California Legislators Reintroduce End of Life Option Act

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On Tuesday, California Assembly Members Susan Talamantes Eggman, Mark Stone, and Luis Alejo introduced the California End of Life Option Act in their chamber of the state legislature. The bill is nearly identical to Senate Bill 128, sponsored by Senators Bill Monning and Lois Wolk and passed by the Senate on June 4, with amendments fine-tuning the process of obtaining medications.

The bill will head next week to a special Assembly Health Committee, established by Governor Jerry Brown for an extraordinary legislative session to consider pending healthcare issues. This means that AB 2X-15, the amended End of Life Option Act, will not have to go through three committees as it did in the Senate. Instead, the bill will only have to be heard in the one special committee and reviewed by a fiscal-impact committee.

Californians, now is the time to urge your Assembly Member to support this important Death with Dignity-style bill. Please send this letter urging them to move the bill forward.

You may have heard opponents of Death with Dignity in California rejoice when the Senators pulled the bill from Committee due to lack of support. The detractors claimed the bill was dead. In reality, the Senators went back to work on the bill and the revised version addresses the concerns of a few hesitant Assembly Members. The Assembly will have until September 11 to approve the bill.

In recent weeks, judges in San Diego and in San Francisco dismissed two separate lawsuits which challenged California’s assisted dying statute; both judges stated that the issue whether Californians have the right to use a Death with Dignity law should be decided by the California legislature. This is why it’s now even more important the bill moves forward in the Assembly.

If you are a Golden State resident, let your Assembly Member know that every Californian, if faced with a horrible death from a terminal illness, deserves to die peacefully at the time and place of their choosing. Send him or her this letter today.

With your help, we are confident the bill will pass. As always, we are grateful for your advocacy efforts.

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California Senate Approves End of Life Option Act in a Monumental Step Toward Death with Dignity

This is a press release we issued in connection with the California Senate vote on SB 128. For more information, contact Peg Sandeen at 503.228.4415 or Peter Korchnak at 503.501.2461.

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The Death with Dignity National Center today applauds the California Senate for [resoundingly] approving Senate Bill 128 – End of Life Option Act, which will allow terminally ill adults with six months or less to live the right to obtain a prescription medication to end their pain and suffering. The bill passed on a 23-14 vote, and now heads to the State Assembly.

Our political arm, the Death with Dignity Political Fund, has been integral in drafting and promoting the bill, underscored to our Executive Director Peg Sandeen. “We are pleased to see our work culminate in this historic vote, a monumental step toward providing Death with Dignity as as end-of-life option for qualified Californians.”

One such state resident, retired San Diego-area community college instructor, Steve Mione, said, “I am grateful to the California Senators for passing the End of Life Option Act. When my terminal melanoma moves to Stage 4 and I will have less than 6 months to live, I will want the option to choose death with dignity. I want to be alert, to say goodbye to my loved ones, and to fall asleep and die peacefully. It’s my right, knowing my end is imminent, to choose a merciful death. It comforts me that the Senators voted to provide me and my fellow Californians with this option.”

Providing peace of mind and control for the terminally ill while safeguarding against coercion for those who are vulnerable, SB 128 is closely modeled on the Oregon Death with Dignity Act.

Death with Dignity National Center’s Vice President George Eighmey said, “Our testimony on the 17 years of flawless implementation of Oregon’s law not only refuted the opponent’s unfounded allegations, but convinced many senators that having a similar California law would provide their constituents with the full range of end-of-life options.”

The Death with Dignity National Center expressed gratitude to the bill’s sponsors, Senators Monning and Wolk, for garnering the necessary support in the Senate to pass SB 128.

“Polls show overwhelming—and growing—support for physician-hastened dying,” said Sandeen. “The time is right for California to adopt this law.”

Mione concurred, saying, “I urge the California Assembly to follow the Senate’s lead and swiftly pass the End of Life Option Act.”

