The Liberty to End One’s Life

How the marriage equality movement led the way for death with dignity.

By

terminally ill.
As the death with dignity movement builds a critical mass, social and political pressure may force even conservative states to consider easing restrictions on physician-aided suicide.

Aja Riggs doesn’t want the state of New Mexico to dictate how she’ll die. Riggs suffers from uterine cancer—currently in remission, but likely to return—and fears it will leave her in excruciating pain during her final days. To avoid so much torment, Riggs wants to be sure her doctor can ease her into death through a painless overdose if she so chooses. But New Mexico law prohibits physician-assisted suicide. So Riggs, along with two oncologists, is suing to have the statute struck down as a violation of her fundamental rights under the state constitution.

Initially, Riggs scored a major win in a state district court, which found that terminally ill patients have a fundamental liberty interest in securing assisted suicide. Earlier this month, however, an appeals court reversed that ruling. The setback is probably temporary. Bolstered by a blistering, incisive dissent, Riggs is taking her case to the progressive state Supreme Court. There, she hopes she can persuade the justices to force New Mexico to respect the legal rights of dying patients.

Court challenges to assisted suicide bans are nothing new. In a 1997 case calledWashington v. Glucksberg, a badly fractured U.S. Supreme Court rejected a broad challenge to Washington’s prohibition. Five members of the court held that the right “to assistance in committing suicide is not a fundamental liberty interested protected by the Due Process Clause.” Only “those personal activities and decisions” that are “deeply rooted in our history and traditions,” the majority wrote, are protected by the Constitution—and assisted suicide is not “deeply rooted” in the American tradition. At the same time, five justices also found that “suffering patients” may have “a constitutionally cognizable interest in obtaining relief from the suffering that they may experience in the last days of their lives.”

This apparently contradictory ruling was the handiwork of Justice Sandra Day O’Connor. A consummate baby-splitter, O’Connor tried to bridge the gap between the court’s liberal and conservative blocs. Instead, she created a paradoxical ruling that has, ever since, stood on extremely shaky constitutional grounds. In fact, the court’s recent ruling in the same-sex marriage case Obergefell v. Hodges seriously dented the validity of Glucksberg by replacing its crabbed logic with a more modern, expansive definition of “liberty.” (Chief Justice John Roberts accused the Obergefellmajority of “effectively overruling” Glucksberg—as though that’s a bad thing.)

The New Mexico Constitution has a due process clause that’s virtually identical to the one in the United States Constitution, which holds in the Fifth and 14th amendments that no one shall be deprived of “life, liberty, or property, without due process of law.” Like the federal version, New Mexico’s protects substantive rights fundamental to individual dignity and autonomy. But the New Mexico Supreme Court has declared that its state constitution may be interpreted more expansively, to encompass a grander definition of individual dignity. Riggs argues that the New Mexico Constitution should protect her right to choose when to end her suffering.

001In a somewhat apologetic decision, the court of appeals refused to allow this more generous reading, holding that the state may force a terminally ill patient in extreme agony to remain alive until her life reaches “its natural end.” But in dissent, Judge Linda M. Vanzi laid waste to the majority’s argument, writing that it “reflects a shocking disrespect for the individuals whose circumstances would bring them to seek aid in dying.” Vanzi first notes, correctly, that Obergefell seriously erodes—and maybe even overrules—Glucksberg. (Same-sex marriage, after all, certainly isn’t “deeply rooted” in American history.) She then explains that even ifGlucksberg remained good law, she would “reject it as unpersuasive, flawed, and inadequate to protect the rights of New Mexicans.” Instead, Vanzi writes that New Mexico’s own traditional respect for individual autonomy should lead the court to hold that the state’s citizens have a “liberty right to aid in dying from a willing physician.”

And if New Mexico’s due process clause implies this right, another provision all but demands it. In a passage unique to the New Mexico Constitution, “all persons” in the state are promised “natural, inherent and inalienable rights.” Among these are “the rights of enjoying and defending life and liberty … and of seeking and obtaining safety and happiness.” This provision, Vanzi asserts, “affords New Mexico citizens the right and agency to defend their lives and liberty by availing themselves of aid in dying” when terminally ill. The state simply cannot justify “intrud[ing] upon the doctor-patient relationship as it relates to the constitutional right to aid in dying.” Vanzi concludes:

The question at the heart of this case is who has the right to decide when and how a mentally competent, terminally ill New Mexican will end her life after the options for meaningful improvement of her terminal condition have been exhausted, such that “life” means being forced to endure unbearable suffering until death arrives. … Other choices and decisions central to personal autonomy and dignity have long enjoyed the status of constitutionally protected liberty interests. I would hold that the New Mexico Constitution protects aid in dying as a liberty interest.

