can’t be who you are … I don’t see why you should have to lie in a bed and wait to die,” Kratter said. Her plans to take the prescribed medication in her home changed after a Riverside Superior Court judge last week rejected an effort to restore California’s End of Life Options Act.

The next motion, which urges the judge to cancel his ruling, is set for June 29.

The Act, which took effect June 9, 2016, was deemed unconstitutional by Superior Court Judge Daniel Ottolia. Major hospital systems like Stanford and Kaiser Permanente, and all hospice programs are now suspending access to the medication, creating what some say is a “panic” among the terminally ill in the state.

“We advised our physicians and care teams that the California End of Life Option Act is currently not in effect,” a Sutter Health spokesperson said in an email to Capitol Weekly. “Activities authorized by the act may not take place without further guidance from the courts.”

“We are deeply disappointed that the court ruled against us, but we thank Attorney General Becerra for defending the law,” said Kevin Díaz, national director of legal advocacy for Compassion and Choices, in a prepared statement. The next motion, which urges the judge to cancel his ruling, is set for June 29.

“But the one month delay until the hearing is unacceptable,” he said, “because in the meantime the law is not in effect and terminally ill Californians now are left without the option of medical aid in dying to peacefully end unbearable suffering.”

Dr. Lonny Shavelson is the founder of Bay Area End of Life Options, which opened its doors after the state’s End of Life Option Act passed.  Whether it’s coordinating hospice or aid-in-dying prescriptions, Shavelson and his team have interacted with over 700 requests.

Patricia Gonzalez-Portillo, communications director for Compassion and Choices, said that 504 Californians have received the medication since June 2016.

“We have been at the bedside of 89 patients as they took their medication. We stayed with them until their death,” Shavelson said. More than 150 patients were assisted and cared for until death even if they did not take dying medications.

To qualify for the medication in any medical setting, patients must reside in the state where the law is in effect, be mentally competent and be diagnosed with a terminal illness that will lead to death within six months, as confirmed by two physicians.

According to Death with Dignity, the process entails two oral requests, one written request, waiting periods and other requirements.

Patricia Gonzalez-Portillo, communications director for Compassion and Choices, said that 504 Californians have received the medication since June 2016. Last July, the California Department of Public Health released a report showing 191 terminally ill Californians received prescriptions from 173 doctors for aid-in-dying medication between June and December of 2016.

A little under 60 percent of those individuals decided to self-ingest the medication, Gonzalez-Portillo said.

“With good supervision and good hospice care, it is not a terrible way to die because there is sedation. It can be done.” — Lonny Shavelson.

Gonzalez- Portillo said like any other medication, the out of pocket cost for aid in dying medication can vary from a few dollars to several thousand.

Shavelson said his office has been flooded with calls since the court’s decision last week. “What do I do now? How do I approach my death?,” he said. “We don’t abandon these patients..this has created a huge fear and a lot of panic.”

Some patients choose to die in their own homes with hospice care, some will move out of state.

Establishing residency is the easy part, Shavelson said. It’s often the move that takes a toll on patients.

“Some patients should have a good second thought about how difficult it is to move into a new apartment or to live in a new hotel room, to establish care with new doctors. To do all of that is a tremendous stress on a family and patient,” he said.

Others will choose to use Shavelson’s team for support of intentionally refusing food and drinking. It may seem harsh, but Shavelson said his team has a system.

“With good supervision and good hospice care, it is not a terrible way to die because there is sedation. It can be done,” Shavelson said.

As of April, Colorado, the District of Columbia, Oregon, Montana, Vermont and Washington had physician-assisted dying statutes. Hawaii will also be joining the list, effective 2019, if the judge cancels his ruling.

The American Academy of Medical Ethics is against the Act, and has been since appealing it in 2016. Quoting the Hippocratic Oath, “I will never give a deadly drug to anyone if asked for it, nor will I make a suggestion to this effect,” the Medical Ethics website reads.

“The statement above is the foundational moral principle of medicine, pledged by doctors for centuries as they attempt to cure and relieve suffering without injuring the patient. It’s a principle being eroded by the movement to legalize physician-assisted suicide (PAS) and euthanasia,” according to its website.

“Most of my patients are within three to four weeks of dying and they had specific plans for how they want their death to be,” Shavelson said.

