Tag: Death And Dying

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Death Makes Life Possible – Redefining Attitudes Towards Death and Dying

Newly Released Book and Documentary by Social Anthropologist, Marilyn Schlitz, Ph.D., Explore How to Transform Our Fear of Death into New Models for Living & Dying.

What if contemplating and facing our mortality allowed us to live our lives more fully, without fear? In the newly released film and companion book Death Makes Life Possible, Dr. Marilyn Schlitz, PhD, presents a wealth of teachings and practical guidance on how to turn this taboo topic into a source of peace, hope, connection, and compassion.

“Our beliefs about what happens when we die define how we live today. And more and more of us are discovering a radical truth: when we release our fear of death, we open to an immensely richer life right here and now.” says Dr. Schlitz.DEath-Makes-Life-Possible1-620x868

Rich in scientific investigation and varying worldviews, the book and film feature eminent scientists and scholars, spiritual leaders, devout skeptics, health practitioners, and people from all walks of life, revealing the myriad ways that we grow and change by expanding our perspectives on the ultimate mystery facing each one of us.

The timeliness of this topic is highlighted by the more than 10,000 baby boomers reaching the age of sixty-five every day in the United States alone. By 2040 the number of people turning 65 is calculated to hit 1.3 billion worldwide. However death is not a topic reserved for the elderly since it is something everyone will eventually face. These works invite us to address our views about death and to examine our beliefs about what we think will happen next.
“As we seek to transform our views on death,” says Dr. Schlitz, “we can build new perspectives on our mortality that redefine who we are and what we are capable of becoming.”

Death Makes Life Possible release date: May 1st, 2015. Executive Producers are Marilyn Schlitz and Deepak Chopra. The film is distributed by Specialty Studios. The book is published by Sounds True Publishing.

ABOUT THE AUTHOR
Marilyn Schlitz, PhD, is a social anthropologist, writer, and speaker who has been a leader in the field of consciousness studies for more than three decades. The author of Consciousness and Healing (Elsevier, 2004; with Tina Amorok and Marc Micozzi) and Living Deeply (New Harbinger, 2008; with Cassandra Vieten and Tina Amorok), she serves as president emeritus and a senior fellow at the Institute of Noetic Sciences. Dr. Schlitz lives in California. See marilynschlitz.com.

THE BOOK
Death Makes Life Possible – Revolutionary Insights on Living, Dying and the Continuation of Consciousness by Marilyn Schlitz / Sounds True / May 1, 2015 / Paperback / 233 pages / ISBN: 978-1-62203-416-1 / ebook ISBN: 978-1-62203-453-6 / US $17.95 / Self-Help, Death and Dying / World Rights

THE FILM
Death Makes Life Possible – Transforming the Fear of Death into an Inspiration for Living by Marilyn Schlitz / Specialty Studios/ Digital Release / May 1st, 2015 : Amazon / DVD – Educational & Community Screening Licensing: deathmakeslifepossible.com

 

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What happens to your Facebook profile after you die?

Your online accounts and profiles can live on after you die. Here’s how to plan for your digital afterlife

By Jeff Blyskal

Life used to be so simple. You lived, you died, and the assets you amassed during your time on earth were passed on to your heirs. Now, however, there is some new unfinished business that needs to be taken care of before you go: your personal digital assets.

What are these? Well, your Facebook wall is one of them. The digitized thoughts, photos, and videos that you post there are stored at data centers in the U.S. and Sweden. And think about all of the other Internet services with storage features that you’ve come to rely on—among them mobile bank accounts, online mutual-fund accounts, and bill-pay accounts.

If you write a blog, you may have years of published material online. If you operate an Etsy account, sell stuff on eBay, or own an online business, you have even more property scattered about on so-called cloud servers. We’ve all amassed a king’s ransom of those personal digital assets. One study released by McAfee, the security technology company, estimated their average value at almost $55,000 in the U.S.

