Certain hospice-related subjects seem easy to write about. For me, California’s End of Life Option Act (EOLOA) is not one of those easy topics.
In June 2016, the EOLOA became law.
The EOLOA allows dying patients to take medication to end their life. Two doctors must examine that adult patient (18 years of age and older), with both agreeing she or he has an illness that will lead to death in six months or less. The EOLOA has extensive steps the patient is personally responsible for taking. Those steps include meeting with doctors, completing forms, and drinking the medicine. The process is intentionally complicated.
Which of the statements below would you make?
1. Since that day in June 2016, I think people are taking their own lives by suicide.
2. Since that day in June 2016, I think doctors are murdering their patients.
3. Since that day in June 2016, I think there’s another worthwhile option for a dignified death.
I suspect a majority of Californians—or anyone where a “right to die” law* permits a medically assisted death—would like a fourth choice for a truthful answer:
4. Since that day in June 2016, like always, I try my best to get through the day, week, month.
Most avoid the subject of death. Most worry about kids, work, parents, school, insurance, weather, mortgages, what’s for dinner, and a hundred other trivial or immense responsibilities and activities.
The end of my life is way, way down the road.
Dying happens to other people.
But the EOLOA concerns my death and my personal decisions. (People may vehemently debate the death penalty—and obviously capital punishment involves death and is also a controversial topic—but most on either side of the issue will never be personally affected by the state ending a prisoner’s life. For the majority of protestors and supporters, death is an abstract.)
And so, what about your death? You may die accidentally, in a war zone, from a natural disaster, or Covid-19. You may die in your bed after a massive heart attack no one—including you and your doctor—anticipated. In 2020 hospice served an estimated 1,700,000 Americans of the nearly 3.5 million that died. In other words, about half of Americans will annually die in the care of a hospice agency. Those 1.7 million patients all had an illness that would cause their deaths in six months or less. Two physicians had to agree on that timeline.
“Six months or less” is one of the places where the EOLOA and hospice overlap.
When you know you are going to die, how do you want to die?
Here’s where my former hospice colleagues may not like what I suggest:
If you’re an “alert and oriented” hospice patient, active and able to make your own decisions, that you immediately tell the hospice staff about your interests in the End of Life Option Act (or the similar laws in other states).
I hope that hospice agency (in the regions where it’s allowed) offers clear information on the EOLOA and answers all patient and caregiver questions.
Based on research**, the typical patient considering a medically assisted death share common, profound concerns. These include loss of control, pain, and becoming a burden to others.
Those common concerns are exactly what hospice helps with.
And that’s why I’d prefer that a patient immediately discusses end-of-life options with hospice. Too often, families don’t discuss choices; instead, they plunge into crisis after crisis. 30% of patients have a last breath within a week of entering hospice. They are frequently incapacitated by disease, treatments for the illness, and silence about any next steps. Hospice becomes exclusively about pain management and scrambling to support the overwhelmed caregivers. It’s a blur of fast decisions and fearful consequences.
But if you live in a right-to-die state and can make your own decisions and still take simple actions, please make sure your hospice gives you information about the EOLOA (or similar laws).
Listen carefully to them.
My personal never-researched guess is that 99.8%*** of the time, patients and families will choose hospice care over the right-to-die option. You will have control because of hospice. Hospice care will work hard to reduce pain. A hospice will support family and friends.
I believe including the EOLOA in early conversations about your death means that your loved ones can better communicate (which includes different views, trust, listening, and expressing fears and honest words) about the real needs and hopes at a point when everyone can participate in decisions.
Whether you agree or disagree with the EOLOA, will it be an easy discussion? Probably not.
But might that conversation be one of the most important times spent with those who matter most in your life? Definitely yes.
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* Current places with variations of a “right to die” law: California, Colorado, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont, Washington, Washington D.C.
** I’ve just referenced one source for a research sample. With Oregon having a right-to-die option since 1997, the research is extensive and relatively easy to find. In the various information I’ve read, the number one reason given for wanting the right-to-die option continues to be “loss of personal control” as death approaches.
*** Hey, my suggested percentage is my unreliable guess. I would personally choose hospice care over the EOLOA. But I’m grateful for California’s EOLOA. There are situations where an individual will responsibly and rightly choose this particular path. What would a potential “situation” be? I have no answer . . . and that’s my point. End-of-life decisions are personal, unique, and private. They are not one size fits all.
Photo by Damian Siodłak on Unsplash
My book, A Companion for the Hospice Journey, is available at Amazon. By the by, when early readers gave feedback on the drafts of my book, several wanted me to delete the chapter I included on the right-to-die option. I kept it in. I strongly believe a hospice patient and his or her family should be able to discuss “everything.”