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.