The problem is, “after you die, there’s no one monitoring all these assets anymore, which makes them vulnerable to theft,” says Gerry W. Beyer, a professor at Texas Tech University School of Law and a leading expert on the estate-planning aspects of digital assets.

Complicating matters, secret usernames, passwords, and other login codes used to keep intruders out die with you. That makes it very difficult or even impossible for your survivors to take proper control of your digital assets. State laws granting rightful access to survivors are in their infancy, while user agreements usually bar access by others to protect their customers’ privacy.

Here is Beyer’s advice for properly protecting your digital afterlife.

Start with an inventory

Because it’s easy to save frequently visited website addresses on your Internet browser’s bookmarks bar, the first entry in your paper-based inventory should be a list of the usernames, passwords, and other login access codes to your computers, tablets, smart phones, and other connected devices. Do the same for your encrypted hard drives, flash drives, and other storage devices; encrypted home network routers; voice mail; and any fobs, cards, or other physical digital-key devices that require multifactor authentication security.

Your inventory on paper should then list the Web addresses where your trusted agent can access your account-login pages, along with the necessary e-mail accounts, usernames, passwords, security codes, and login procedures. Don’t forget the information needed to reset the password, often your e-mail address where a reset code will be sent, and the secret “Who was your best childhood friend?” question(s), whose answers only you know.

Find and appoint an agent

Because there may be indecorous photos or e-mails or other digital secrets you don’t want your survivors to see, take steps to prevent a family National Enquirer eruption. Neatly segregate the indelicate material from the harmless, find and retain a trusted third party to handle your digital affairs, and instruct him on how to manage it. This is best handled by a family attorney, executor, or estate administrator.

Draw up a power of attorney

Don’t put instructions and access information into your will because that becomes a public document once it’s admitted into probate. Instead, have your estate attorney draw up a digital-assets durable power of attorney. That will legally authorize your attorney or the trusted agent you name to gain access to your accounts and devices, should you become incapacitated, incompetent, or otherwise unable to handle your own affairs. Your agent’s authority under the durable power of attorney ends when you die, but thereafter, your personal representative (executor under a will, administrator if intestate) picks up the authority to act.

Store your inventory safely

Of course, all of your access codes are the keys to your digital kingdom, so the printed inventory should be kept securely in a safe-deposit box, Beyer says. Maintain a digital version of your print inventory to note changed passwords or newly added Web services. Store that on an encrypted flash drive, and retrieve and update the paper version as often as is feasible. Destroy the old print list after the new one replaces it.

Look for user controls

Online services have not yet caught up with the digital afterlife concern. “Many have some sort of policy in their user agreement that may allow access to an executor or authorized agent upon submission of a death certificate and documentation,” Beyer says. “The industry could solve the problem by providing a screen when you open an account, asking who you authorize to have access if you become disabled or deceased.”

But Beyer expects companies to get up to speed on this in the coming years, and some have already done so. Google’s Inactive Account Manager, launched in 2013, lets you instruct the Internet giant on what to do if your account becomes inactive for any reason, including your death. You can choose to have your data deleted after three to 12 months of inactivity or authorize trusted contacts who can receive data from some or all of your Google services, including Blogger, Drive, Gmail, and YouTube.
Complete Article HERE!

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Snyder opposes recognizing terminally ill gay man’s marriage

by Chris Johnson

Rick Snyder, Michigan, gay news, Washington Blade
Michigan Gov. Rick Snyder opposes the recognition of a terminally ill gay man’s marriage.

 

Michigan Gov. Rick Snyder announced in a legal brief filed late last week he opposes state recognition of the marriage of gay man in the Wolverine State who’s terminally ill.

In a five-page brief dated April 16 and submitted to the U.S. District Court of the Western District of Michigan, Snyder argues Michigan shouldn’t be required to recognize the marriage of Bruce Morgan, an East Grand Rapids, Mich., resident who’s suffering from brain cancer and married his partner, Brian Merucci in New York in 2013.

