Part 2 of 3: Medical Aid in Dying and the California End of Life Option Act

THE DETAILS (Part 2)

This is a partial transcript of a recent video recording of Facebook live. In part 2 of this series, Dr. Bob Uslander answers many frequently asked questions about Medical Aid in Dying (MAID) and the California End of Life Option Act. This information is for general education on this sensitive topic. Please seek professional consultation on this topic before making any decisions or contact us with any questions.

Read part 1 of this series here. The Overview

Read part 3 of this series here. The Challenges

Watch the full video recording of the Facebook Live event here.

Part two of this series will give you more details of how the Medical Aid in Dying process works.

Medical Aid in Dying and the California End of Life Option Act – Questions

Dr. Bob Uslander, Founder – Integrated MD Care

So how long does it take someone to get through the process?

The minimum amount of time is 15 days from the first request of the attending physician to the second request of the attending position, it cannot happen at any sooner than 15 days. In that intervening period, the consulting physician visit can happen. It can also happen before the initiation with the attending physician, it can happen after.

A written request form can also happen the taken care of and submitted within the 15 days before the 15 days after the 15 days, but the minimum amount of minimum amount of time it takes someone to get through the process is 15 days. In many cases we are able to make it happen in those 15 days. When people go through the process in other hospital systems or their physician groups who may not have this process developed quite as well, it often takes longer.

It doesn’t always and I’m not in any way shape or form bashing anyone else, I don’t know how other systems work. But I know how our system works. The minimum amount of time it takes is 15 days and often people can get access to the medication on the 16th day and have the ability to ingest the medication that quickly.

Another question we get all the time is how do I find a doctor to help me?

I wish I had the quick and easy answer to that, but the answer is, it depends on where you are. It depends on what healthcare system your part of. There are some hospital systems that have processes in place. Other hospital systems refer patients out to other doctors, some primary care doctors are comfortable and willing to support patients through this and those who aren’t often will refer to another physician such as myself. There’s an organization in California volunteer organization called End of Life Choices, California. https://endoflifechoicesca.org/

Compassionate Choices is another organization that can guide people and sometimes is willing to provide recommendations as far as how to find physicians to help but it can still be challenging. https://compassionandchoices.org/

Question we hear – “I thought it was illegal in California.”

There was a brief period back in 2018 when the California End of Life Option Act was overturned by a judge in Riverside County. There was a challenge brought by a group of physicians and lay people challenging the constitutionality of the of the law and how it was passed, and a judge agreed and overturn the law. Then an appeal was made by the Attorney General of California and the law was reinstated.

Do I have to be on hospice in order to go through Medical Aid in Dying?

The answer is no. Many patients aren’t on hospice, but they still have a terminal condition that qualifies them with a six-month life expectancy. Hospice can be very valuable and beneficial. They can provide support for many different facets, but it’s not necessary. It’s not required. There are some hospices that support patients who are going through Medical Aid in Dying and support them. Bottom line is that a patient does not need to be on hospice.

Who will be there with me when I take the medication if I go through the Medical Aid in Dying process? Does the law require that a medical professional or anybody be there at the time of ingestion?

The answer is no. The law does not stipulate that anybody need to be present at the time of ingestion. It is highly recommended that somebody else be with the patient and it is also highly recommended that somebody who has experience in supporting people through this process and being with the patient and being with the family be present.

I’ve been with a number of patients and families as the individual was taking the medication and falling asleep and dying. And it’s very clear to me that doing this without a professional, without somebody who is knowledgeable who can be a strong and supportive presence to help let people know what’s normal and what’s not normal if there’s any cause for concern, is incredibly invaluable. I actually wish that everybody who did this had a professional physician or a well-trained nurse or a guide of some sort. End of Life Choices California is an organization that has volunteers to assist.

Hospices also have people who are trained to be present. The experience is usually not dramatic, but it’s stressful. It’s very unusual and for people to go through that without guidance and support can leave them scarred. It can create stress and anxiety and trauma that may never be able to be resolved. Being present with the patient and the family- it’s more for the family. It’s not so much for the patient.

Most of the time, by the time a patient gets through this process and they are ready to ingest the medication, they’re beyond ready. They’re eager. So, they don’t need a lot of guidance and support at that point, but it’s the families the loved ones, the friends, the people who are there and sometimes it’s other medical professionals who have no experience that need the guidance and support of a professional.

