Little is said about euthanasia, about being able to end a life in a dignified, safe and assisted manner when a patient's health is no longer of good quality and his or her day-to-day existence is diminished.
However, the recent request for euthanasia by the legendary French actor Alain Delon, who at 86 years of age has decided to end his life, has brought to the table an issue that, at least in California, is possible.
"Euthanasia is the most logical and natural thing to do," Delon said in January 2021 during an interview with the weekly Paris Match, where he told how he was fully recovered from the stroke he suffered in mid-2019.
"I am in favor. First of all because I live in Switzerland, where euthanasia is possible, and also because it seems to me the most logical and natural thing to do. From a certain age, from a certain moment, we have the right to come out of this peacefully, without going through hospitals, injections or such things," he stressed.
For many, the idea is unthinkable, however, California has sought to be at the forefront of the issue and even push for amendments to its controversial End-of-Life Option Act to allow it to continue until 2031.
California's End of Life Option Act allows terminally ill patients with a life expectancy of less than six months to end their lives by taking medications prescribed by a physician.
In October 2021, Gov. Gavin Newsom signed an revised version of the law, extending it until January 2031 and relaxing some restrictions of the 2015 version that, according to its promoters, had become barriers for dying people wishing to avail themselves of the law.
The original law contains numerous measures designed to ensure that patients are not coerced by family members who see them as a burden, or a potential economic opportunity.
Under current law, patients who wish to die must make two requests, made verbally, for the drugs at least 15 days apart. They must also request the drugs in writing, and two physicians must agree that the patients are legally eligible.
After receiving the drugs, patients must confirm their intention to die by signing a form 48 hours before taking the drugs.
In addition, they must be able to take the drugs without assistance, either orally, rectally or through a feeding tube. And physicians may refuse to prescribe drugs that induce death.
After the law had been in force for some time, its promoters and practitioners came to the conclusion that some safeguards prevented access to this option for certain patients.
Some were so sick that they died during the 15 days they had to wait between the first and second request for medication. Others were too weak or disoriented to sign the final certificate.
The revised law reduces the waiting period from 15 days to only two days and eliminates the final certificate.
It also requires healthcare facilities to post their policies on euthanasia or assisted dying on the Internet.
Physicians who refuse to prescribe the drugs - either out of principle or because they do not feel qualified - are required to document the patient's request and transfer the file to any other physician the patient designates.
The most important part of the new law, according to its promoters, is the reduction of the waiting period.
According to Chandana Banerjee, M.D., a clinical professor specializing in palliative medicine at City of Hope National Medical Center in Duarte, California, many patients she has seen were afraid to broach the subject of their own death until they were very close to the end.
"By the time they made that first request and had to wait those 15 days, they would lose their decision-making ability, go into a coma or pass away," Banerjee noted.
Amanda Villegas, 30, of Ontario, California, became a vocal advocate for updating the law after watching her husband, Chris, die an agonizing death from metastatic bladder cancer in 2019.
When the couple inquired about the possibility of physician-assisted death, Villegas said, the staff at the Seventh-day Adventist hospital where Chris was being treated told them, inaccurately, that it was illegal. When her husband finally requested the death-inducing drugs, it was too late: he died before the end of the 15-day waiting period.
The new law "will open the doors to people who might? experience the same obstacles," Villegas said. "When you are dying, the last thing you need is to have to overcome bureaucratic barriers to access peace."
Assisted dying is on the same political dividing line as abortion, and has long faced opposition from many religious institutions and anti-abortion groups. It has also met with resistance from some disability rights organizations that claim it belittles the lives of those who are physically dependent on others.
"We oppose the idea of the state providing a vehicle for people to commit suicide," said Alexandra Snyder, CEO of the Life Legal Defense Foundation, a nonprofit law firm.
Snyder said the 15-day waiting period provided important reflection time for patients to think about a decision that is irreversible. "Now, whatever safeguards there were in the law are gone."
Proponents of the law say that a patient's decision to take the drugs to end his or her life has always been voluntary, and they have seen no evidence to the contrary.
Although neither version of the law requires a medical professional to be present when the patient takes the medications, the medical rules encourage the involvement of professionals in the dying process, said Lonny Shavelson, M.D., president of the American Clinicians Academy on Medical Aid in Dying.
The drugs should be kept in the pharmacy until the patient is ready to take them, Shavelson said, although that doesn't always happen.
From the time the aid-in-dying law went into effect in June 2016 through Dec. 31, 2020, just under two-thirds of the 2,858 people who received prescriptions took the drugs and died, according to the most recent data from the California Department of Public Health. The rest died before they could take the drugs or found other ways to manage their pain and emotional distress.
Most major private health plans - including Kaiser Permanente, Anthem Blue Cross, Blue Shield of California and Health Net - cover drugs that aid in dying, and related doctor visits, as does Medi-Cal, the government-run health insurance program for low-income people.
However, more than 60 percent of people taking these drugs are Medicare beneficiaries, which does not cover them.
Whatever decision a patient makes, it is important to be more open about euthanasia and our mortality, stated state Sen. Susan Eggman, D-Stockton, author of the revised aid-in-dying law.
"We should all have more conversations about life and death, and what we want and what we don't want and what a peaceful death is," he said. "We're all going to die."
With information from Kaiser Health News
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