A federal court had struck down Michigan’s ban on same-sex marriage in March 2014, but the U.S. Sixth Circuit Court of Appeals reversed the decision, upholding the state’s prohibition on gay nuptials. That case is now pending before the U.S. Supreme Court.

Snyder had acceded to another court ruling requiring Michigan to recognize the marriages of around 300 same-sex couples who wed during a “window” period after the initial court ruling, but before the Sixth Circuit placed a stay on the weddings. But the governor says the decision in that lawsuit, Caspar v. Snyder, isn’t enough for the court to grant state recognition of Morgan’s marriage.

“The only circumstance cited by Plaintiffs not previously considered by this Court is the decision in Caspar,” Snyder said. “But Caspar is non-precedential and factually distinguishable. Consequently, the legal and factual landscapes relevant to staying this case remain the same as they did when this Court issued the stay, and Plaintiffs’ motion should be denied.”

The lawsuit, Morgan v. Snyder, was filed private attorneys on behalf in June 2014, but the case was stayed in August as marriage litigation was pending before the Sixth Circuit. Earlier this month, the plaintiff couple sought a relief from the stay in the aftermath of the decision in the Caspar case.
Complete Article HERE!

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Half of US states consider right-to-die legislation

By Malak Monir

More than a dozen states, plus the District of Columbia, are considering controversial medically assisted death legislation this year.

assisted dyingThe laws would allow mentally fit, terminally ill patients age 18 and older whose doctors say they have six months or less to live to request lethal drugs.

Oregon was the first state to implement its Death with Dignity Act in 1997 after voters approved the law in 1994, and four other states — Montana, New Mexico, Vermont and Washington — now allow for medically assisted death.

As of April 10, at least another 25 states have considered death with dignity bills, according to Compassion & Choices, a Denver-based nonprofit organization that advocates for these laws. Some of those bills already have died in committee.

“The movement has reached a threshold where it is unstoppable,” said President Barbara Coombs of Compassion & Choices, who was also chief petitioner for the Oregon Death with Dignity Act.

The issue of medically assisted death rose to prominence last year with the case of Brittany Maynard, 29, who was told she had six months to live after being diagnosed with brain cancer. Maynard was a strong advocate for Death with Dignity, and when she learned of her grim prognosis, she moved from her home state of California to Oregon, where terminally ill patients are allowed to end their own lives.

“I would not tell anyone else that he or she should choose death with dignity,” she wrote in an op-ed on CNN.com. “My question is: Who has the right to tell me that I don’t deserve this choice? That I deserve to suffer for weeks or months in tremendous amounts of physical and emotional pain? Why should anyone have the right to make that choice for me?”

Maynard died Nov. 1 after taking a lethal prescription provided to her by a doctor under Oregon’s death-with-dignity law.

Many states have proposed these bills, which some advocates call right-to-die legislation, after Maynard’s eventual death in November of last year, but so far none of them have passed.

Coombs, whose organization worked with Maynard to “help carry her voice and her message,” credited Maynard’s advocacy with helping put the issue in the public eye, to the point where legislators are hearing from their constituents that this is a pressing need.

“Brittany Maynard’s death … made it a political issue for younger people, not just older people,” said Arthur Caplan, founding director of the Division of Medical Ethics at New York University Langone Medical Center’s Department of Population Health.A woman holds the hand of her mother who is dying from cancer during her final hours at a palliative care hospital in Winnipeg

The issue has sparked debate with opponents who argue that, given the risk of mistakes or abuse, medically assisted death laws present more dangers than benefits.

“There is a deadly mix when you combine our broken, profit-driven health care system with legalizing assisted suicide,” said Marilyn Golden, a senior policy analyst with the Disability Rights Education and Defense Fund.

The possibility of patients being financially or emotionally pressured into a decision to end their own lives is also a major concern, Golden said.