Vanzi’s brave, powerful dissent is likely to become a rallying cry for the death with dignity movement. But it is also aimed squarely at the New Mexico Supreme Court itself, to which Riggs will appeal her case. There, she may have more luck: All five justices are Democrat-affiliated and have proven quite liberal on issues of personal dignity, including marriage equality. Should they side with Riggs, New Mexico will become the fifth state where terminally ill patients are afforded the liberty to end their lives. That might help create momentum in other states whose legislatures are considering assisted suicide measures.

As the death with dignity movement builds a critical mass, social and political pressure may force even conservative states to consider easing restrictions on physician-aided suicide. This model worked gangbusters with same-sex marriage, and death with dignity advocates are clearly hoping to employ it for their own cause. Eventually, they may even achieve an Obergefell­-type ruling for the movement declaring that the American conception of liberty includes a right for terminally ill patients to choose when to die.

Of course, opponents of physician-assisted suicide like to argue that legislatures, not the courts, should decide the legality of the practice. Yet the constitutional guarantees of life and liberty ring hollow if patients like Aja Riggs are deprived the liberty to end their own lives.

Complete Article HERE!

Right-to-die advocate dies without reprieve: San Mateo resident Jennifer Glass fought for new legislation

By Samantha Weigel

Just months after urging the California Legislature to empower her to cease her suffering on her own terms as she battled an aggressive form of cancer, Jennifer Glass died in her San Mateo home Tuesday night.

jennifer-glass
Jennifer Glass died in her San Mateo home Tuesday night after battling stage 4 lung cancer. Glass had sought changes to state legislation so she could have controlled how she died.

Despite her condition, the 52-year-old was an active advocate for Senate Bill 128: End of Life Option Act and her supporters remain saddened the legislation, which could have allowed Glass to avoid more suffering, stagnated in the Assembly.

A former communications specialist who took charge of high-power campaigns such as for Facebook and Oracle, Glass turned her attention to the state’s right-to-die initiative after being diagnosed with stage 4 lung cancer in 2012, just four months after marrying her husband Harlan Seymour.

A national spokeswoman for the movement who worked closely with the advocacy group Compassion and Choices, Glass died while California lawmakers stalled on a right-to-die law. SB 128 would give patients who are terminally ill the right to terminate their own life after completing a series of checks and balances with doctors and mental health professionals.

Glass fought to extend her life through chemotherapy as well as radiation and even did better for a time; however, a CT scan taken in June of this year showed her cancer had spread to her lungs, liver, abdomen, pelvis and brain. Unable to tolerate chemo, she decided to die at home, Seymour said.

As her lungs filled with fluid making breathing difficult and her pain increased, Glass opted to undergo palliative sedation — a process in which she is medicated into a coma then nutrition and fluids are withheld until the patient dies from the disease or dehydration.

It took her more than five days to die, a disheartening time marked by her awaking from the coma in a panic one evening, Seymour said.

“By the time she started palliative sedation, she was in so much pain, she really couldn’t say goodbye to people. If there was an end-of-life option, she could have started earlier, even just one day, she could have said goodbye to her loved ones and had a quiet death,” Seymour said. “Palliative sedation is really just a slow motion version of what the end-of-life option offers. Instead of a seven-day, dragged-out death in a coma, it’s a death that could just last a few hours and allows for a better ending with one’s family. … It would have been a great comfort to her if she had the choice to end her life in a faster manner. She would have suffered less.”

Had SB 128 been enacted, Glass would have been able to obtain aid in dying through prescription medication that she could have taken at home allowing her to die in her sleep, sometimes in as little as 30 minutes — as in the case of Brittany Maynard, a 29-year-old Bay Area resident who moved to Oregon to exercise her right to die, according to a press release from Compassion and Choices.

Opposition

Opponents say SB 128 could have unintended consequences as insurance companies looking to cut costs or those without good access to health care may be more inclined to use these types of laws.

“The concerns of our coalition, there are many but primarily, is that you cannot base broad public policy decisions on one case, you have to look at all of California and not just a single individual or a narrow group of individuals,” said Tim Rosales, spokesman with the Californians Against Assisted Suicide. “Consider how these policies would impact everyone in a state as diverse as California; particularly in parts of California where people do not have access to the types of health care where they can get second and third opinions or access to better treatment.”

