Dr. David Amies: California's Death with Dignity law could use some fine-tuning

In his latest blog post, Dr. David Amies looks at the recent case of a Californian woman with ALS who opted to take advantage of the state's newly enacted Death with Dignity law. While the woman was successfully able to end her life, her final moments did not afford her with the dignity she should have received.

In mid-August, Linda Van Zandt of California published the story of her aunt’s last few weeks and months on Earth for the Los Angeles Times. Van Zandt's aunt was diagnosed with Lou Gehrig’s disease about six months before her death. It was rapidly progressive and so she decided to avail herself of California’s new Death with Dignity laws that came into effect in June this year. So desperate had she been that she attempted to commit suicide by slashing her wrists shortly before the legislation was enacted. On June 9, once the rules were operative, she declared in writing that she wished to end her life with medical help. At this point, the descent into chaos began.

Van Zandt found great difficulty obtaining any useful information about how to proceed. Her aunt’s own physician refused to return telephone calls. A few days were consumed in making calls to everyone who might be able to help. Finally, a helpful hospice doctor was found, who agreed to make a house call. A complicated protocol had been established by the new law: a 15-day waiting period; a statement from a licensed physician attesting to the mental competence of the applicant; a signed request witnessed by two persons, only one of whom could be a relative; a second opinion from an independent physician; and notification on the part of the patient of their desire and ability to take the lethal medications.

After more searching, cooperative doctors were rounded up and the paperwork completed. Of some practical importance was that, during the time expended upon the search, the poor lady’s symptoms were getting worse and some doubt arose about whether she would actually be able to swallow the necessary medications. A race against time ensued since dysphagia was one of her main symptoms. Finally, when the waiting period elapsed, the prescription was written and the drugs sent for. They comprised a package of secobarbital (100 capsules), two anti-nausea pills and one anti-seizure pill. This little lot was sent round to the house in an Uber taxi along with a bill for $3,000. (My estimate of the cost of these medications to the pharmacy was around $200 at the most, representing a nice little mark-up!)

Rush against time

No doctor could be present at her death, under the terms of the new law. However, one of the doctors issued detailed instructions about the administration of the drugs, including the requirement that they had to be consumed within an hour. The prescribing had not taken into account the size, sex, age and overall state of health of the patient. Nor it seems, had much attention been paid to the principal difficulty being experienced by the poor lady: almost complete inability to swallow.

The anti-nausea pills were crushed and mixed with a homemade sweet syrup. The anti-seizure pill was placed under her tongue. Linda Van Zandt’s sister and her husband emptied out the contents of the secobarbital capsules using toothpicks and mixed them in more of the syrup. This made a cupful of bitter sludge that had to be consumed by an enfeebled woman, who could barely swallow, within the hour – already almost up.

The family had planned a beautiful day: Bible readings, music, love, family members, calm and peace. Instead, they were faced with rushed commotion, problems, and doubt over whether their relative would actually be able to get the medicine down. But, thankfully, after taking very little of the lethal sludge, she slipped into unconsciousness and died quietly and peacefully.

After it was all over, Linda was quite sure that the right thing had been done. Her admiration for her aunt, who was determined to take matters into her own hands come what may, was greatly increased. She had decided that her life was no longer worth living, so she took advantage of new rules and with willing, if somewhat frantic help, from her family, was able to achieve her aims. So sad then, that the regulations made the entire affair such a dramatic, chaotic mess rather than the peaceful and comforting scene that all concerned had wished for.

Perhaps California’s legislators will study this case and fine-tune their work.

Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWD Canada's Physicians Advisory Council.


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