“Assisted suicide automatically becomes the cheapest [treatment] option,” Golden said. “They [patients] are being steered toward hastening their deaths.”

Golden pointed out that the safeguards in place with the legislation in Oregon do not address certain issues, such as doctor shopping, where patients whose physician deems them unfit for lethal medication seek treatment with other doctors who might give them a more favorable answer.

The fact that the legislation does not require the presence of objective witnesses could mean that patients are not willingly self-administering the medication as the law intends, Golden said. It opens up the possibility of elder abuse by heirs or abuse caretakers.

Coombs said the Oregon law has functioned as it was meant to and even has led to unexpected benefits in improving quality of life for terminally ill patients.

“I think the movement is a good thing,” Caplan said. “It has proven to be effective and not abused in Oregon and Washington.”

Many of the people who request the medication never end up taking it, though having it allows them to have a sense of security, Caplan said.

With proper checks and balances, the law should not be problematic, he said.

“Between one-third and one-half of patients never take the medication,” Coombs said. “They just derive a lot of peace of mind from having the option.”

Maynard, who received her prescription in May last year, held onto it until November, once she had decided that the suffering had gotten to be too much, she said.

In Oregon between 1997 and 2014, 1,327 people were prescribed lethal medication, 859 of whom died from ingesting the medication, according to the latest data from the Oregon Public Health Division’s yearly report. In Washington state, 549 people received prescriptions under the state’s Death with Dignity Act from 2009 to 2013; 525 of them died, though not all of these deaths are confirmed to have been the result of ingesting the medication, the state Department of Health’s latest report states.

Both Oregon and Washington found that participants had three major concerns: loss of autonomy, diminishing ability to engage in the activities that make life enjoyable, and loss of dignity. Meanwhile, only about a third of patients in both states were concerned about inadequate pain control.

“It’s not as simple as pain,” Coombs said. “Everyone gets to identify their own definition of suffering.”

Similar bills repeatedly have failed to pass either as ballot initiatives or as legislative measures in other states. More than 140 similar proposals in 27 states have failed since 1994, according to the Patients Rights Council.
Complete Article HERE!

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At the End of Life: Death Doulas and Home Funerals

Alternatives to institutions emerge in caring for dying people and their families

by Shannon Firth

When Lee Hoyt was in college her parents died — first her mother and then her father. Hoyt, now a retired teacher and volunteer at Gilchrist Hospice in central Maryland, said the losses were exacerbated by the abrupt separation from her parents.

“They were whisked away by the funeral home. It was done the conventional way, and no one talked to me about it,” she said.

Julie Lanoi, RN, a mental health clinician, hospice nurse and vice president of New Hampshire Funeral Resources Education and Advocacy (FREA) felt similarly about her own experience.

As a full time caregiver for both of her grandparents, Lanoi was upset by how quickly her grandmother’s body was taken from her when she died.

“It feels unnatural to me to have that distancing from the experience so quickly,” said Lanoi. “The person that you have loved your whole life is all of a sudden, they’re just gone out of the room, and you never see them again. Or you never see them again in that natural state.”

At the time, Lanoi was resigned to the process. “And then I realized there was another way to do it.”

Lanoi came across an article online on home funerals and “conscious dying.” The concept of “conscious dying” encourages conversation and decision-making, so that patients and families can make death and the bereavement process more meaningful and more intimate.

Both women are now what are variously called death doulas, death midwives, midwives to the soul, transition guides, psychopomps, and thanadoulas. They believe that there should be alternatives to institutions for people at the end of life, and to conventional afterlife care — that is, funerals — as well.

Interest in home funerals seems to be growing, particularly among providers. According to the National Home Funeral Alliance, 23% of its members are also medical providers — this includes doctors, nurses, and physical therapists. An additional 22.5% are spiritual care and social workers.

Still, said the group’s president, Lee Webster, “We are a death-denying a culture.”

