Because it can be hard to discuss death and the decisions around it, hospitals and medical staff encourage the use of advance care directives. However, many people still wonder whether their directive for a peaceful death will be respected.
The difficulty in discussing the topic prompted the Rotary Club of Los Altos to invite Kim Callinan, CEO of the nonprofit Compassion & Choices, to speak at the club’s May 2 meeting about the work her group does to improve end-of-life care options.
One Rotarian said her father had clearly stated his end-of-life wishes to avoid extended pain, but his wishes had not been respected; the attending physician left it up to the family to decide whether the doctor would assist in his passing.
According to Callinan, Compassion & Choices advocates for legislation allowing terminally ill adults to get a doctor’s prescription for medication they can decide to take if their suffering becomes unbearable, enabling them to die peacefully in their sleep. Currently, eight states and the District of Columbia have authorized medical aid in dying via ballot initiatives, court orders or legislation: California, Washington, Oregon, Montana, Colorado, Vermont, Hawaii and New Jersey.
Samantha Trad, state director of Compassion & Choices, gave an overview of California’s End of Life Option Act, which authorized medical aid in dying for terminally ill patients in 2016. Trad said California’s law will expire in 2026, so ongoing lobbying on the issue is important.
In 22 other states, Compassion & Choices has developed public education campaigns supporting medical-aid-in-dying legislation. Similar legislation has been under development in 18 additional states.
Callinan said the vision of Compassion & Choices is to be “a society that affirms life and accepts the inevitability of death, embraces expanded options for compassionate dying and empowers everyone to choose end-of-life care that reflects their values, priorities and beliefs.”
To be eligible for an aid-in-dying option, an individual must be a state resident, an adult over 18, terminally ill, given a prognosis of six months or less to live, and mentally capable of making his or her own health-care decisions. In addition, the patient must be given information about all other end-of-life care options, and informed that he or she can decide not to take aid-in-dying medication at any time.
State law also requires two California physicians to agree that an individual is eligible to use the end-of-life option. The individual must make three voluntary requests, including two oral requests at least 15 days apart and one written request (not via an advance directive) to the physician.
If a terminally ill person uses medical aid in dying, the death certificate does not list the underlying, terminal disease as suicide, according to Compassion & Choices representatives. This is for insurance, legal, disease-tracking and research purposes.
The forms required for use of the law are posted on the California Department of Public Health website at cdph.cagov/Programs/CHSI/Pages/End-of-Life-Option-Act-.aspx.
The website compassionandchoices.org/california offers information, including an online Find Care tool, suggestions on how to talk to a doctor and interview a hospice about medical aid in dying, as well as a Doc2Doc confidential phone number that physicians can call for support in prescribing medical aid in dying.
Marlene Cowan is a member of the Rotary Club of Los Altos. For more information, visit losaltosrotary.org.