 


  • Bradley Williams

    Time to amend assisted suicide law.
    Correction there is no medical supervision or witness required at the time of the flaunted “self administration “ in the US.
    The laws/bills that the international euthanasia monopoly crafts are not OK. Amending the CA euthanasia law is sorely needed (and OR, WA, CO and HI). Even as they proclaimed that the poison must be self-administered to divert normal scrutiny they did not provide for an ordinary witness. The difference is that without a witness it allows predators to force euthanasia but with a witness they would up hold individual choice.
    Amendments would include not allowing an heir to be part of the process, requiring a witness to self-administration, restore the illegality of falsifying the death certificate, require the posting of the poison applied in the medical record, register organ/tissue trafficking, reveal commissions and memorials paid to the corporate facilitators to guard against the profiteering that is of public record in the industry.

  • Ron Russell

    Bradley: Why do you need to impose yourself in this? You’re from Montana!! No matter what concessions would be made, you’d find some justification to throw a monkey wrench into someone’s wish to pass peacefully. Then again, I saw you post the same stuff at the Sacramento Bee. Because of your ilk, I know someone who’s denied the compassion this law provided–that’s nothing more than we’d give a dying dog. As to your claim about medical records: Why should someone’s life insurance be voided, because you wanted them to live (or suffer) for a few more days than the law allows? What’s the benefit to you, if a death certificate says suicide or the underlying cause that drove someone to seek the law’s benefits? As to organ trafficking, I call B.S.! The person I refer to; wanted to donate organs and because of the disease, can’t give them away. The Life Legal Defense Foundation (part of those who brought the suit that denies the law’s benefits) argue on their website: “1.California’s End of Life Option Act does not require a psychological evaluation prior to receiving a prescription for aid-in-dying drugs. This lack of basic psychological evaluation and treatment constitutes medical negligence”. In the case I refer to, there was not 1 evaluation/exam, not 2–but 3 exams! After all that, the Doctor has filed the required paperwork with the state, but thanks to the courts, we don’t know if there will be a denial of the law’s benefits when the time comes and we expect that to be soon!

    The Life Legal Defense Foundation website goes on to state that the law takes advantage of the vulnerable. In this case, we had to not only ask, but seek out
    the medical professionals who do this and their services were not cheap, nor
    covered by insurance. No one suggested this as a way to save insurance or
    family funds. One large check later and I’m praying that on appeal, this Riverside judge’s actions are overturned, before the disease progresses to a terrifying state.

    All of this is by folks who would enforce their morals on the rest of us in any way that they can. No matter what concessions would be made, folks like Bradley and the Life Legal Defense Foundation will never accept the law’s concepts. We should acknowledge that and decide that if they don’t like the law–they don’t have to use it. They aren’t constructive partners on this issue and I question their “standing” to have taken the judicial action many now suffer from. How are plaintiffs harmed, because someone isn’t forced to suffer the worst that any disease has to offer? If this is truly a free country, why shouldn’t everyone have the right to avoid a fate worse than death? What’s going on now is not right and we should act to minimize suffering when someone’s quality of life has ended and that person asks for the help this law provides.

    • BdgrGrrl

      Mr. Russell,
      I’m from Ohio and agree with Mr. Williams. Every state that doesn’t have an assisted suicide law has skin in this game. Some of us want to prevent this practice from coming to our states. We do not want it to become SOP in other states so that it will seem so innocent and without negative consequences in our states. And no, I’m not a conservative Republican. I’m a lifelong centrist Democrat.

      • Ron Russell

        You’re a Democrat–Fantastic!! I don’t know where I pointed out a political party and I wonder why you needed to mention it? I did note that Bradley was sticking his nose in a California issue from out of state and oh that’s right–you’re from Ohio! Again, another person coming into a California issue, where they are not wanted or needed and making an awful situation, even worse. I don’t mess with Montana or Ohio. I do take your point about what “in blazes is being part of a caring society all about”? In a caring Society, why can’t I be spared the worst that disease has to offer? We’d do this for a dog, so why can’t I have that choice? Why should I be forced to linger as a vegetable and crap all over myself–forcing others to clean up for me? I’d rather have my loved one’s not be forced to remember me for that. I’m taking care of my own final arrangements, so that others don’t have to do this–so why shouldn’t I have the choice not to face the worst? If my quality of life is gone, why continue to suffer or just struggle to breathe? Do you know what it is like not to be able to get the air you need to breathe? In terms of my life and my existence, all I ask is that outsiders like you, Bradley and the Life Legal Foundation, not interfere with what should be up to me in what amounts to an awful situation, BEFORE you stuck your nose into it!–seeking !o make it worse!