“We’re the only creatures in existence that know we have a finite end,” she continued. “Not discussing it is ludicrous.”

The goal of home funeral guides is to walk patients and their families through the after-death process.

“We all want to feel that we’re not alone.”

Coaches, Fixers, Handholders

The role of death doulas or death and dying guides, as the Alliance calls them, is simple but important.

Patients will call on these individuals to help them write advanced directives, to plan wakes and funerals, and to help prepare their friends and family for what is about to happen. These guides can also help dying patients with the emotional and psychological work of forgiving injuries. “So that you can have a more peaceful ending to your relationships,” Hoyt said.

Many end-of-life guides will sit with families and offer support as patients are dying. Hoyt has also been called to the bedside of patients who have already died. She sat beside one man who had been dead 5 hours, while the family drove to the hospital. “The daughter was very grateful someone was there and that he hadn’t been alone,” she said.

After death, instead of having the patient’s body removed by a professional, Hoyt coaches family members in how to wash the body, properly rinse the mouth, shut the jaw, and dress him or her. It’s legal in all states for families to bathe a loved one, even after death, she said.

If the patient is in a hospital or nursing home, Hoyt can help families to complete the legal forms that would allow the family to bring a loved one home, if they wish to.

(Nine states mandate that families must engage with funeral homes. Webster’s group is actively lobbying to change this.)

While Hoyt is a volunteer, many guides and educators are paid for their work.

Jerrigrace Lyons, founder and director at Final Passages, in Sebastopol, Calif., charges an education fee to families of about $1,500 for the work she does over 3 or 4 days.

“I’m always willing to negotiate if people have a hardship with finances,” she said.

Although there is no legal license for death and dying guides, Lyons offers certification in end-of-life training. She conducts in-services at hospitals and sells guidebooks on end-of-life-care and occasionally speaks to medical students at universities.

Hoyt, who received her certification from Lyons, said, “The impetus for the movement in the beginning was healing, the really healing benefits of continuing to be engaged with the care, [and] providing a continuum of care for your loved one after death.”

The reason is obvious. “It keeps you busy and keeps you engaged in doing something that you know is very productive. It’s your final act of love,” she added.

While Hoyt could not rewrite the tragic experience of losing her parents, she was able to support the family of a close friend through her death and funeral process.

Hoyt remembers a house, filled with music, wind-chimes, and bird sounds. The windows were all open and the breeze blew into every room. Her friend lay in her bed barefoot in a favorite coat, under a giant pine bough. Then the family carried her friend in a seagrass casket strewn with lavender to a van that brought her to a burial site, where family and friends threw flowers into the air over her friends’ body.

“It was the most natural ritual that I’ve ever been a part of,” she said.

Guidance at a Distance

Lanoi’s role is to educate families so they can conduct patient-centered and family-directed funerals. She speaks with caregivers and relatives over the phone and holds workshops to share concrete practical and legal steps involved in the process.

She also connects families with traditional and nontraditional resources related to after-death options.

Lanoi said home funerals are not as unconventional as most people think.

“This is the way this was always handled for centuries and centuries and centuries,” she said.

“I think people have a fear that the body’s going to be decomposing before their eyes and it’s just, that’s not what happens.”

Conscious dying slows down the process and allows families to actively grieve their loss instead of setting themselves apart from it, she said. Many families of hospice patients have been bathing, toileting, dressing, and caring for their loved ones for years. That this should abruptly end because a person has died, and that an individual’s care be passed over to a stranger, seems odd to her.

“In caring for the body of the loved one for the last time, in washing the body for the last time, in having them be present with you after the death for a period of hours, it’s a very different experience than the ‘detaching from’ that we conventionally do, and we can miss out on some important emotional experiences,” she added.

When she speaks about her work with other medical colleagues, Lanoi said, “most of the time it’s been ‘Oh, I didn’t know you could do that.’ Some will even say, ‘That’s what I want.'”