Rosales noted many states across the country turned down legislation dealing with the issue this year and instead, California should focus on making hospice and palliative sedation more accessible.

Another option

While opponents often cite palliative sedation as a suitable alternative, representatives from Compassion and Choices argue Glass’ case proves it didn’t allow her to die peacefully.

“With Jennifer, it obviously did not work as effectively. … It’s really important for people to understand that in reality, palliative sedation does not work for everyone and those folks need another option. Medical aid in dying is that option,” said Toni Broaddus, campaign director for Compassion and Choices California. “In that sense, this legislation is really somewhat neutral because it doesn’t tell anyone what they have to do at the end of their life, but it says you can have all the medically possible options out there at the end of life. Public policy, and this is good public policy, I think is for the state not to be telling people they can’t have access to a service or prescription that many other states are using.”

Glass’ family agreed adding palliative sedation is not as dignified and can be much more painful for both the patient and their loved ones. Glass’ sister Mavis Prall noted it was not the quick nor peaceful option she was fighting for.

“She did not want her loved ones to have to watch the life drain from her over a five-day period, nor to watch her lose all dignity as her body slowly shut down,” Prall said in the press release. “Members of the California Legislature should be aware that their inaction has painful consequences. I urge them to pass the End of Life Option Act this year.”

Glass publicly spoke in support of SB 128, co-authored by state Sen. Bill Monning, D-Carmel, as she fought to provide those who are suffering with a choice.

‘Keep fighting’

Glass had been scheduled to testify in the Assembly’s Committee on Health July 7 but the hearing was canceled and has yet to be rescheduled. Broaddus acknowledged while SB 128 easily passed the Senate, there weren’t enough votes in the Assembly. Yet as Glass requested, they will continue to advocate for the bill to be adopted this year, Broaddus said.

“Her message to us had been ‘keep fighting, don’t stop fighting,’” Broaddus said. “This issue is very very personal for people. Despite what it may appear, it does not break down party lines or ideological lines. It’s something people look at very personally based on their own experience.”

Sen. Monning expressed his condolences while noting SB 128 is still in action.

“My heart goes out to her family. We will continue to pursue Jennifer’s commitment to establish the right of terminally ill patients to have all end-of-life options made available to them,” Monning wrote in a press release.

Legacy

Seymour said he would continue to support the right-to-die movement that could have spared his wife from further suffering and prefers she be remembered as a strong, loving and logical woman.

“Jennifer was very worried about suffering greatly in the process of her death, and she was concerned about what it would do to her loved ones. She didn’t want to die drowning in her own lung fluid and that’s essentially how she died,” Seymour said. “If you allow palliative sedation, there’s no reason not to allow a faster, less traumatic, less painful way of going as well. … I really want to see Jennifer’s legacy and her dream of having an end-of-life option come true.”
Complete Article HERE!

Island resident one of few to choose death with dignity

by SUSAN MCCABE

These days it’s common to openly discuss topics that past generations would have considered rude, such as sex, money, politics and religion. Death on the other hand, particularly one’s own, often remains a conversational taboo for many, though it’s probably one of the most important discussions to be had with those closest to us.

Greg Smith
Greg Smith

In this state, some people are taking that final topical frontier out of the humidor with death cafes and advanced directives. Some also are taking action with Compassion & Choices, the organization now working with residents in Washington, Vermont and Oregon who choose physician assisted suicide (PAS) when they are diagnosed with fewer than six months to live and no reprieve in sight. Former Washington Governor Booth Gardner led the voter initiative that legalized PAS in this state in 2008, as he faced his own demise from Parkinson’s disease.

Only a small number of people in Washington have taken advantage of the law since its passage. One of them, islander Greg Smith, followed through on his choice on July 27, peacefully surrounded by loved ones. Smith was a long-time advocate of death with dignity and, in an effort to enlighten others, he recorded a conversation with his friend, Lin Noah, on a Voice of Vashon episode of Island Crossroads about two weeks before his final going away party.

Smith was candid in telling the story of his battle with lung cancer, which returned “with a vengeance” two years ago. In May of this year, his doctors told him there was nothing more they could do and that he had two to six months to live. Smith said his decision to take his own life had germinated well before that — at his initial diagnosis.

