Gov. Jerry Brown just signed a historic End of Life Option Act, sometimes called the right to die. It affects us all, since some day, we’re all going to die. Death is one of the few absolute certainties in life, and yet we all act as if it’s not going to happen, and certainly not today or tomorrow, but perhaps some time in the future … way over there, somewhere. That attitude about death way in the future doesn’t seem to be much related to age. You can be 38 or even 98 — it’s still going to be way in the future, you think.
But it does happen and there are a few things we can all do to ease the way — when that time comes, way in the future. The act the legislature passed and the governor signed allows a doctor to prescribe lethal doses of drugs to terminally ill patients. The truth is, it legalizes what often has been an unspoken understanding between the doctor and their patient or the patient’s family about the dosage that can be given. It typically comes in the form of the doctor saying “now be careful about how much pain medication you give because, above a certain level, it could slowly be fatal.”
California — along with many other states — has something called an advanced medical directive. There is a statutory form you can find online and fill out. You have a right in California to say what treatment you will and won’t accept. You have a right to refuse medication, to refuse a feeding tube if you can’t eat, to refuse oxygen, to refuse an IV drip, to refuse just about anything, even something as basic as an aspirin. You can decide who will be your agent (assuming you become incapacitated) and what their powers will be. Now they’ve added the right to die. It sounds like all the bases are covered, but believe me, despite all the laws, it’s a lot more difficult to exit this world than you think.
The first obstacle you face is your doctor. To many doctors, death is a failure — an enemy they spend their life battling. They have to be optimistic, they have to believe there is one more thing they can try, one more possibility, no matter how small the chance, that just might work. You and your family have to be certain, which means you have to talk to the patient and that is one very difficult conversation.
If you’re in a hospital, you practically have to have the instructions tattooed on your chest — or someone there as your advocate — otherwise, the system is going to spring into action at crises point and they’re going to resuscitate you, no matter how many DNR orders there are in your chart. On a personal level, I saw this happen with my mother who lived to three months shy of her 100th birthday. She lived in her apartment in Brooklyn, being taken care of by private caregivers. The visiting nurse would make her visit, hear a little distress in her lungs, perhaps the beginning of pneumonia, and immediately call 911. The ambulance would then take her to the hospital where they would pound her chest, give her massive doses of antibiotics that made her sick and, finally, after they got it all under control, send her back home to see the process repeated again some months later. It was sheer torture. When she was still lucid, my mother was very clear that this was not what she wanted, and if she had a voice, she would have pulled the plug in a nanosecond. Sadly, she had to go through this for several years until her body simply wore out.
I understand the people who opposed the End of Life law. Many feel life is sacred and this is not an appropriate choice for a human to make. Also, not all families are loving and caring, and there could be all sorts of nasty reasons to pull the plug on Grandma. It’s far from perfect, but the problem is technology. We have the capacity through modern medical technology to keep people alive with medical machinery for long periods of time. I suspect we are going to go through a difficult adjustment period with this new law, working out the details, but long term, I believe we did a good thing, and I intend to take advantage of the new law, sometime far, far in the future.