In 2016, California became one of just five states where a person can legally choose to end his or her own life, after the End of Life Option Act became law. Passed in 2015 during a special session of the California legislature, the act gives patients the ability to ask a physician for a special prescription with a singular, controversial purpose: to commit suicide due to terminal illness. The act has thus far produced 191 prescriptions, with 111 patients following through as of its first six months being on the books.
On Saturday, Oct. 21, in Ojai, California State University, Channel Islands, Associate Professor of Health Science Carol Mack, Ph.D., J.D., R.N., will present “New Option at the End of Life,” a talk on the subject of physician-assisted suicide, as part of the university’s Library Lecture Series.
VCReporter: Tell us about the “Death with Dignity” campaign.
Professor Mack: The idea is that if you have a terminal illness and you’re in a lot of pain and you want to exit, then you should be allowed to do so with the help of medical science. It got a fresh start with Brittany Maynard, the young woman who went to Oregon in order to take advantage of their death-with-dignity law because she had terminal brain cancer.
What is the End of Life Option Act?
For people who have a terminal diagnosis and six months or less, they can request that their doctor give them so-called aid-in-dying drugs, which is essentially an overdose in sleeping pills. They can request that, after going through a number of legal hoops, and can be given that prescription and choose to end their life whenever they choose.
Does it hurt?
Most people lose consciousness pretty much right away and then die within a half an hour.
You’re going to discuss challenges that the law presents during your lecture. Please elaborate.
One concern, and by the way I’m a nurse as well as an attorney, is that by law, only the person who is terminal can request the aid-in-dying drugs, and that person has to be able to take it themselves without anybody giving it to them. So one issue is that if someone has a disability where they can’t do that, they can’t participate, which may or may not be an issue. My main concern is that, even though the law contains penalties for so-called undue influence, which is somebody exerting their influence over someone else, that is very difficult to prove in a court of law and it’s likely to happen. Even if that doesn’t happen, in my opinion, it’s likely that some patients will choose to end their life rather than be a burden on their family.
Let’s talk about your first concern; how do you address the inability of the disabled to take advantage of this law?
There’s no penalty for another person being present when you decide to take the pill but there are criminal penalties if someone gives you the medication. You have to be able to take it yourself; that’s just the bottom line. There was an artist in Ojai who chose to exercise her right to die like this and she had Lou Gehrig’s disease. I can only assume that her concern was that she would reach a point where she wouldn’t be able to [do it herself]; that’s an assumption on my part. If she lost that capacity then she wouldn’t be able to exercise that option.
What is “undue influence”?
There’s a legal definition of undue influence and it is that when a stronger person exerts their influence over a weaker person, so the weaker person does something they wouldn’t have done otherwise. It’s often the case with types of elder abuse, where a younger person moves in on the elder, befriends them and suggests that they might want to change their will; but in a court of law it’s difficult to make determinations. In this case, there would be no recourse if the person had already taken the pills.
It sounds as if this law could never be perfect.
There are a lot of safeguards built into this law. Physicians do not have to participate, patients don’t have to take it, they have to make two verbal requests and a written request, and it takes two physicians to agree that a patient has a terminal diagnosis. The one thing missing in the law is that it says that the physician who gives the drugs or prescribes them, if he thinks that the patient has mental issues then they can request a mental evaluation, but it’s not required. It’s up to the primary care physician to decide if that’s needed.
Do you think that a mental health evaluation should be required?
I do, yeah.
Do you have any other concerns with the law?
If you look at the people who have participated, they were white, well-educated and had good insurance coverage, so in my mind you have to ask why have people of color, people of lower economic status not taken advantage?
Is it expensive?
[The pills] are expensive. I don’t know how much exactly, but I have heard that they are about $3,000 for the dose.
Is it covered by insurance?
I believe it is by some, and I find this very amusing: There’s a provision in the law that makes it illegal for an insurance company to send you a letter that says, we’re not going to pay for your treatment anymore but you might want to take advantage of the End of Life Act.
Mack will present “New Option at the End of Life” 1-2:30 p.m. at the Ojai Library, 111 E. Ojai Ave., Ojai. For more information, visit www.go.csuci.edu/librarylectureseries.