“I’d seen friends and family members leave this mortal coil with the disease,” he explained, “and realized that was not the end I wanted for myself.”

To offer a chance for family and friends to say goodbye, Smith organized a party for the night before he was to drink his final cocktail.

To assure that key friends and family could attend, “I had to schedule my suicide around other people’s vacations,” he said laughing. He added that he chose a date just three months after his final diagnosis because he didn’t want his sons to go through the final stages of lung cancer with him.

Smith’s sons, ages 31 and 28, spent considerable time working with him to accept his early demise – Smith was only 61 – and respect his wishes for a peaceful passage. Smith called his choice an opportunity to “stand up with dignity, face cancer and embrace my sons one last time,” rather than dwindle from life in small and excruciating increments.

Snubbing his nose at cancer, Smith said he chose PAS to take control of his life away from the disease and end it on his own terms. Smith had written on a national PAS blog for some time, urging people in other states to have the freedom to choose. One reader took his impassioned diary to the American Medical Association’s (AMA) national convention. The follow-up report was that the AMA’s ethics committee reviewed Smith’s diary with fresh eyes, generating hope that the association might reconsider their opposition to PAS.

To those who would wonder if he might change his mind, Smith said he didn’t want to continue “playing roulette” with the end of his life and that he was ready to say goodbye. He added that with the awareness of death’s imminence, he felt he had used his time well, deepening important relationships.

Some would say doctors have been behind the curve in the move toward choices at the end of life. Naturopath Brad Lichtenstein leads so-called death cafes in Seattle, where people gather over coffee to address the inevitable, honestly and in a safe environment. He has stated that while most physicians eschew heroic measures at the end of their own lives in favor of dying quietly at home, they often implement every available life-prolonging tool for their patients.

“For a physician, when a patient dies, they’ve failed,” he explained.

Statistics show that more money is spent in the last months of life on extra measures that often will not prolong life at all. But, in the absence of a living will or advance directives, doctors will do everything possible to keep a patient technically alive.

Lichtenstein’s death cafes, the growth in the number of palliative care physicians and the entry of hospice care into the mainstream all herald changes in the end-of-life field. Soon, islanders will have access to a program to assist in the process of identifying preferences and creating advance directives for end of life before it is imminent. Called Honoring Choices, it is based on a model that originated in Lacrosse, Wisconsin, and will be offered by nurse practitioner Wendy Noble, and Carol Spangler, who has a graduate degree in public health. The two will offer facilitation services to families free of charge.

Noble and Spangler will host a presentation on Thursday by Bernard “Bud” Hammes, Ph.D., the medical ethicist who developed and directs the Wisconsin program (Respecting Choices). Hammes, an international leader in the field of end of life issues and advance care planning, has been featured on NPR, ABC’s Good Morning America, CBS Sunday Morning, NBC Rock Center and, most recently, on the PBS program, “Caring for Mom and Dad.”

He will appear with, among others, representatives from Honoring Choices Pacific Northwest, the Snohomish County Health Leadership Coalition and the Whatcom Alliance for Health Advancement, two organizations that have successfully implemented the program in their communities.

The presentation, according to Noble and Spangler, will provide specifics on what advance care planning means, why it’s important and what’s happening in the state to help people develop advance care plans.

What the two say they hope to do on Vashon is two-tiered. Their first step is to train others in the process of facilitating Honoring Choices.

“With a trained team,” said Noble, “we’ll begin small group conversations about advance directives and provide appropriate documents and instructions for completing and filing those directives.”

And when invited, they’ll meet with individuals and their families to help clarify their wishes for end of life health care.

As Spangler noted, “Determining and sharing end of life choices is a process. It’s a difficult discussion to start with one’s family.”

She and Noble say they are committed to helping Island residents start those discussions and share their decisions.

Professionals in the “death trade,” as it’s often referred to, agree that discussions of death and dying are really about living. With the implementation of this program, it appears that Vashon will soon be a place where people are ready to lead both the exploration and the conversation.

Complete Article HERE!

California Judge Throws Out Lawsuit On Medically Assisted Suicide

By April Dembosky

Christy O’Donnell, who has advanced lung cancer, is one of several California patients suing for the right to get a doctor’s help with prescription medicine to end their own lives if and when they feel that’s necessary.

Three terminally ill patients lost a court battle in California Friday over whether they should have the right to request and take lethal medication to hasten their deaths.

San Diego Superior Court Judge Gregory Pollack said he would dismiss the case, adding that the issues were beyond his role as a judge to decide and should instead be put to the California state legislature or voters to establish new law.

