Thursday, California becomes the fifth, and by far the largest, state to allow physicians to prescribe lethal medications to terminally ill patients who request them. But like Oregon’s 18-year-old “Death With Dignity Act”, California’s “End of Life Option Act” is proving to be just as controversial among those who work with the terminally ill.
Patty Berg represented northwest California in the State Assembly from 2002 to 2008.
“My husband was a physician and died of a brainstem stroke in 1987,” she says. “And he would have begged me to end his life had he survived the stroke. I knew it.”
During her years in the legislature Berg tried and failed three times to pass medically-assisted suicide legislation.
“Because of the threat of the California Medical Association and medical associations in other states, and the Catholic church, and the disability community. Those three. It’s all about the money,” she says.
Then, this past year, for the first time ever, the California Medical Association adopted a ‘neutral’ stance. Many attribute this change of heart to Brittany Maynard, the 29-year- old terminal cancer patient who drew worldwide social media support in advocating for her own right to die. She exercised that right by moving to Oregon and ending her life on November 1, 2014.
By sheer coincidence, that was the same day Doctor Michael Fratkin started crowd-funding for what would become Resolution Care, a Eureka Palliative Care Clinic dedicated solely to “bringing capable and compassionate care for everyone, everywhere as life approaches completion.”
“I appreciate what the California End of Life Options Act means and signifies for our society,” Fratkin says. “We are waking up, we are turning our attention to the hardest and most difficult issue human beings face: their own mortality.”
But Doctor Fratkin - like nearly all the physicians I spoke with - stops short of unequivocally stating he would sign such a fatal prescription. He feels medically-assisted suicide will only be used by a very small number of people. A number he says doesn’t even come close to what he estimates are the nearly 400,000 Californians who qualify for palliative care, but less than one percent are actually receiving it.
Doctor Jennifer Heidmann is a geriatrician who agrees with Doctor Fratkin that palliative care is grossly underutilized. But unlike most physicians I spoke with she has no problem being unequivocal in her views regarding the End of Life Option Act.
“That’s a line I’ve never chosen to cross,” she says. “And I’m just worried about the slippery slope of using my trusted position to push someone faster toward the end of their life.”
Doctor Heidmann works with some of the most frail and at-risk elderly in Humboldt County.
“The main thing for me is the vulnerability of the people I care for. And the concern that expediting death is not tending to people who may be suffering in a way that feels like a safe thing for someone who has taken the oath that I took to do,” she says.
It’s not just the emotions of this issue that are compelling; so are the numbers. A recent Gallup Poll finds that 7 out of 10 Americans support medically-assisted suicide when the prognosis is dire and the pain unmanageable. Over the past 18 years under the Oregon law roughly two- thirds of those who get a lethal prescription actually follow through and ingest it. Most of these are cancer patients, college-educated, and just over 70-years- old. Most died at home and gave three reasons for following through: loss of dignity, a lack of joy and productivity, and the loss of autonomy. Again, Dr. Jennifer Heidmann:
“I understand why people think this is important as an option,” Heidmann says. “And I do support autonomy. But I think as a society we need to think about what it is about suffering around loss of the ability to be a super productive person. What is it about our society that makes that so intensely painful for us? And is there something more we could be doing to support each other?”
Palliative care specialist Michael Fratkin believes honoring choice is key to honoring autonomy.
“For me the best path for a person is the one they choose,” he says. “Whatever it is. Whether it’s Brittany Maynard, or somebody that wants to die 6 weeks later in an ICU with a tube down their throat. I’m most dedicated that they choose. That they have been informed. That they’ve been supported. That they’ve been held while they’ve sorted out their relationship to what’s really happening. And then made a choice. Their choice. Period.”
Eventually, Californians will get to decide whether or not the End of Life Option Act works as promised. Unlike the Oregon law which is permanent, the End of Life Option Act will be reviewed in 10 years and voters will decide if they want it to continue.