My very, very strong recommendation is if somebody goes to Medical Aid in Dying, you do not do it without the presence of somebody who’s experienced and knowledgeable to be there with you. When we do that kind of support we help take care of whatever else needs to happen, making the phone calls to the mortuary, to the hospice agencies, to whoever and I think that’s important because families want to be family and not try to be the people who know how to do this process and make sure it goes smoothly.

I recognize that this is controversial. This process is controversial for people on moral grounds and religious grounds. There are a number of people who don’t agree with it and I respect that I respect everybody’s individual choice and individual inability to determine what’s right for them.

What I have a hard time with and am very intolerant of is – other people trying to impose their views on others and say that this is wrong or it should not be legal because others shouldn’t have this option because “I don’t believe it’s the right thing.” I believe in freedom of choice. I believe that we all deserve to be able to make the decisions about how we live and how we die.

Will people be coerced into taking the medication?

This is clearly an important option for people who are dying. So, one of the one of the concerns raised by people who oppose this law is that the people will be coerced into taking the medication, they’ll be unduly influenced especially those who are frail or those who have disabilities. I don’t believe there’s ever been a case where somebody has told me somebody was coerced into doing this.

Can I say that it’s never happened? I can’t. My experience is the patients are the ones who need to coerce their family members or their loved ones or their friends to allow them to do this to be comfortable with it to support them in it.

We frequently have people who want this option. They want to go through the Medical Aid in Dying process, but they’re afraid to tell their loved ones. They’re afraid to tell their family and their friends because they think they’ll be judged because they think that it’ll hurt them, they won’t be allowed to do it.

How do I how do I have that conversation? How do I bring it up in a way that won’t make them try to shut it down?

One of the things that we do is we have conversations with family members once we meet with patients and they express an interest and they qualify. We’re very open to having conversations with their loved ones to understand where the resistance is, to understand what the reluctance is and where their concerns are. We help to not normalize it but make it understandable.

People ask, “why would you want to choose this option?” We help them understand the process so that they can know that they’re not going to be with a loved one who takes medication and then struggles and suffers and has seizures and flops around in the throes of death. This is an extremely peaceful, gentle, dignified way for a life to end. It’s basically falling asleep and dying in your sleep.

How do you bring it up to a loved one or a family member who may be resistant?

I think they you have to help them see what it’s like to be living in your shoes, in your bed, in your state. People have a hard time understanding why somebody would choose to end life any sooner than it has to especially if they don’t look like they’re suffering or struggling terribly. It’s a fear. It’s a fear of losing somebody of giving up and not having control and giving up the control to the individual who’s making this choice.

Most of the time with the right guidance and the right support we’re able to help family members and loved ones and friends come around to seeing this as a gift to offer their loved one.

The gift of acceptance. The gift of supporting them. The gift of allowing them to have this control to feel this empowerment when that has been taken away from them by their illness. There’s no way to express strongly enough, the power of giving people back their choice and empowering them to make this decision.

A number of people who get the prescription for medication never take it. Just knowing they have it, knowing they have the option they don’t have to struggle beyond a point that’s acceptable for them.

This gives patients back the empowerment and the peace of mind that has been taken from them. A lot of systems miss this a lot of times when patients are going through this process. The support and care for the family and the loved ones is missed, and that’s huge. It’s a critical gap and I think it needs to it needs to be emphasized and prioritized.

What is the medication?

A lot of people say, “just give me the pill.” It’s not an injection. It has to be taken by the individual themselves. The medication currently that is used is a combination of medications that includes a couple of medications that affect the heart. Morphine, which most people are familiar with. And a medication called diazepam which is Valium and an antidepressant and in powders that get mixed with water or juice or some liquid and it ends up being about half a cup of liquid.

The patients take a couple of anti-nausea pills prior, then they consume this mixture and they will generally fall asleep within four or five minutes sometimes a little longer sometimes a little sooner.

The majority of people will peacefully stop breathing within an hour or two. Sometimes it happens much quicker. Sometimes it happens and it takes many hours, but the patients generally stay deeply sedated, asleep, unaware as far as we can tell of anything happening around them. They don’t seem to struggle. There are exceptions to everything, of course. In general, this is a peaceful process and it is a combination of powders that get mixed with water.