Plaintiffs vowed to appeal the ruling.

“This is certainly frustrating, but it’s a temporary setback,” said Elizabeth Wallner, a plaintiff in the case, who has been diagnosed with Stage IV colon cancer. “I am optimistic that we’ll prevail in the end. It’s too big of an issue to leave uncovered.”

Wallner began a series of treatments for her cancer in 2011, including surgeries to remove her colon and parts of her liver, radiation, and numerous rounds of chemotherapy. In the midst of this, when her son was 16, she realized that she wanted to have control over her own death.

“I was throwing up in the bathroom and my son was taking care of me,” she said. “I looked over at his face and I saw him absolutely stricken, watching his mother experience this. I thought, that’s enough — my son doesn’t need to see this. I should have the right to make that decision when it’s time.”

The case she and others brought to the court seeks to challenge current California law (Section 401 of the state penal code), which makes it a crime to deliberately aid or advise another person to commit suicide. Wallner and the other patients say the law prohibits their doctors from discussing or prescribing medications that could end their lives; and that prohibition, they say, violates their rights to privacy, liberty, and free speech under the California Constitution.

Attorneys for the plaintiffs — the three patients and a physician — argue that the option to hasten death is an extension of previously recognized legal rights to make end-of-life decisions, including the right to refuse life-sustaining treatments, like a feeding tube or ventilator.

“When you’re suffering, and you know you’re going to die anyway, it should be up to you to decide when enough is enough,” said Kevin Diaz, an attorney and director of legal affairs for the advocacy group Compassion & Choices, which is representing the plaintiffs. “We’ll keep trying anyway we can to make sure this is an option.”

But California Attorney General Kamala Harris, one of the defendants in the case, argued that there is no right to assisted suicide embedded in California law. Health statutes that protect patients’ rights to withdraw treatment, Harris said, do not include a right to provide proactive assistance to end someone’s life.

“No court has ever extended the right to privacy to encompass an affirmative medical intervention to kill oneself,” Julie Trinh, deputy attorney general, wrote in a legal brief.

She wrote that while the court has sympathized in the past with the plight of the terminally ill, it concluded that the question of allowing physician-assisted suicide is a legislative matter, rather than a judicial one.

The judge in this case agreed. He said he would issue a formal ruling on Monday.

A bill that aims to legalize physician-assisted suicide in California (SB 128) has been tabled for the rest of the year, after stalling in the Assembly Health Committee. Several attempts in other states to pass a similar bill this year have failed.

The practice is legal in five states: The courts authorized the practice in Montana and New Mexico; Vermont passed a law in its legislature; and voters approved ballot measures in Washington and Oregon.

There is one other lawsuit pending in California.

The three patients who are plaintiffs in the case dismissed Friday are worried that the legal process will be too slow to provide relief for them. Christy O’Donnell, a single mother from Santa Clarita, Calif., who is dying from lung cancer, explains her situation in the video below, released earlier this year.

O’Donnell broke down in tears after Friday’s hearing. “I don’t have much time left to live,” she said. “These options are urgent for me.”
Complete Article HERE!

Lawmakers Stall California Doctor-Assisted Suicide Bill Amid Religious Fight

 

Legislation that would have allowed terminally ill patients to legally end their lives in California stalled Tuesday amid fierce opposition from religious groups.

The authors of the right-to-die bill did not present the legislation to the Assembly Health Committee as scheduled because it did not have enough votes to advance.

The panel includes multiple Democratic lawmakers from heavily Catholic districts in the Los Angeles area, where the archdiocese actively opposed the legislation.

“We continue to work with Assembly members to ensure they are comfortable with the bill,” Democratic Sens. Bill Monning of Carmel and Lois Wolk of Davis, and Assemblywoman Susan Eggman of Stockton said in a joint statement. “We remain committed to passing the End of Life Option Act for all Californians who want and need the option of medical aid in dying.”

Christian Burkin, a spokesman for Eggman, said the bill could not meet the deadline to pass committees this year while lawmakers remained uncomfortable with the bill.

Religious groups say allowing doctors to prescribe life-ending drugs is assisted suicide and goes against God’s will. Religious opposition helped defeat similar legislation in California in 2007.

Montana, Oregon, Vermont and Washington have court decisions or laws permitting doctors to prescribe life-ending drugs. A court ruling is pending in New Mexico.

