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Will California’s New Right-To-Die Law Inspire A National Movement?

Christy O’Donnell, who has terminal cancer, breaks out into tears after lawmakers advanced right-to-die legislation that she supports, at the Capitol in Sacramento, Calif. CREDIT: AP PHOTO/RICH PEDRONCELLI, FILE
Christy O’Donnell, who has terminal cancer, breaks out into tears after lawmakers advanced right-to-die legislation that she supports, at the Capitol in Sacramento, Calif. CREDIT: AP PHOTO/RICH PEDRONCELLI, FILE

In Matt Fairchild’s mind, there are three ways to die: in your sleep, comfortably, or uncomfortably. Fairchild has stage-four skin cancer. For years, he’s been uncertain about which of these endings he’ll ultimately face. Last week, he got his answer.

On Thursday, the California law allowing terminally ill people to access lethal medication — and giving them the option to take it whenever and wherever they choose — went into effect.

It gives me a sense of peace, a sense of comfort for my future.

“It gives me a sense of peace, a sense of comfort for my future,” said Fairchild. “I plan on taking action to ensure I don’t die uncomfortably.”

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For Fairchild, having control over this final decision is the biggest relief. He’s not planning on taking the medication anytime soon, but he’s glad that it’s an option for when the time comes.

“There’s only so much space in my brain, so much space in my body…eventually the tumors will take hold,” said Fairchild. “I do like the idea of knowing that before I lose control of some of the most important things, I can still have a little control and peace as I pass.”

California is the fifth and largest state to pass this kind of bill — and some policy experts say it could inspire other states to follow suit. It joins four other states — Oregon, Washington, and Vermont — in legalizing the right-to-die, but surpasses at least 11 states who rejected this kind of legislation in the last year.

Fairchild currently gets cancer treatment every three weeks — something he’d have to stop before benefiting from the right-to-die law. To get a lethal prescription, a terminally ill patient must be off lifesaving medication and have confirmation from two doctors that they only have six months or less to live.

A patient must also have the mental capacity to make this serious decision to qualify for medication. If a patient is thought to be suffering from “impaired judgement,” that patient may be required to get a mental health assessment prior to a doctor’s sign-off. http://thinkprogress.org/health/2014/12/17/3604626/doctors-death-dignity-survey/The End of Life Option Act was signed into law by Gov. Jerry Brown in October, but he gave providers nine months to prepare for the substantial changes in their field before setting it in motion. While hospitals and smaller palliative care providers have held workshops for staff and community Q&A; meetings during that time, it’s impossible for health workers to be entirely prepared for the unknown challenges that come with implementing a new, controversial policy.

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Leah Hellerstein, a social worker with University of California San Francisco’s cancer center, said she’s participated in a few classes to specifically understand a social worker’s role in implementing the law. For now, she said, there are a lot of unknown wrinkles to iron out as the policy takes root.

“My job is keeping our patients informed on what options they have, and answering any questions before they actually see a doctor,” said Hellerstein, who is scheduled to consult her first patient about this option on Friday. “But I have a lot of my own questions, too.”

A big question is cost. The federal government is legally banned from funding any aid-in-dying programs. Medicare only covers consultation on end-of-life decisions, and the medication alone could cost between $3,000 and $5,000 out-of-pocket, thanks to recent price hikes by pharmaceutical giants. However, California can cover costs through the state health program, Medi-Cal. The state estimates that around 443 Medi-Cal recipients will obtain the drug over the next year. In the three other states that allow this option, most private insurers cover this medication, but it varies by insurer.

Hellerstein said UCSF expects an influx of patients as a result of the law, especially because local Catholic-based hospitals are choosing to opt-out — a caveat to the law. Individual doctors can also refuse to prescribe this medicine, even if their employer supports the option. She has yet to hear how many UCSF providers will lean in this direction.

It doesn’t have to be celebrated, but it doesn’t have to be avoided

National Catholic organizations, including hospitals, have been vocal in their opposition to any right-to-die legislation. Initially, even Gov. Brown, a former Catholic seminarian, felt conflicted with the concept. He shared his thought process after signing the bill in October:

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“In the end, I was left to reflect on what I would want in the face of my own death,” Brown wrote. “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill.”

In the face of new challenges, Hellerstein remains encouraged by the law’s bigger implications for patients facing the end of their lives.

“The majority of us are very happy about the policy…anything that allows our patients to feel more empowered about their decision is important,” she said.

Fairchild’s renewed outlook on his future best embodies this sense of empowerment.

“[Before now,] I felt limited in the fact that I’d have to make illegal choices, or difficult financial choices,” he said. “Dark, uncomfortable choices.”http://thinkprogress.org/health/2014/11/03/3587674/terminally-ill-women-oregon-dies/He imagined his family whispering around his hospital bed, wondering when he was going to pass. He’s also thought about suicide. But now that obtaining lethal medication is legal, he hopes people can become more comfortable talking about aid-in-dying with their terminally ill family members.

“Maybe a family… can be more open to the conversation, so there’s not so much secrecy or so much darkness around death,” Fairchild said. “It doesn’t have to be celebrated, but it doesn’t have to be avoided.”

California’s law passed just one year after terminally ill California resident Brittany Maynard moved to Oregon to legally end her own life with the state’s right-to-die law. Her story redefined right-to-die laws for many skeptics, and her recorded testimony in support of California’s legislation contributed to its victory. California’s act is modeled specifically on Oregon’s nearly 20-year-old law.

Fairchild is hopeful that California’s law can nudge other states into action, especially since he knows the overwhelming relief of being granted this new right.

“To think that you can be sick in one state and suffer, and in another state you wouldn’t, is completely baffling,” he said.