Image by < a href=”https://flic.kr/p/3eZk7G” target=”_blank”>Josh Mazgelis

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Faith and the End of Life

This guest post is from Barbara Karnes, award-winning end-of-life educator and nurse who has been instrumental in creating the patient/family educational booklet for hospice. A former hospice nurse, director, and consultant, Barbara is the author of the booklets A Time to Live: Living with a Life Threatening Illness; Gone From My Sight: The Dying Experience; The Eleventh Hour: A Caring Guideline for the Hours to Minutes before Death; My Friend I Care: The Grief Experience; the book The Final Act of Living: Reflections of a Long Time Hospice Nurse and a family-oriented DVD/booklet kit New Rules For End of Life Care. She blogs at Something to Think About.

The definition of the word faith from the Free Merriam-Webster Dictionary is:

  • fidelity to one’s promises; sincerity of intentions;
  • belief and trust in and loyalty to God;
  • belief in the traditional doctrines of a religion firm belief in something for which there is no proof;
  • complete trust.

Approaching the end of our life generally promotes questions and searching about purpose, meaning and the direction our life has taken. Any of the above definitions for faith apply to our end of life search. These thoughts may not be shared with anyone but I believe we ask ourselves questions like: What have I done? Whom have I touched? What has this life been about? What is my belief about an afterlife? And, if a belief in God has been a part of our life, have I lived up to the expectations I believe are a part of a relationship with God?

Because our relationship with God, or absence of a relationship with God, is very personal it is not up to outsiders to try to influence that relationship unless asked. The operative words here are “unless asked.” Facing the end of life is not the time for conversions or saving, again, unless asked.

Because on many levels we are asking meaningful questions about the course our life has taken, major spiritual work takes place. The person approaching death does this work as the dying process progresses and withdrawal from this world reaches a place of introspection. It appears people are merely sleeping when really they are doing perhaps the most important work of their lives—figuring out what their life has been about.

The approach of the end of our life is a personal search and not a place for others to share their beliefs unless, of course, we are asked.

With people of the same religion, same beliefs, such as with members of a church, synagogue, mosque, shrine, or temple, in the months before death spiritual conversations are helpful if they are initiated by the person facing death. Some people welcome conversations, others prefer to find answers from within.

We must always respect a person’s choices. Remember, we approach this final challenge in our life in the same manner we have approached all of our challenges. If a belief in God or a specific religion was not a part of living our life our beliefs will probably not change now. I will add that sometimes we will return to the religion and belief we had when we were younger but this doesn’t seem to happen enough to really count on it.

There are many paths to self discovery. Religion is but one path. I walk a broader path in the hopes that each of us, regardless of our beliefs, may experience compassionate end of life care.

Image by Where Is Your Toothbrush?

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Life with Dignity

This guest post is from Karen Kaplan, who in 1992 became one of the the first 200 female rabbis in the world. In 2007 she became a board-certified chaplain and served in hospices on the East Coast for 7 years. She is the author of the book Encountering The Edge: What People Told Me Before They Died which consists of true quirky stories about her hospice patients and what they most cared about and believed in (the book is available on Amazon and wherever books are sold, as a softcover or as an ebook; excerpts and reviews are available at the website of Pen-L Publishing.). Karen also blogs at Offbeat Compassion.*

Being a healthcare chaplain is like being a detective. When a person on hospice talks with me about dying, I immediately want to hunt for what is beneath the surface. How are they talking about it? Why during this particular visit? What are they not saying? If they are asking to die ahead of schedule, I especially want to help them express what is driving this wish. I cannot help but wonder if some people who opt for a doctor-assisted death would no longer find it compelling if they only had the right venue to (1) unbury unresolved emotional and spiritual distress, and (2) to fully understand it and fully feel it by relating it out loud to a nonjudgmental listener who is willing to receive it. I strive to provide that safe and sacred place.