When providers ask about the risk of infection, she advises home funeral guides to tell families to use the same universal precautions they would as when a patient was alive. Providers will also ask about their own liabilities. Once a death certificate is signed, “the medical world’s job is over,” she said.
Complete Article HERE!

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At center of SCOTUS gay marriage case, a story of love amid crippling disease

By Timothy M. Phelps

There are more than 30 plaintiffs in the gay marriage lawsuits that will be argued before the Supreme Court this month. But the case that will go down in history is named for just one, Jim Obergefell, a 48-year-old real estate salesman from Cincinnati who is battling Ohio over a word the state wants to write on his late husband’s death certificate: “single.”

The naming of the multiple consolidated gay marriage suits as Obergefell vs. Hodges was a clerical fluke, but the story behind it is one of the most unusual and poignant of the cases to be decided by the justices in June. It is a story of love amid a crippling disease, a triumphant wedding ceremony aboard a chartered medical jet on the tarmac in Baltimore, and then a legal battle over whether Obergefell’s three-month marriage to a dying John Arthur would be recognized on a piece of paper after he was gone.

“Here’s the last official record of John as a person, and it would be wrong,” said Obergefell, interviewed Sunday on the steps of the Supreme Court building, where the unassuming former corporate consultant never imagined himself.

The justices are widely expected to rule in favor of legalized gay marriage nationwide. But they also asked to hear arguments April 28 on a possible smaller step, letting states resolve the issue but forcing those where same-sex marriage is illegal to recognize unions performed in other states. That dispute is at the heart of Obergefell’s suit.

Obergefell and Arthur had been together for 20 years, often working side by side as consultants in Cincinnati for corporations like Oracle. They wanted to marry, but Ohio banned same-sex marriage. They didn’t want to marry in another state because it would have been a “symbolic” union invalid at home.

Two years ago, when the Supreme Court struck down the federal Defense of Marriage Act, they began to reconsider. The fact that Arthur had been diagnosed with amyotrophic lateral sclerosis, or ALS, a fatal, crippling neurological disorder often called Lou Gehrig’s disease after the baseball player, added “a much greater sense of urgency,” Obergefell said.

“With John’s death approaching, it just gave us more of an impetus and more of a desire to have our relationship validated and recognized,” Obergefell recalled. “We suddenly saw the opportunity to say ‘I do’ and have it matter from a legal and governmental perspective. But if John had not been dying from ALS, we still likely would have gotten married because after 20 and a half years together we wanted to be treated the same as other couples.”

Arthur’s worsening condition created additional obstacles to their plans.

“When we decided, ‘Let’s try and make this happen,’ at that point [John] was bedridden and in hospice care at home,” Obergefell said. “All he could do was move his right hand and his head a little, and speak.”

The couple decided to marry in Maryland, which offered simpler licensing requirements. But Obergefell did not think Arthur could make it by car. The only feasible option seemed to be chartering a medical jet at a cost of $13,000.

When he posted their financial dilemma on Facebook, friends and family quickly raised the money.

They never left the plane in Baltimore. On July 11, 2013, Arthur’s aunt, Paulette Roberts, performed the marriage, having ordained herself a minister for the occasion online. Each of them said, “I thee wed,” Arthur with some difficulty. A newspaper photographer came aboard to capture the moment.

The couple quickly discovered that the ceremony made a difference in their relationship. “We just felt different, having that government recognition of our relationship,” Obergefell said. “Having the government say you exist, you count.”

When they got back to Cincinnati there were 30 friends to greet them on the tarmac.

But mindful that Arthur’s disease was likely to claim his life soon, the couple set out on one final mission: to ensure that his death certificate would reflect their legal marriage.

Their lawyer, Alphonse Gerhardstein, warned them that it would be an uphill legal battle, but he filed an emergency suit in federal court.

