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Who May Die? California Patients and Doctors Wrestle With Assisted Suicide Who May Die? California Patients and Doctors Wrestle With Assisted Suicide
(about 9 hours later)
LOS ANGELES — Beginning Thursday, California will be the fourth state in the country to put in effect a law allowing assisted suicide for the terminally ill, what has come to be known as aid in dying. Lawmakers here approved the legislation last year, after Brittany Maynard, a 29-year-old schoolteacher who had brain cancer, received international attention for her decision to move to Oregon, where terminally ill patients have been allowed to take drugs to die since 1997. LOS ANGELES — On Thursday, California became the fourth state in the country to put in effect a law allowing assisted suicide for the terminally ill, what has come to be known as aid in dying. Lawmakers here approved the legislation last year, after Brittany Maynard, a 29-year-old schoolteacher who had brain cancer, received international attention for her decision to move to Oregon, where terminally ill patients have been allowed to take drugs to die since 1997.
Oregon was the first state to pass an assisted suicide law, and was followed by Washington and Vermont. Under a Montana court ruling, doctors cannot be prosecuted for helping terminally ill patients die, as long as the patient makes a written request. With the California law, 16 percent of the country’s population has a legal option for terminally ill patients to determine the moment of their death, up from 4 percent.Oregon was the first state to pass an assisted suicide law, and was followed by Washington and Vermont. Under a Montana court ruling, doctors cannot be prosecuted for helping terminally ill patients die, as long as the patient makes a written request. With the California law, 16 percent of the country’s population has a legal option for terminally ill patients to determine the moment of their death, up from 4 percent.
In the states with assisted suicide laws, the number of people who request and take medication to hasten dying has steadily increased. In Oregon, for example, 16 people ended their lives under the law in 1998, and by 2015, that number had grown to 132.In the states with assisted suicide laws, the number of people who request and take medication to hasten dying has steadily increased. In Oregon, for example, 16 people ended their lives under the law in 1998, and by 2015, that number had grown to 132.
The California legislation is strict, intended to ensure that patients have thought through the decision and are making it voluntarily. Patients must make multiple requests for the medication and have a prognosis of less than six months to live.The California legislation is strict, intended to ensure that patients have thought through the decision and are making it voluntarily. Patients must make multiple requests for the medication and have a prognosis of less than six months to live.
Many hospitals have not yet released policies for dealing with the law. And no doctor, health system or pharmacy will be required to comply with a patient’s request. Doctors who object to the practice are not even required to refer patients who request the medication to another physician.Many hospitals have not yet released policies for dealing with the law. And no doctor, health system or pharmacy will be required to comply with a patient’s request. Doctors who object to the practice are not even required to refer patients who request the medication to another physician.
Roman Catholic and other religious health systems have said they will not participate. “We are crossing a line — from being a society that cares for those who are aging and sick to a society that kills those whose suffering we can no longer tolerate,” José H. Gomez, the Catholic archbishop of Los Angeles, said in a statement Wednesday.Roman Catholic and other religious health systems have said they will not participate. “We are crossing a line — from being a society that cares for those who are aging and sick to a society that kills those whose suffering we can no longer tolerate,” José H. Gomez, the Catholic archbishop of Los Angeles, said in a statement Wednesday.
Here is how two patients and two doctors are preparing for the new order.Here is how two patients and two doctors are preparing for the new order.
Kristy Allan, 63, lives in Placerville, where her small bungalow overlooks the lush foothills of the Sierra Nevada. With her athletic frame, she does not look like someone ready to die. But she has been under hospice care since the start of the year, having already undergone four rounds of chemotherapy since learning she had Stage 4 colon cancer in 2009. She has already talked to her doctors about her desire to get the medication that will allow her to die when she chooses, and she plans to make her request formal this week. She does not know with certainty when, or even if, she will take it. But she knows what would make her ready to do so.Kristy Allan, 63, lives in Placerville, where her small bungalow overlooks the lush foothills of the Sierra Nevada. With her athletic frame, she does not look like someone ready to die. But she has been under hospice care since the start of the year, having already undergone four rounds of chemotherapy since learning she had Stage 4 colon cancer in 2009. She has already talked to her doctors about her desire to get the medication that will allow her to die when she chooses, and she plans to make her request formal this week. She does not know with certainty when, or even if, she will take it. But she knows what would make her ready to do so.
Ms. Allan has already defied some predictions. When her 30-year-old daughter got engaged last spring, she wondered whether she would make it to the wedding. But she did, designing and sewing her mother-of-the-bride dress herself, and baking desserts for the reception.Ms. Allan has already defied some predictions. When her 30-year-old daughter got engaged last spring, she wondered whether she would make it to the wedding. But she did, designing and sewing her mother-of-the-bride dress herself, and baking desserts for the reception.
Ms. Allan has spoken to her husband and her two adult children about the decision.Ms. Allan has spoken to her husband and her two adult children about the decision.
Wolf Breiman, 88, who learned he had multiple myeloma seven years ago, does not know what will push him to the edge to ask for the medication. But Mr. Breiman, who lives in Ventura, relishes the idea of having the right to choose precisely when and where to die.Wolf Breiman, 88, who learned he had multiple myeloma seven years ago, does not know what will push him to the edge to ask for the medication. But Mr. Breiman, who lives in Ventura, relishes the idea of having the right to choose precisely when and where to die.
Dr. Sunita Puri, a palliative medicine specialist at Keck Medicine of the University of Southern California, is writing the hospital’s policy on the new law. To prepare, she asked her colleagues what they would do if their patients sought help in dying. While more than 60 percent of those she surveyed said they supported the legislation in theory, half of the doctors who responded told her they would not prescribe the medication themselves.Dr. Sunita Puri, a palliative medicine specialist at Keck Medicine of the University of Southern California, is writing the hospital’s policy on the new law. To prepare, she asked her colleagues what they would do if their patients sought help in dying. While more than 60 percent of those she surveyed said they supported the legislation in theory, half of the doctors who responded told her they would not prescribe the medication themselves.
Some health care systems will make a psychiatric evaluation a prerequisite for receiving the drugs. Dr. Puri has heard from many doctors who worry that they are not fully prepared to determine whether a patient is able to make the request to die, not suffering from depression or in the kind of pain that palliative and hospice care could alleviate.Some health care systems will make a psychiatric evaluation a prerequisite for receiving the drugs. Dr. Puri has heard from many doctors who worry that they are not fully prepared to determine whether a patient is able to make the request to die, not suffering from depression or in the kind of pain that palliative and hospice care could alleviate.
In Berkeley, Dr. Lonny Shavelson bristles each time he hears a doctor talk about discomfort with prescribing end-of-life medication. A former emergency room physician, Dr. Shavelson has just begun his own practice dedicated to providing care for those seeking to end their lives. Here is how he imagines talking to reluctant doctors.In Berkeley, Dr. Lonny Shavelson bristles each time he hears a doctor talk about discomfort with prescribing end-of-life medication. A former emergency room physician, Dr. Shavelson has just begun his own practice dedicated to providing care for those seeking to end their lives. Here is how he imagines talking to reluctant doctors.
Dr. Shavelson, who will charge patients $200 for an initial consultation and $1,800 if they move forward, said the most important response he would have for any patient who approached him was simple: Why? He believes the approach should not be different from any other aspect of medicine.Dr. Shavelson, who will charge patients $200 for an initial consultation and $1,800 if they move forward, said the most important response he would have for any patient who approached him was simple: Why? He believes the approach should not be different from any other aspect of medicine.