Aid-in-dying advocates hoped the tide would turn after national publicity surrounding 29-year-old Brittany Maynard, who moved from California to Oregon to legally end her life in November following a diagnosis of terminal brain cancer.

In widely viewed videos and national media appearances, she said she deserved to get life-ending drugs in her home state of California. Maynard’s family members advocated for the right-to-die bill in Sacramento after her death.

The bill had advanced out of the state Senate on a mostly party-line vote, with Democrats in support and Republicans opposed.

California’s bill was modeled on Oregon’s law, which has been used in more than 750 deaths since voters approved it in 1994. Advocates for people with disabilities say terminally ill patients could be pressured to end their lives to avoid burdening their families.

The California Medical Association had dropped its decades-long opposition to aid-in-dying legislation, saying the decision should be left up to individual doctors if they want to help patients end their lives.

Legislatures in Maine and Colorado have rejected right-to-die bills this year. Similar efforts have stalled in other states.

Complete Article HERE!

California’s controversial assisted-death bill divides doctors

By Alexei Koseffakoseff@sacbee.com

When the California Medical Association removed its long-standing objection to assisted death in May, it seemed to clear a legislative path for Senate Bill 128, which would allow physicians to provide lethal drugs to patients with less than six months to live.

But the powerful doctors group’s neutral position has not quelled the controversy, either among lawmakers or in the medical community. After passing the state Senate last month, SB 128 could meet its end during a hearing Tuesday in the Assembly Health Committee, where it stalled two weeks ago over growing objections from Latino Democrats.

Nearly 18 years after Oregon enacted the country’s first assisted-death law, doctors also remain strongly divided over the ethics of the policy. Does it provide patients with a personal choice to end their suffering, or violate a physician’s oath to do no harm? The answer can be deeply personal.

Pro: ‘We treat our pets better than we treat our loved ones’

Michael Amster- Assisted death is 'compassionate act'

Dr. Michael Amster, a pain-management specialist in Fairfield, deals with dying patients every day.

But he was unfamiliar with assisted death before last year, when a college friend who lived in Oregon came to the end of a debilitating two-year battle with gynecological cancer. As his friend considered taking advantage of the state’s law, Amster said she found a “peace of mind knowing that she could end her suffering if it got too unbearable.”

“She shared that, because of that, she was able to live her life more fully in the present moment and not worry about the future and the unknowns,” Amster said. Though his friend died too quickly to use Oregon’s law, “watching what she went through woke me up to understanding the value of having this option available in the end-of-life process.”

Amster has since become an advocate for assisted death in California, urging lawmakers to pass SB 128. He sees it as an issue of personal choice and autonomy in health care, rather than as physicians assisting patients to commit suicide, as some opponents have framed it.

“All it does is hasten a natural process,” he said.

Opponents have pointed to existing palliative care and pain management options as better ways to help dying patients in their final days. But Amster said available medications don’t work for everyone or can provide a poor quality of life, leaving people delirious and sedated.

He draws a contrast between sick animals, who are put down when their suffering becomes too great, and people, who are left to ride out the natural course of their dying process until their bodies finally shut down.

“We treat our pets better than we treat our loved ones, is what it comes down to,” he said. “There needs to be another option for people that are really stuck and suffering greatly.”

If SB 128 becomes law, Amster would be open to prescribing the medication. He said he already has those conversations with patients who come to him seeking help in dying, but he has to be “clear with them the boundaries” about what is legal.

That hit home last year as another friend of Amster’s in Davis was dying of ovarian cancer. She explored the possibility of moving to Oregon, but didn’t have enough time left to establish residency, so she began to talk about ending her own life in a “ritual” surrounded by loved ones.

“I watched my friend and her husband horrified and scared about, you know, if she chose to take all of her hospice medication and overdose and die, like, could he be thrown in jail if he knew about this?” Amster said.

When his friend began consulting Amster about how she might overdose, he said he had to make the difficult decision to distance himself.

“As a friend and someone who loved her, I wanted to help her end her suffering,” he said. “But ethically and with my license and what I felt what was the right thing, there was nothing I could do to help her.”

Amster hopes that legalizing assisted death in California will bring those conversations about dying into the open, and get people thinking about their own wishes.

“What are our values? What do we consider humane treatment for someone who’s at the end of their life?” he said. “Is that really suicide, or is that compassion?”

Con: Focus on improving hospice care

Dr. Daniel Mirda

Dr. Daniel Mirda, a hematology and oncology specialist in Napa, tries to take the fear out of cancer treatment.