Eleven days after their wedding, a federal judge ordered Ohio to issue the word “married” on the death certificate when Arthur died. Like many other gay marriage rulings around the country, it was based on the 2013 Supreme Court decision striking down part of the federal Defense of Marriage Act.

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Two doctors fight for their own choice of how to die

By Anna Gorman

Dan Swangard, a 48-year-old physician from San Francisco, was diagnosed in 2013 with a rare form of metastatic cancer.
Dan Swangard, a 48-year-old physician from San Francisco, was diagnosed in 2013 with a rare form of metastatic cancer.

Dan Swangard knows what death looks like.

As a physician, he has seen patients die in hospitals, hooked to morphine drips and overcome with anxiety. He has watched dying drag on for weeks or months as terrified relatives stand by helplessly.

Recently, however, his thoughts about how seriously ill people die have become personal. Swangard was diagnosed in 2013 with a rare form of metastatic cancer.

To remove the cancer, surgeons took out parts of his pancreas and liver, as well as his entire spleen and gallbladder. The operation was successful but Swangard, 48, knows there’s a strong chance the disease will return. And if he gets to a point where there’s nothing more medicine can do, he wants to be able to control when and how his life ends.

“It’s very real for me,” said Swangard, who lives in Bolinas, Calif. “This could be my own issue a year from now.”

That’s one of the reasons Swangard joined a California lawsuit last month seeking to let doctors prescribe lethal medications to certain patients who want to hasten death. If he were given only months to live, Swangard said, he can’t say for certain whether he would take them.

“But I want to be able to make that choice,” he said.

The right-to-die movement has gained renewed momentum in California and around the nation following the highly publicized death of an East Bay woman with brain cancer. Brittany Maynard, 29, moved to Oregon to take advantage of its “Death with Dignity” law and died in November after taking a fatal dose of barbiturates prescribed by her doctor.

The California lawsuit asks the court to protect physicians from liability if they prescribe lethal medications to patients who are both terminally ill and mentally competent to decide their fate.

The lawsuit argues that while it is against the law in California for anyone to assist in another’s suicide, these cases are not suicides. Rather, the suit argues, they are choices by a dying person on how his or her life should end and decisions about one’s own body protected under the state constitution.

Separately, two California state senators have proposed a bill that would allow doctors to prescribe lethal medication to certain terminally ill adults.

Three states — Oregon, Washington and Vermont — already have laws allowing physician-assisted deaths. Courts in New Mexico and Montana also have ruled that aid in dying is legal, and a suit was also recently filed in New York.

Legislation is pending in several other states. Kathryn Tucker, an attorney on several of the court cases, is also spearheading the California lawsuit. This time, she and her legal team decided to include among the plaintiffs two doctors with life-threatening illnesses, Swangard and a retired San Francisco obstetrician.

Physicians “have a very deep and broad understanding about what the journey to death can be like,” said Tucker, executive director of the Disability Rights Legal Center. “The curtain is pulled back. For lay people, death is much more mysterious.”

Historically, doctors have been some of the most vocal critics of assisted suicide, also called aid-in-dying. The American Medical Association still says that “physician-assisted suicide is fundamentally incompatible with the physician’s role as healer.” Similarly, though it hasn’t taken a position on currently proposed legislation, the California Medical Association has said that helping patients die conflicts with doctors’ commitment to do no harm. “It is the physicians’ job to take care of the patient and that is amplified when that patient is most sick,” said spokeswoman Molly Weedn.

But a recent survey of 21,000 doctors in the U.S. and Europe shows views may be shifting. According to Medscape, the organization that did the survey, 54 percent of American doctors support assisted suicide, up from 46 percent four years earlier.

Swangard is among those who believe that taking care of patients means letting them choose how their lives should end. That’s not the same as killing patients or facilitating suicide, he said.