Providing Life with Dignity

Such a place is rarer than we might expect. Almost anyone we talk to has their own agendas, their own emotional baggage, their own anxieties and discomforts. Most people rather talk than listen. We all know that, because when we are trying to talk about something that triggers strong emotions, we do not get very far without being interrupted. Even worse, the content of their interruptions often minimize or otherwise dismiss our feelings. Thus many people are deprived of the dignity of having their feelings honored. As a chaplain and as a hospice chaplain in particular, my aim is to provide life with dignity such that terminal patients will more likely be emotionally and spiritually at peace when they die. I think society should advocate for more of such care as yet another safeguard against a doctor-assisted death that need not happen. As much as the death with dignity movement wants to ensure a dying person’s legal rights to have control over his or her death, I do think it is their duty to put at least as much energy into ensuring all other alternatives have been exhausted. Thus, for example, properly trained chaplains for end-of-life care should be funded not just for hospice patients but for anyone facing death who is not on hospice and who wishes to talk with one.

The last time I was invited to write for this blog, I answered the editor’s question about why I chose to write my career memoir, Encountering The Edge: What People Told Me Before They Died. This time I would like to share an excerpt from this book that shows how one of my patients, who I will call Mrs. Wilson, grappled with her search for meaning as she discussed her own end.

From Encountering The Edge

I had a 97-year-old patient who could be witheringly blunt about her concerns about her own death as well as just about everything else. Mrs. Wilson usually turned down my offers to visit, but accepted just often enough for me to keep trying as I made my rounds in the assisted living section. Her refusals were very abrupt and off-putting, so I had to coax myself to keep giving a knock on her door and not give up. One day she was seated by a small round table sorting through her mail, and deigned to let me in “for a few minutes but that’s all.” She delegated the task to me of throwing away each rejected piece one by one. (Apparently they and not I were the object of rejection that day.)

Mrs. Wilson was mourning her own end, which she could not have been blunter about. She assailed me with question after question concerning her impending nonexistence. It was all I could do to force myself to keep my eyes on her face and not hem and haw. Looking at me as if ready to confirm I would disappoint her by having no answers, she asked, “How do I prepare to die? What do I tell my children?” I talked of reviewing loose ends in relationships and of pondering her legacy, but she rejected those options as readily as the doomed pieces of mail. “I have no loose ends to resolve,” she retorted. Given some mutterings over certain family members during former visits, I knew this was hardly the case. But there was no reason to challenge her. Furthermore, I believe that some of the things chaplains and social workers and therapists say to the people they serve are like time capsules. After the visit is long over, the patients may choose to release those words into their consciousness. Words that initially were jarring can soothingly cleanse away hurts that had been held in bondage for a good period of time. Before I left, she went on to say that my responses to her questions confused her. So she was already considering the provocative implications of my answers, while I was left wondering what she had hoped to hear me clarify.” (When I saw her a few weeks later, she had stopped putting up barriers to our interaction, acting more kindly than I had ever seen.)

The Final Lap

This particular excerpt is clearly not about someone who wants to have help with an early death. But it does show the complexities and ambiguities involved in making sense of our current and past life against the poignant drama of knowing we are in the final lap. May we not be too hasty in procuring our own end lest we miss out on some of the most significant scenes before the final curtain descends.

* This blog posts does not constitute Death with Dignity National Center’s endorsements of these publications. All subheadings are ours, not the author’s.

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California Senate Judiciary Committee Passes SB 128 – End of Life Option Act

The California Senate Judiciary Committee on April 7 approved Senate Bill 128 – California End of Life Option Act by a 5 to 2 vote.

With the vote, California took another step towards providing Death with Dignity as an end of life option to its 39 million citizens.

We applaud Senators Lois Wolk, Bill Monning, and others for sponsoring legislation whose time has come. We were pleased to play an integral role in the drafting and deliberations of the bill, and honored to speak before the Committee on the Oregon experience and our exemplary implementation of the law.

The End of Life Option Act will next be considered in the Senate Appropriations Committee, with a hearing to take place in May. In the meantime, we will continue to work with the bill sponsors to promote the bill’s passage.

Help make this bill become law!