        • BdgrGrrl

          1) The reason I mentioned that I’m a Democrat is that people often presume that Democrats usually support assisted suicide, which is not always true.
          2) Obviouly, I don’t know what disease you have, but certainly hope and pray that you receive the best possible medical, palliative, spiritual, emotional/mental health, and adjunctive (music therapy, massage therapy, pet therapy, acupuncture, or whatever is appropriate) care. From the experience of others, I also know that some people who fear the worst at the end of life never go through what they expect will happen.
          3) “We’d do this for a dog…”. My husband and I have had four cats in our thirty-two years of marriage. In every case, yes, we eventually had to make the tragic decision of putting them down. (For the last two, I had to do this myself because he had to move to long-term care when his frontotemporal degeneration (dementia) made it impossible to safely care for him at home any longer. But we tried very hard to treat their illnesses first, like giving two cats with renal failure subcutaneous fluid injections. (One improved so much that we could discontinue the injections and she lived an additional 1.5 years.) We wished so badly that they could tell us whether they wanted us to continue treatment. If there had been a cat hospice, I would have wanted to let the cats spend their last days there.
          4) Human beings, yourself included, never become vegetables. It breaks my heart whenever anyone refers to a human that way. I feel terrible that you would ever see yourself as a potential non-human. You and all human beings are 100% human until you breathe your last breath. Being a valuable member of the human family has nothing to do with IQ points, physical capability, the ability to read, write, feed or dress oneself, or use the toilet. If it did, infants would be out of luck!
          5) I hope you have a family who will not love you any less if you need to use Depends or is not willing to remember you for the totality of your life, not the last months or weeks when you are very ill. If they cannot, that is their problem, not yours.
          6) If assisted suicide was close to passing in the Ohio legislature or there was a referendum where people could vote to legalize it, I’d have no problem with you writing letters to newspapers in its support, testifying before our House or Senate, or supporting it in any way as long as you were respectful. It’s called freedom of speech.

          • Ron Russell

            I don’t care about party, but I do care when my rights are curtailed and that’s what, you, Bradley and the Life Legal Foundation are doing. If you haven’t experienced what it’s like to struggle to breathe and not be able to, then you will never know the absolute terror involved. The alternative is absolute sedation, where I’d want to be a house plant and that leaves me in the position of not being communicative AND of course, craping all over myself AND leaving my loved one’s in an awful position, while their agony over my passing, is only drawn out. This isn’t my first experience with a terminal situation, as I’ve done Hospice work for those that I cared about and in those circumstances–everyone involved wished we had this law. In each case, no one benefitted by being forced to endure the worst that disease had to offer. As Dr. Shavelson would say, it is up to me and that’s the current status of the law and I pray that it stays that way. I noted that you actually used this option for your pet. Don’t deny me that, if I need it. Many people who sign up for this, don’t actually use it. But having the option in their back pocket, gives them the confidence to live on, while waiting for disease to progress. In many circumstances, while they are waiting, a complication of the illness that drove them to this option, takes them out–while they enjoyed a quality of life that was still acceptable. But between when they signed up for Physician Assisted Suicide and death, they were able to live and enjoy their remaining time, knowing they’d be spared the worst. You have 6 months from ordering the drugs, to when they have to be used. In some cases you can get the medication on a short enough lead time, that the drugs don’t have to be obtained, until matters get real bad. I think the shortest time line is 48 hours before they are needed, but I have to check on that. I read somewhere that 11% who have the drugs, never use them. However on this issue, it should be up to the patient and not external actors. The law, as I see it is not being abused and forgive me for resenting that Riverside judge, you, Bradley and the Life Legal Foundation for meddling in matters where you have “no standing”.

          • Bdgrrll

            Thank you so much for your work in hospice care.

            We will never agree on this issue.

            You will have to wait (not much longer) for the next court decision and take it from there.

            God bless you.

          • Ron Russell

            So you guys are going to continue to do harm to the most vulnerable. You freely admit that you used this option for your pet and yet you’d deny that to a suffering human. I can’t begin to express my contempt with your efforts and hypocrisy.

  • Ron Russell

    For reference:
    “Bradley Williams ·
    President at Montanans Against Assisted Suicide”

    From the Sacramento Bee,in response to an article by Erwin Chemerinsky, dean and professor of law at the UC Berkeley School of Law;

    Read more in the comments section:
    http://www.sacbee.com/opinion/california-forum/article211598679.html

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