California’s New Law Simplifies Death Assistance Process

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

But after 18 months without cancer, the disease returned with a vengeance in June 2003. She broke her bones and invaded the spinal canal, washing her brain with malignant neoplasms.

For the past six months, as she lay on her bed in the home hospice with constant pain, supplemented with a morphine drip around the clock, losing her sight and fading from the skeleton, the thought of ending her suffering by taking her own life did not endure. ” not even join our conversations.

I thought a lot about those dark days when I dropped in California. End of Life Option Lawwhich allows terminally ill patients with a life expectancy of less than six months to commit suicide by taking medication prescribed by a doctor. In October, Governor Gavin Newsom signed revised version of the law, extending it until January 2031 and loosening some of the restrictions in the 2015 version that supporters say have become an obstacle for dying people to take advantage of the law.

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

According to current legislation, patients who wish to die must submit two oral requests for medication at least 15 days apart. They must also request drugs in writing, and the two doctors must agree that patients are entitled to do so. After receiving the medication, patients must confirm their intention to die by signing the form 48 hours before taking them.

Patients must take the medication unaided, either by swallowing it with a drink or by pressing a plunger attached to an IV or feeding tube. And doctors may refuse to prescribe lethal drugs.

After some time, the law came into force, its supporters and practitioners came to the conclusion that some guarantees made this option inaccessible to some patients.

Some patients were so sick that they died within 15 days and had to wait between the first and second requests for medication. Others were too weak or disoriented to sign the final grades.

The revised law reduces the 15-day waiting period to two days and abolishes the final attestation.

It also requires healthcare providers to post their dying policies online. Physicians who refuse to prescribe medications – for reasons of principle or because they do not feel qualified – are required to document the patient’s request and pass the record on to any other physician the patient prescribes.

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

Dr. Chandana Banerjee, Associate Professor of the Department of Palliative Medicine in St. City of hope The National Medical Center in Duarte, California, says she has seen many patients who were afraid to bring up the topic of their own death until they came to an end.

“By the time they made that first request and then had to wait those 15 days, they had either stopped making decisions, fell into a coma, or died,” Banerjee says.

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Amanda Villegas, 30, of Ontario, California, became an outspoken supporter of the law’s renewal after she watched her husband Chris die an excruciating death from metastatic bladder cancer in 2019.

When the couple asked about the possibility of a doctor-assisted death, Villegas said, staff at the Seventh-day Adventist hospital where Chris was treated inaccurately told them it was illegal. When he finally made a request for drugs that cause death, it was already too late: he died before the 15-day waiting period expired.

The new law “will open doors for people who may … face the same obstacles,” says Villegas. “When you die, the last thing you need to do is overcome bureaucratic hurdles to achieve peace.”

Medical care for the dying is on the same political fault line as abortion and has long been opposed by many religious organizations and anti-abortion groups. He also faced resistance from some organizations for the protection of the rights of persons with disabilities claiming that it belittles the lives of those who are physically dependent on others.

“We object to the very idea that the government provides people with the means to commit suicide,” says Alexandra Snyder, CEO of the Life Legal Defense Foundation, a nonprofit law firm that opposes abortion. The 15-day waiting period provided patients with an important cooling-off period for them to contemplate an irreversible solution, she said. “Now there are no guarantees that were in the law anymore.”

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

While no version of the law requires a healthcare professional to be present when a patient is taking medication, medical standards encourage professional participation in the dying process, said Dr. Lonnie Shavelson, chairman of the American Academy of Physicians for the Care of the Dying. Medicines should be kept in the pharmacy until the patient is ready to take them, although this does not always happen, he said.

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

Most major commercial health plans, including Kaiser Permanente, Anthem Blue Cross, Blue Shield of California, and Health Net, cover death medication and associated doctor visits, as does Medi-Cal, the government’s public health insurance program. with low incomes.

However, more than 60% of those on drugs are in Medicare, which does not cover them. Effective life-ending drug combinations are available for as little as $ 400.

If you are considering dying with medical help, talk to your doctor sooner rather than later, in case you need the help of another doctor. If your doctor agrees to help, the law requires he or she to discuss other end-of-life options with you, including hospice and palliative care.

Whatever choices a patient makes, it’s important to be more open about their mortality, says State Senator Susan Eggman (M.D.), author of the revised Death Assistance Act.

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

Leslie and I had a lot of these conversations, until cancer finally drove her insane.

In her final months, she often fell into a semi-conscious state, inaccessible to us all day. Then, when we thought that she would not return, she suddenly opened her eyes and begged the children. She sat in a wheelchair and joined us at the dinner table.

These periods, which we called “revivals,” were a source of great comfort for all who loved Leslie, but especially for the children who were happy and happy that their mother was back.

While I’ll never know for sure, I suspect Leslie was reluctant to give up moments like this.

Kaiser Health News is the national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation and is not affiliated with Kaiser Permanente.

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