  • Thank the Senators voting Aye. The bill moved out of this committee by a vote of 5 to 2, along party lines. Please contact Senator Hannah-Beth Jackson (Chair, D-Santa Barbara and Ventura Counties), Senator Robert M. Hertzberg (D-LA/San Fernando), Senator Mark Leno (D-San Francisco/San Mateo), or Senator Bob Wieckowski (D-Fremont/Alameda and Santa Clara Counties) (Senator Bill Monning, SB 128 co-sponsor, also voted in favor) to exppress your appreciation for their vote, especially if you live in their district.
  • Thank the bill sponsors. Call, email, or send a letter to SB 128 sponsors, Senators Bill Monning (D-Carmel) and Lois Wolk (D-Davis) in appreciation of their leadership on the issue. Or use our online Thank You card below.
  • Share your story. Heartfelt personal stories were a crucial part of the Committee testimony in favor of the End of Life Option Act. Please fill out this simple form to let us know how you got involved in the Death with Dignity movement or why you support California’s proposed legislation.
  • Make a contribution. We remain optimistic the law will pass, but for that to happen we need your support. It is thanks to you that we are able to do our work in promoting Death with Dignity laws in California and elsewhere. Your gift will stay in California and help promote SB 128 as it moves through the legislative process. Thank you.

About SB 128 – California End of Life Option Act

The California End of Life Option Act closely follows the model of the Oregon Death with Dignity Act with some modifications, most of which are required to comply with the California statute. Similar to the Oregon law, the California End of Life Option Act provides that only qualified, terminally ill adults who are residents of California may request and obtain prescriptions from their physician for medication that the patient has the capability to self-administer. A person may not qualify solely because of age or disability.

In order to receive the prescription the terminally ill patient is required to have two physicians confirm the patient’s prognosis of six months or less to live and that the patient has the mental competency to make health care decisions for him or herself. Two oral requests to be made to a physician, a minimum of 15 days apart, in addition to one written request with two witnesses attesting to the request before the prescription can be written.

In addition, the proposed bill includes voluntary participation by doctors, pharmacists and healthcare facilities, safeguards against any coercion of patients by establishing felony penalties for coercing or forging a request, and a patient’s right to rescind the request.

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California Senate Health Committee Approves SB 128 – End of Life Option Act

Image: California Senate Health Committee hearing on SB 128

“Some years ago, my precious brother Jeff died a death I would not wish on anyone. Yesterday my spirits were lifted.

At the Senate Health Committee Hearing on SB 128 – California End of Life Option Act, I was privileged to witness the powerful testimony of families who, like my own, had to stand like giants in a moment after they were just ordinary people. Those brave people who provided testimony in support of SB 128 spoke for their loved ones. And they stood for us all.

It was a landmark day in California as the Senate Health Committee approved SB 128. This is one of several hurdles the bill faces, but California is poised to catch up to Oregon in this push for greater choice in how we meet end of life challenges.”

This first-hand account from the California Senate Health Committee Hearing on SB 128 – California End of Life Option Act comes from our supporter Kate P., a Sacramento, California, resident.

It was, indeed, an emotional hearing. Along with hundreds of others in attendance, I was moved by the powerful personal testimonies. These stories highlighted what we know from the Oregon experience: Death with Dignity as one of several end of life options provides peace of mind and control for the terminally ill while safeguarding against coercion for those who are vulnerable. SB 128 would allow patients who are mentally competent and have fewer than six months to live, as determined by two physicians, to obtain prescriptions for medication to end their lives in a humane and peaceful manner, while protecting the vulnerable with strict guidelines and procedures.

Yesterday afternoon the California Senate Health Committee approved the proposed Senate Bill 128 – California End of Life Option Act. I was pleased to be instrumental in working with both bill sponsors, State Senators Lois Wolk and William Monning, to craft the law.

