California’s new law eases the process of assisted dying

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During her three-year battle with breast cancer, my wife, Leslie, graciously endured several rounds of horribly toxic treatments to save time with our two young children.

But after 18 months without cancer, the disease came back in force in June 2003. She fractured her bones and invaded her spinal canal, plunging her brain into malignancy.

For the past six months, as she lay in her home hospice bed in constant pain, strapped to a 24-hour morphine drip while losing her eyesight and withering into a skeleton, l he idea of ​​ending his suffering by ending his life has not even entered our conversations.

I thought a lot about those dark days watching California End of life option law, which allows terminally ill patients with a life expectancy of less than six months to end their life by taking medication prescribed by a doctor. In October, Governor Gavin Newsom signed a revised version of the law, extending it until January 2031 and relaxing some restrictions in the 2015 version which its supporters say have become obstacles for dying people who wish to avail themselves of the law.

The original law, which remains in effect until January 1, contains many safeguards intended to ensure that patients are not coerced by family members who view them as a potential financial burden or windfall.

Under current law, patients who wish to die must make two oral requests for medication 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 ingesting them.

Patients should take the drugs without assistance, either by swallowing them in a drink or by pushing a plunger attached to an IV or feeding tube. And doctors can refuse to prescribe drugs that cause death.

After the law had been in effect for a while, its supporters and practitioners concluded that certain safeguards made the option unavailable to some patients.

Some patients were so sick that they died within 15 days of waiting between their first and second requests for medication. Others were too weak or confused to sign the final certificate.

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

It also requires healthcare establishments to publish their assisted dying policies online. Doctors who refuse to prescribe the drugs – whether on principle or because they do not feel qualified – are required to document the patient’s request and forward the file to any other doctor designated by the patient.

The most important part of the new law, supporters say, is the shortening of the waiting period.

Dr Chandana Banerjee, clinical assistant professor specializing in palliative medicine at City of hope The National Medical Center in Duarte, Calif., Said they saw many patients who were afraid to bring up the subject of their own deaths until they were very close to the end.

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

Amanda Villegas, 30, of Ontario, Calif., Has become a strong advocate for updating the law after watching her husband, Chris Davis, die an excruciating death from metastatic bladder cancer in 2019.

When the couple asked about the possibility of a medically assisted death, Villegas said, staff at the Seventh-day Adventist hospital where Davis was being treated told them, wrongly, that it was illegal. When he finally applied for the lethal drug, it was too late: he died before the 15-day waiting period was over.

The new law “will open doors for people who might… encounter the same obstacles,” Villegas said. “When you die, the last thing you need is to cross bureaucratic barriers to achieve peace. “

Medical assistance in dying straddles the same political fault line as abortion and has long been contested by many religious institutions and anti-abortion groups. He also encountered resistance from some disability rights organizations who claim that it belittles the lives of those who are physically dependent on others.

“We oppose the very idea of ​​a state providing a vehicle for people to kill themselves,” said Alexandra Snyder, chief executive officer of the Life Legal Defense Foundation, a non-profit anti-abortion law firm. . The 15-day waiting period, she said, has provided an important period of reflection for patients to reflect on a decision that is irreversible. “Now all the guarantees that were in the law are gone.”

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

Although neither version of the law requires the presence of a medical professional when a patient is taking the drugs, medical standards encourage professional participation in the dying process, said Dr. Lonny Shavelson, president. from the American Clinicians Academy on Medical Aid in Dying. Medications should be kept at the pharmacy until the patient is ready to ingest them, he said – although this does not always happen.

Since the entry into force of the law on assisted dying in June 2016 until December 31, 2020, just under two-thirds of the 2,858 people who received prescriptions actually took the drugs and died, according to most recent data of the California Department of Public Health. The rest died before they could take the drugs or find other ways to deal with their pain and emotional distress.

Most of the major commercial health plans – including Kaiser Permanente, Anthem Blue Cross, Blue Shield of California, and Health Net – cover assisted dying drugs and associated doctor’s visits, as does Medi-Cal, the drug program. government-run health insurance for people. with low income.

However, over 60% of those who take the drugs have Medicare, which does not cover them. Effective combinations of life-ending drugs are available for as low as $ 400.

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

Speak to your doctor as soon as possible if you are considering physician-assisted dying, in case you need to seek help from another doctor. If your doctor is willing to help you, the law requires them to discuss other end-of-life options with you, including hospice and palliative care.

Regardless of a patient’s choice, it’s important to be more open about our mortality, said State Senator Susan Talamantes Eggman (D-Stockton), author of the revised Health Assistance Act. dead.

“We should all have more conversations about life and death and what we want and don’t want and what a peaceful death is,” she said. “We are all gonna die.”

Leslie and I had a lot of these conversations, until cancer finally took her mind off her.

In her final months, she often sank into a semi-conscious state, 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 children. She got into her wheelchair and joined us at the table.

These times, which we called “awakenings”, were a source of great comfort to all who loved Leslie – but especially to the children, who were relieved and delighted to be reunited with their mom.

While I’ll never know for sure, I suspect Leslie wouldn’t have wanted to rule out such moments.

This story was produced by Kaiser Santé news, one of the three major operational programs of Kaiser Family Foundation.


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