The Art of Dying Well

California's end of life option

Posted Jun 17, 2016

Source: The Golden Gate Bridge, photo by Rich Niewiroski, Jr., Wikimedia Commons

We all want to live well, and for as long as we can. But then what? Death being inevitable, it seems to me that at some point dying well becomes as important as living well.

This month my state (California) will allow physicians to assist in the death of terminally ill patients, joining four other states that already have such a law. (I was surprised to learn that Oregon, the first in the nation, has had one since 1998.)

The California law is not without controversy. Governor Jerry Brown, both a lawyer and a former Jesuit seminary student, agonized over whether to sign the bill last October, but later said that he could not deny the terminally ill the comfort of knowing that such an option was available to them. Many doctors see it as contrary to their Hippocratic Oath, which pledges to do no harm, and several groups have joined in a lawsuit charging that it is unconstitutional.

So, what's all the fuss about? How does the new law work, who is eligible for it, and what is the cost?

How it works: To begin with, California's End of Life Option is not assisted suicide or euthanasia, in which the physician administers the substance that kills the patient, as in Jack Kevorkian's day. (Remember "Dr. Death?") It is completely voluntary. The physician prescribes the medication, and the patient ingests it on his or her own. All medical doctors licensed to practice in California can prescribe the lethal drugs, but that, too, is voluntary. Any physician can refuse a patient's request to write a prescription, and need not refer him or her to another doctor who will.

Eligibility: The patient must be a California resident, at least 18 years old, mentally competent, and terminally ill, with a prognosis of no more than six months to live. But that's only the beginning. A second doctor must concur with the first. During the lengthy process, no fewer than five forms must be filled out at various times—by doctors, pharmacists and the patient—before the prescription can be filled. After receiving the drug the patient must fill out another form within 48 hours prior to self-administering it. (The cause of death, incidentally, will be listed as the underlying disease, not suicide.)

The cost, and who pays: The cost to the patient is around $5,000. Why so much? Ask Valeant Pharmaceuticals, the makers of Seconal, the most commonly used drug in states that have aid-in-dying laws. Valeant hiked the cost of a lethal dose from $200 to $3,000, just after California's law was passed. As to who will pay, some of the larger health insurers have already said they would cover the cost for their terminally ill patients. Others will probably follow their lead. In any case, if we can judge by Oregon's experience, huge numbers of terminally ill Californians will not be requesting the drug. Fewer than 1,000 have taken advantage of the Oregon law during the nearly two decades it has been on the books in that state.

It's no surprise that opinions about our End of Life Option have been all over the map, as expressed in articles, op-ed pages, and letters to the editor. Some see it as humanitarian, others oppose it on ethical or religious grounds, not to mention the lawsuit charging that it is unconstitutional.

For the terminally ill, just knowing that a way to die with dignity is available has been called a big comfort. One patient, who says he will soon take advantage of the law, writes in a letter to the editor of the Los Angeles Times, "I could easily end my life in ways that would be quite messy and unpleasant for others. But this humane law will allow me to die in a peaceful and dignified manner, at a time and place of my own choosing, and in the company of people I care about."