You can help to make this bill become law:

  • Thank the bill sponsors. Call, email, or send a letter to SB 128 sponsors, Senators Monning – D-Carmel, and Wolk – D-Davis, in appreciation of their leadership on the issue.
  • Thank the Senators voting Aye. The bill moved out of this committee by a vote of 6 to 2 along party lines. Contact Senators Hernandez (D-LA/West Covina, Committee Chair), Hall (D-LA/South Bay), Mitchell (D-Culver City), and Roth (D-Riverside), particularly if you are in their district, to express your appreciation for their courageous vote.
  • Share your story. Heartfelt personal stories were a crucial part of the testimony in favor of the End of Life Option Act. Let us know how you got involved in the Death with Dignity movement or why you support California’s proposed legislation by completing this simple form.
  • Make a contribution. We remain very optimistic the law will pass, but for that to happen we need your support. It is thanks to you that we are able to do our work in promoting Death with Dignity laws in California and elsewhere. Your gift will go a long way in promoting SB 128 as it moves along through the legislative process. You can make the difference. Thank you.

The End of Life Option Act will next get a hearing in the Judiciary Committee on April 7. We’ll be there again, continuing to work with the bill sponsors to promote the bill’s passage.

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Exclusive: A summary of the announcement of End of Life Option Act in California

As we recently wrote, our representatives attended the announcement on January 21, 2015, of the End of Life Option Act in the California State Capitol. A recording of the 45-minute long press conference is available online. Today we bring you an exclusive summary, including our introduction. Please take a few minutes to watch the video and share your thoughts in the comments.

The Announcement of California End of Life Option Act from Death with Dignity National Ctr on Vimeo.

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End of Life Option Act Introduced in California

Press Conference Announcing End of Life Option Act at California State Capitol, 1/21/2015

Representatives from Death with Dignity National Center attended the announcement of the End-of-Life Option Act at the California State Capitol in Sacramento on Wednesday, January 21, 2015. Sponsored by Senators Wolk and Monning, Senate Bill 128 provides peace of mind and control for the terminally ill while safeguarding against coercion for those who are vulnerable. We are pleased to have worked with Senators Wolk and Monning to draft the proposed California legislation, the End of Life Option Act, and we will deliver our political and strategic experts who have worked successfully to pass legislation in Oregon, Washington, and Vermont to assist the California efforts.

George Eighmey, DDNC Vice President, said: “We are proud to be here today to support Senators Wolk and Monning as well as the people of California, in proposing a Death with Dignity law to provide a peaceful and dignified death for those suffering from terminal illnesses. The time is right for California to adopt this law.”

The Golden State has always been a leader in progressive policy reforms protecting individual rights. Thanks to this leadership, our movement traces its earliest roots to California, as the Death with Dignity National Center was founded here in 1993. We were proud to join these efforts yesterday.

Watch the full press conference below:

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Demystifying Death: A Life Moment

Photo by Alex Dodd
Photo by Alex Dodd

Stacey Tinianov is a caffeine-powered working mama and shiny object follower, runner, suburban environmentalist, cyclist, breast cancer ass-kicker, and empowered patient advocate. Follow her on Twitter, @CoffeeMommy.

Several weeks ago, my almost 13-year old daughter sat in the backseat as I drove her to a sports activity. Frequently, as she nears her teen years, this drive time is spent in silent meditation (aka: ignoring Mom’s questions about the day) but occasionally, we sing along together to the radio.

Without exception, my favorite days are the days she peppers me with questions that instigate an open dialogue.

“What do you think happens when you die?” she asked as if she were asking what we were having for dinner.

“What do you think happens?” I asked back immediately. The verbal sidestep is a typical mom move designed to create the opportunity to hear her untainted view as well as give myself time to think about my own answer.

She was patently unmoved by my attempt to deflect.

“I asked you your opinion,” she deadpanned and we locked eyes in the rearview mirror.

“Well,” I stammered thoughtfully, “I don’t exactly know.”

It wasn’t as if I hadn’t given a great deal of thought about the process of dying and what comes after death. We have said goodbye to several close friends and family members recently and the topic has been at the top of my mind.

