New California law simplifies the end-of-life assistance process


During her three-year battle with breast cancer, my wife Leslie generously endured multiple rounds of terrible toxic treatments in order to have more time with our two young children.

But after 18 months of cancer-free, the disease made a comeback in June 2003. It fractured her bones and invaded her spinal canal, bathing her brain in a malignant tumor.

In the last six months, when she was lying on the hospice bed at home, she often felt pain, instilled morphine 24/7, and lost her eyesight and withered into bones. The idea of ??ending her pain by ending her life did not “or even participate in it.” Our conversation.

When I was studying California, I kept thinking about those bleak days End-of-life choiceIt allows terminally ill patients whose life expectancy is less than six months to end their lives by taking drugs prescribed by their doctors. In October, Governor Gavin Newsom signed a Modified version It was extended to January 2031 and some restrictions were relaxed in the 2015 version. Supporters say these restrictions have become obstacles to dying people who want to take advantage of the law.

The original law, which is in effect until January 1, contains many safeguards designed to ensure that patients are not coerced by family members who see them as a burden or potential financial wealth.

According to the current law, patients who want to die must make two oral medication requests at least 15 days apart. They must also request the medication in writing, and the two doctors must agree that the patient complies with the law. After receiving the drug, patients must sign a form to confirm their intention to die 48 hours before taking it.

Patients must take these medications without assistance, either by swallowing the medication into a drink or pushing a plunger connected to an intravenous or feeding tube. The doctor can refuse to prescribe lethal drugs.

After the law took effect for some time, its supporters and practitioners concluded that certain safeguards prevented certain patients from using this option.

Some patients were so sick that they died within 15 days of waiting between the first and second request for medication. Others are too weak or disoriented to sign the final certificate.

The revised law shortened the 15-day waiting period to two days and cancelled the final certification.

It also requires medical institutions to publish their end-of-life assistance policies online. Doctors who refuse to prescribe medication-whether in principle or because they feel unqualified-must record the patient’s request and forward the record to any other doctor designated by the patient.

Supporters say that the most important part of the new law is to shorten the waiting period.

PhD.Chandana Banerjee, Clinical assistant professor specializing in palliative medicine City of Hope The National Medical Center in Duarte, California, said she has seen many patients who are afraid to bring up their own death themes near the end of their lives.

“When they made their first request and had to wait for those 15 days, they either became completely hesitant or fell into a coma or died,” Banerjee said.

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Amanda Villegas, 30, from Ontario, California, became an outspoken advocate of updating the law after witnessing the painful death of her husband Chris from metastatic bladder cancer in 2019.

When the couple asked about the possibility of the doctor’s assistance in the death, Villegas said that the staff at the Seventh-day Adventist Hospital where Chris was being treated wrongly told them that it was illegal. When he finally applied for the lethal drug, it was too late: he died before the 15-day waiting period ended.

The new law “will open the door to those who might… encounter the same obstacles,” Villegas said. “When you are about to die, the last thing you need is to get peace through bureaucratic obstacles.”

End-of-life medical assistance and abortion cross the same political fault line, and have long been opposed by many religious institutions and anti-abortion groups.Also met with resistance from all sides Disability rights organizations Claims that it degrades the lives of those who are physically dependent on others.

“We oppose the whole idea of ??the state providing people with suicide tools,” said Alexandra Snyder, chief executive of the Life Legal Defense Foundation, an anti-abortion non-profit law firm. She said that the 15-day waiting period provides an important cooling-off period for patients to reflect on an irreversible decision. “Now, there are no legal safeguards.”

Proponents of the law say they have not seen evidence that the patient’s decision to take life-threatening drugs was not voluntary.

Dr. Lonny Shavelson, president of the American College of Medical Aid Clinicians for the End of Life, said that although neither version of the law requires a medical professional to be present when the patient takes the medication, medical standards encourage professionals to participate in the end-of-life process. He said these drugs should be kept in the pharmacy until the patient is ready to take them-although this does not always happen.

According to the data from the “Law to Rescue the Death and Heal the Wound”, from the effective date of June 2016 to December 31, 2020, of the 2,858 people who received prescriptions, less than two-thirds actually took the drug and died. The latest data From the California Department of Public Health. The rest died before taking drugs or finding other ways to manage pain and emotional distress.

Most major commercial health plans—including Kaiser Permanente, Anthem Blue Cross, Blue Shield of California, and Health Net—cover emergency medicines and related doctor visits, as well as Medi-Cal, a government-run health plan Insurance plan. And low income.

However, more than 60% of people taking these drugs are on Medicare, and Medicare does not cover these drugs. An effective life-terminating drug combination is only $400.

If you are considering medical assistance for death, please talk to your doctor as soon as possible in case you need to seek help from another doctor. If your doctor agrees to help, he or she is required by law to discuss other end-of-life options with you, including hospice and palliative care.

State Senator Susan Egman (D-Stockton) said that no matter what choice patients make, it is important to be open to our mortality rate. He is the author of the revised law on life-saving.

“We should all have more conversations about life and death, what we want and what we don’t want, and what is peaceful death,” she said. “We will all die.”

Leslie and I had a lot of these conversations until the cancer finally took her mind.

In the last few months of her life, she often fell into a semi-coma and stayed away from us for several days. Then, just when we thought she would not come back, she suddenly opened her eyes and asked the children. She would sit in her wheelchair and sit at the dining table with us.

Those times we call “Awakening” are a great comfort for everyone who loves Leslie-especially for the children, who are so relieved and ecstatic that their mother has returned.

Although I can never be sure, I doubt that Leslie would not want to foreclosure at such a moment.

Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.



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