“I can’t tell you how many times a person comes to me and they’re very afraid of their illness and they’re facing a lot of possible disasters,” he said. “Yet oftentimes having a plan simplifies their life, helps them deal with it and better understand what to do.”

He takes the same approach with SB 128, which he has testified against as president of the Association of Northern California Oncologists.

While Mirda understands why someone facing a lethal and debilitating illness might want to “head it off at the pass,” he sees his role as providing patients with the best options possible for living their “most productive life” going forward.

“I don’t think in the same sitting I can tell you how to fight your cancer and this is how you end the fight,” he said.

Mirda shares some of the ethical concerns that other opponents of assisted death have expressed: Would the socioeconomically challenged be more likely to choose this option because medical therapies are too expensive? How much sway would a patient’s family have over their decision? Would it be overused?

He also objects to cutting short the process of dying, which he believes can be an important time for patients and their families.

“When you first find out you have an illness, the last thing you want to do is kill yourself,” Mirda said. Then as time goes on and people deal with the consequences, they can assess their quality of life and decide whether to keep seeking treatment.

“This idea of getting ready for death is sometimes as valuable to people as doing therapy to avoid it,” he said. “How are you going to spend that time that you have left?”

For loved ones, there’s a chance to say goodbye.

Mirda’s mother-in-law died from acute leukemia last month. At first, he said, the family wanted her to live longer. But as she developed various complications from the cancer, everyone was integrated into her struggle and eventually understood that she could no longer keep fighting it.

He compares it to his father’s sudden death many years ago, which left him in the lurch. When his mother-in-law finally died, the family was “kind of at peace.”

“You have done everything possible to help this individual,” he said. “There are no regrets at all.”

Mirda would rather that California focus on improving hospice care, which he regards as a “totally supportive environment” for both dying patients and those they are leaving behind.

“That to me is really where the real effort would have to be exerted – respecting the individual, but then respecting who this is going to affect that moves on,” he said.

If lawmakers pass SB 128, however, Mirda said he would at least make sure that his patients are informed of their options and free to choose for themselves. Whether he could prescribe the medication himself may depend on his relationship with the patient who asks.

“Could I do that if faced with it? We’ll have to see,” he said. “It would almost have to be as individual as the decision itself.”

Complete Article HERE!

‘End of Life Option Act’ Offers Death with Dignity for Trans Man

California legislators and the Compassion and Choices coalition are pushing for a bill allowing terminally ill patients to shorten the inevitable dying process

BY

Michael Saum

In 1996, on the cusp of the lifesaving three-drug HIV cocktail, Eric Roberts starred inIt’s My Party by director Randal Kleiser, one of the first films to feature a gay man who not only insists on dying with dignity but doing so with a festive, emotional flare.

Roberts’ character had been diagnosed with an aggressive disease that would rob him of his mental acuity months before he would actually die, so he wants a goodbye party while he can still recognize the ones he loves. The film was Kleiser’s tribute to his own ex-lover, who died of AIDS in 1992.

In the film Roberts had a brain disease, so he still looked young, fit and beautiful. Most gays with AIDS surrendered vanity early on as their once-worshipped bodies were ravaged by the wasting syndrome or the purple lesions of Kaposi’s Sarcoma. They were rendered helpless and unrecognizable to themselves, an agony sometimes worse than the unrelenting physical pain. Death was a welcome blessing, and many were quietly helped to that end by bereft loving friends, lovers and family, despite the pall of illegality.

It was in this context that efforts to legalize physician-assisted suicide in California were launched in 1992, 1995 and 1999. But the prospect of a dying person choosing a good death became highly politicized by the religious right with the Florida case of Terri Schiavo, where Gov. Jeb Bush sided with the family and ordered her life prolonged, despite the wishes of her husband who said his wife expressly said she wouldn’t want to be kept alive in a vegetative state.

Today there is another effort underway in the California Legislature to pass a well-crafted bill—modeled on the successful death-with-dignity bill in Oregon—that even won the support of conservative Democrat U.S. Sen. Dianne Feinstein and the California Medical Association, which ended its opposition after 28 years.  On June 4, the State Senate passed the End of Life Option Act, SB 128, by 23 to 14, buoyed by a poll last year showing that nearly two-thirds of Californians favor giving a terminally ill patient the option to die peacefully. Currently Washington, Montana, Vermont and New Mexico also have medical-aid-in-dying laws.

