Californians finally have the option to seek assistance in choosing to end their lives.
The state passed a right-to-die law called the End of Life Option Act in this November’s election. Brittany Maynard, the terminally ill young woman whose passionate advocacy for end-of-life choice made her an icon of the right-to-die movement, would be pleased. But as big a step as this is, the law leaves much to be desired.
How it works
Four states currently have laws allowing the right to die: Oregon, Washington, Vermont, and now California. Based on the population of these states, 1/6 of Americans now have the ability to make their own choices about how and when they pass on. 45 states, however (as well as Washington, DC), still have laws making it a crime for a physician to assist a patient’s suicide.
California’s law permits terminally ill patients to obtain prescriptions for pain medication they can use to facilitate their own deaths. The process, sometimes called “death with dignity,” is patient-administered, not physician-administered, suicide. The patient chooses when, how, and if to use them to end life.
Under the California law, a patient must be diagnosed as terminal with less than six months to live. They must make two oral requests to the physician two weeks apart for a life-ending prescription. Additionally, the patient must submit a written request which has to be witnessed by two people who can attest the patient is of sound mind and is not under coercion.
California law has limits
Right-to-die proponents have several issues with the law. First, physicians often find it difficult to establish a precise timeline for a terminal illness; most tend to be optimistic in their diagnoses, making some patients ineligible for assisted suicide although they are certainly terminally ill. In Europe, similar laws allow assistance when the patient is experiencing what is usually called intolerable suffering, taking into account that even if life is expected to continue for some time, it is painful and unwelcome.
Because the law requires the patients to take the pills themselves without assistance, some people with degenerative illnesses (such as ALS) choose death earlier than they might truly want to, to ensure they are able to take the pills themselves. The law also leaves out those with dementia and Alzheimer’s, who suffer greatly but often have no specific short-term terminal diagnosis.
The missing piece
While the law in California and the other three right-to-die states do offer some patients an option, they also shine a light on one of the biggest problems in the US healthcare industry. Huge emphasis is placed on curative treatments, such as surgery, chemo, radiation, technology, as well as other painful—and many times unsuccessful—options. Meanwhile, little emphasis is put on palliative care that helps patients cope with a terminal illness and achieve a relatively pain-free death.
“I think it’s a moot debate that’s divorced from the reality of end-of-life care,” says David Magnus, a bioethicist at Stanford Medical School, who believes that there is a huge lack of doctor-patient communication about treatments available for illnesses. Physicians offer treatments without giving patients a complete view of the pain involved or the likelihood of success. A study in the Journal of Oncology found that with better communication more patients would choose hospice over radiation or chemo.
Taking matters into your own hands
Although you cannot plan ahead for every eventuality, having an advanced health care directive in place can make clear your wishes regarding pain management, feeding tubes, and all life-sustaining treatment. In addition, it is essential to talk to your family members and the people you choose to make decisions for you. “They need to know what your wishes would be so they can honor them,” says Leslie Fried, senior attorney at the American Bar Association’s Commission on Law and Aging and director of the Alzheimer’s Association’s Medicare Advocacy Project.
A few tough conversations now can save you—and those who love you—from experiencing unnecessary confusion, doubt, and pain later.
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