“The greatest human freedom is to live, and die, according to one’s own desires and beliefs. From advance directives to physician-assisted dying, death with dignity is a movement to provide options for the dying to control their own end-of-life care.”
-Death With Dignity

A new end-of-life law recently passed the California Senate and is now seeking support from the Assembly (SB 128). It attempts to honor our evolving humanity to meet our 21st century end of life circumstances by giving us the choice to end our lives earlier than the normal time span of our terminal diagnosis. As an estate planning attorney for over 15 years, I’ve had the privilege of experiencing the death process with thousands of clients and their families. Almost 20 years ago, through the Georgetown Law Center Clinic, I drafted and successfully lobbied the passage of the Assisted Suicide Prevention Act at the Federal level. It was intended to provide resources to individuals who, if given a wheelchair, a computer or whatever they needed to have hope of being able-bodied enough to have a meaningful life, they would no longer request physician-assisted suicide. That law passed but was never funded.

 

The following are my reflections in hopes of grappling with the practical and spiritual dimension of whether at the end of life, I would choose to “opt out” of the death process. It is my intention to set aside any moral judgment, so that I can identify the practical pros and cons, while still honoring various spiritual benefits of the death process. My hope is that each of us can decide for ourselves based on our particular circumstances and spiritual beliefs. I believe that proper regulation of the law can ameliorate its potential abuses against the less able bodied and most frail members of our community. I don’t think we should outlaw fire just because a few of us will get burned.

 

This topic is like playing with fire because while choosing the moment of our death has always been available, for many, it continues to carry a heavy moral burden with dire consequences. Those who commit “suicide” are sometimes thought to go to hell in the afterlife and sometimes can’t be buried with their family members. These beliefs have serious consequences. My 34 year old brother literally died of a broken heart when he found out our father had cancer because he believed that my father would not go to heaven with the rest of us.

 

When my grandfather was diagnosed with pancreatic cancer (one of the most painful types), he packed up his boat, said goodbye to his family and headed out to sea by himself — to die alone from starvation and dehydration. A few days later, he returned, and died a painful and prolonged death. My mother remembers staying with him in the hospital for weeks instead of spending Christmas with her 2 small children and husband. She didn’t want him to die alone. My father, a talented doctor, could not bear the fact that he had “failed” to keep his father out of pain and himself became suicidal. My father made it through the crisis and eventually became a hospice volunteer. It is stories like these that make this conversation REAL.

 

It is still a “crime” in this state to take your own life, and just talking about it can land you in a mental institution against your wishes. Those who would assist us at the end of life risk being jailed for murder. So, those who choose this route must do so alone. I remember our much loved mayor who took his life alone in his living room after being diagnosed with cancer. It was a violent end, one I’m sure his family will never forget. He’s not alone in his choice, however. I’m sure than we’ve all heard of someone who after being diagnosed with a terminal illness decided to take the process into their own hands.

 

Most doctors get very little training in end of life comfort care because their whole philosophy has been to avoid death of a patient at all costs. Hospice workers walk a razor’s edge of administering enough pain medication to keep us comfortable but risk over medicating us which could cause our death.

 

In this blog series, we will continue to discuss the moral, ethical and legal implications of such legislation, and what it means for Americans today. Stay tuned for part 2!