Wolk-press-conference-2015

Co-authors Senate Majority Leader Bill Monning and Senate Majority Whip Lois Wolk, with support from the Compassion & Choices Coalitionintroduced SB 128 last January.  The bill has a “checklist” of safeguards to prohibit the possibility of abuse. Essentially the bill would allow a mentally competent, terminally ill adult (18 or over) the option of requesting (both orally and in writing) a doctor’s prescription for medication to shorten the inevitable dying process so they might die peacefully, without pain.

“I’m doing everything I can to extend my life. No one should have the right to extend my death,” out State Sen. Mark Leno  recalls one woman dying of lung cancer saying during a Senate hearing on the bill. Leno is a principal co-author of SB 128.

“I happen to be of the philosophical belief that government should not come between an individual and a decision he or she may make with a physician,” Leno says during a phone interview with Frontiers. “There is nothing more personal and of greater importance than our end-of-life choices. I don’t think government should be in the way. That’s what this bill does. It provides a choice for someone in a very specific situation.”

Leno knows something about this. He lost his partner Doug in 1990 and Doug’s younger brother in 1986. “Those of us of a certain age,” Leno says, “saw the tortured deaths of hundreds of friends” at a time when there was no hope of surviving. “So I’ve seen firsthand how cruel that can be.” And with aging parents and siblings approaching their last years, “it becomes a very real issue all over again.”

Leno says he found it “astounding” that a Republican colleague described his opposition to the bill by suggesting a terminally ill patient could drive over a cliff or shoot themselves in the temple instead. “The level of insensitivity is so extreme,” he says.

Michael Saum and Julia

Michael Saum, a 35-year-old transgender man who is dying from brain cancer (pictured in photo above with best friend Julia), wishes he had that option. Saum’s doctors think he will die in the next few months, before the bill reaches Gov. Jerry Brown’s desk.

“It’s not that I want to die; I don’t want to die,” Michael tells Frontiers. “I love life, but I don’t want to live like this.”

Saum was battling cancer for 14 years before going into remission—an 18-month respite during which he took the opportunity to become the man he always felt himself to be. His mother, who had been fine when then-Heidi came out as a lesbian, could not handle his transition. When he was diagnosed with Stage IV brain cancer that had spread throughout his body, he turned to his lesbian friends, most importantly his best friend Julia, whom he had once dated, to provide him refuge in her El Monte home and to take care of him. “It’s the kind of love I can’t even describe. She’s selfless,” he says.

Saum is currently at the strongest dose of painkiller allowed, but it’s not working. He has severe headaches, nausea, unregulated body temperature, short-term memory loss, unfiltered speech—“so many things go wrong” having big tumors in both the left and right frontal lobes.

“I’m in terrible pain every day, to the point that I’m crying nearly every day,” he says. “I’ve been told by my doctor that there is no chance for change, no miracle; no treatment is going to heal me.

“I think I’m going to pass before this bill is enacted,” Saum says, “but if it’s not there for me, I’m grateful I’m able to help others in my situation.”

Assemblymember Susan Eggman

Out Assemblymember Susan Eggman, Chair of the LGBT Legislative Caucus, is the lead principal co-author in the Assembly. A former hospice social worker who also lost friends in the ‘80s and ‘90s and cared for family members as they lay dying, she is uniquely positioned to understand the significance of SB 128.

“I come at this from a lot of different perspectives,” Eggman tells Frontiers. I believe—and I think polling shows—that Californians are ready for this.” Additionally, 17 years of research out of Oregon show that there is virtually no coercion or abuse.

“We know that oftentimes people don’t even go through with it. They just know that they have that option,” Eggman says. The bill is not for people who are depressed or seniors or disabled. “This is for somebody with a terminal illness, for which no cure is expected, and their end-of-life trajectory is within six months to a year.”

And, she notes, the End of Life Option Act is “for those who have had a certain degree of control in their life—this is something that is important to them.”

Perhaps more people than the dying and their loves ones are beginning to grasp the moral and ethical urgency of this bill. In a sharp contrast to the political and religious-based Schiavo controversy, a bipartisan poll conducted June 16-21 shows that nearly seven out of 10 Californians (69%) support SB 128, and that includes Catholics (60%), non-evangelical Protestants (65%) and evangelical Christians (57%).

Eggman is holding a hearing on the bill on July 7. The deadline to pass SB 128 in the Assembly is September 11.
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