Swangard completed his medical residency in San Francisco in the middle of the AIDS crisis; young men were dying all around him. Throughout his career as an internal medicine doctor, a hospice volunteer and now an anesthesiologist, he has become frustrated with how the medical system handles death. Doctors spend so much time trying to extend life that few focus on what patients want in their last days, he said.

“I don’t think we know how to die,” he said. “We fight tooth and nail to keep that from happening.”

Swangard’s own illness was discovered in early 2013 during a long overdue check-up. He hadn’t been worried about his health — he was obsessed with fitness, swimming regularly and seeing a trainer twice a week. But when the doctor pressed on Swangard’s stomach, he felt a mango-sized mass.

He had a visceral feeling, he said, “something bad was happening.”

Within a week, a surgeon found a neuroendocrine tumor in the pancreas and metastasis in the liver. It was the same cancer that took Steve Jobs’ life — one that doesn’t generally respond to chemotherapy or radiation. “My fears became real,” he said.

The doctors told him they believed they got all the cancerous cells. But Swangard was tormented by questions: Am I going to be alive in a year? Is my cancer going to come back?

“I wasn’t sleeping, I wasn’t exercising, I was marinating in my own sadness and fear of what this all meant,” he said. “I thought, ‘This is going to kill me.'”

Since his diagnosis, Swangard said he has had a greater understanding of his patients’ struggles. Occasionally, he holds their hands and tells them he has been where they are.

Earlier this year, a physician friend asked him if he’d be willing to join the California case. Swangard didn’t hesitate. He didn’t go into medicine to help dying people linger and wants to help change that approach — for his patients and for himself.

When he dies, Swangard said, he wants to be surrounded by people he loves. He doesn’t want to be in a drug-induced haze, nor consumed by worry about what’s next. He wants to be able to say goodbye.

“It is a little bit of a blessing to know how I might die,” he said. “I don’t think a lot of patients have insight into what to expect.”

These days, he wears a Buddhist prayer bracelet, a reminder to focus on the present. He cut his work hours, swims as often as he can and meditates regularly. At home, he stares out at the ocean, often watching dolphins pass by. He makes every effort to stay calm and healthy.

He is in remission but he knows that what happens with the cancer is largely outside his control. An MRI last year showed a small lesion in his liver, which doctors are watching closely.

“It’s this big unknown,” he said.

Dr. Robert Liner, a fellow plaintiff who only recently met Swangard, lives with the same uncertainty.

On his 69th birthday in May 2013, the retired obstetrician had a bad cough. He felt tired and short of breath. His wife took him to the hospital, where doctors discovered malignant masses on his kidneys — advanced-stage lymphoma.

After radiation and chemotherapy, the tumors shrank. He also is in remission. But if the cancer comes back, he said, “the prospects are not going to be good.”

He often thinks of a former patient, a 25-year-old woman with metastatic ovarian cancer. She wanted to die while she still was able to communicate. Liner wasn’t able to help ease her death because the law wouldn’t let him. “I felt like I’d failed her,” he said.

Years before his diagnosis, Liner, now 70, became involved with Compassion & Choices, an organization that promotes aid-in-dying. He has a shelf of books in his San Francisco home devoted to the subject: Being Mortal, Dying Right, Knocking on Heaven’s Door.

He keeps a stack of notecards with quotes about the end of life, which he often recites in speeches to church groups or senior centers. One reads, “The best preparation for death is a life well-lived.”

He believes having medication to hasten death helps terminally ill people live fully in their last weeks or months without being immobilized by fear. “If you are riddled with anxiety, you are not free to concentrate on what’s most meaningful to you,” he said.

Like Swangard, Liner doesn’t know if he would take the medication. He recently married the woman he calls his “beloved” and said he has lots of plans for his retirement years, including writing a screenplay and improving his piano playing.

“My wife says I’d be hanging on to life by my fingernails,” he said.

But that decision should be his to make, with his family and his doctor, he said. “I want the comfort of knowing it’s up to me when enough is enough,” he said.

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