“Some people believe in an afterlife, some people believe in reincarnation, some people believe that dead is dead and life is simply over,” I paused. “I suppose that since energy can neither be created nor destroyed, I believe our spirits live on in some way shape and form. Maybe as energy in a star.”

I anticipated a flurry of questions related to the loved ones who have died in the past six months but none came. Instead, my daughter regaled me with her opinions on death and dying. She was intent on explaining her fear of death is not exactly a fear of death and what comes or doesn’t come next, but a fear of missing out. Fear of not being ready to be finished with life.

“I mean I cannot imagine just not being here. I just have so much to do,” she clarified.

I smiled hearing my daughter discuss death with profound honesty and without a trace of sadness. I smiled not simply because we were having an open conversation about a topic long swept under the rug but because in the context of demystifying death, my daughter and I were sharing a life moment.

This week, I’ll lead the #DWDchat discussion on Twitter to discuss our thoughts and fears about death, how they may have changed over time, and how we bring these up with loved ones. Please join us on Thursday at 7:00pm EDT to share your thoughts.

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A Social Worker’s Role at End of Life

Kevin Kozin, MTS, LICSW, is a clinical social worker and therapist and formerly worked as a hospice social worker. He’s currently a board member of the National Association of Social Workers in Massachusetts and serves as the Chair of the Mental Health and Substance Abuse Committee. He works with adolescents, adults, couples, and families through psychotherapy and grief counseling, which lead to healing results.

The New England Journal of Medicine published an article this April titled, “Implementing a Death with Dignity Program at a Comprehensive Cancer Center”. This well-written article takes a candid look at the demographics and experience of a particular cancer center in Washington state, where the Death with Dignity Act has been in effect since March, 2009. Death with Dignity refers to the Washington and Oregon statutes which allow individuals who have six months or fewer to live (as determined by two physicians) and have the capacity to make medical decisions the option to request prescribed medication which allows for a peaceful and painless death.

The article’s conclusion states, “Overall, our Death with Dignity program has been well accepted by patients and clinicians.” As a practicing clinical social worker and former hospice social worker, this comes as no surprise to me. The National Association of Social Workers in Washington continues to be a strong proponent of the Death with Dignity law Washington passed in 2008. As a board member and Chair of the Mental Health and Substance Abuse Committee of the National Association of Social Workers in Massachusetts, I know our chapter also worked in support of legislation through a ballot initiative here and the initiative lost by less than 1%. The ballot measure was modeled on the assisted dying laws in place in Oregon and Washington. Why would our organization of social workers support this legislation so enthusiastically? Because social workers stand for giving people—especially the dis-empowered—as much self-determination as possible.

Perhaps one element of this New England Journal of Medicine article which was highly edifying to me is the role of the social workers at the Seattle Cancer Care Alliance. In practice, a social worker is assigned to each individual who’s considering requesting the medication allowed under the Death with Dignity Act. The social workers’ role, as advocate, is to assist the individuals in understanding their options as well as providing a safeguard to ensure decisional capacity, screening out clinical depression and anxiety, and coordinating across multiple disciplines. The social workers coordinate with family, friends, pharmacists, physicians, care staff, attorneys, insurance companies, and anyone involved in the process to help the individual make a clear and thoughtful decision. The role of a hospice social worker in Massachusetts is very similar in that we’re constantly looking to empower those who are dying with whatever resources are available to them and enable them to make their own decisions, when possible. Hospice social workers are experts in care coordination and hearing all of the various stakeholders in the care of the dying individual, making sure all voices are heard, and ensuring the dying individual’s choices are respected.

In reading “Implementing a Death with Dignity Program at a Comprehensive Cancer Center” in the New England Journal of Medicine, I’m once again reassured the small percentage of dying individuals in Washington who qualify for assisted death are getting excellent care, and social workers are playing a strong role in ensuring these individuals’ choices are respected. I look forward to a greater understanding of Death with Dignity throughout the United States—one which isn’t based on fear but on compassion—and allows for more options and self-determination for those at the end of their lives.

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