SAN FRANCISCO – Helen Handelsman has been waiting for this day.
Diagnosed in 2013 with late-stage breast cancer, her second bout with the disease, the San Francisco resident has a few wishes: to make it to her 85th birthday in January and to ask her doctor for a lethal drug prescription under California’s new right-to-die law.
“I want to tell him that this is what I want,” said the grandmother, who now can feel the tumors developing under her collarbone.
“I’ve watched my sister and my father and my son-in-law die from cancer,” she said. “It was morally wrong to keep these people alive when there was no hope they would survive. And the pain can be so horrible.”
On June 9, eight months after it was signed into law by Gov. Jerry Brown, California’s controversial End of Life Option Act became active.
The law allows mentally capable adults, diagnosed with six months or less to live, to ask doctors for prescriptions to end their lives when they choose.
For Handelsman and many other terminally ill Bay Area residents, the physician aid-in-dying law comes as a relief. Patients may decide against using the medication, but just knowing it is there, they say, gives them solace.
Yet, to opponents who continue to rail against its implementation, the law remains a dangerous overreach by the state. Foes argue that it places patients – especially the elderly – at risk for coercion, with little support for other options, and no requirement of witnesses to their self-administered deaths.
In June, the group Californians Against Assisted Suicide and its partners launched a watchdog website that asks the public to monitor “examples of mistakes, misuse, coercion and abuse” in the law.
“This law does not apply to everyone equally,” said Tim Rosales, a spokesman for Californians Against Assisted Suicide.
He pointed to annual state reports from Oregon and Washington – where right-to-die laws have been in place for years – that say one of the biggest reasons people choose aid-in-dying is their fear of being a burden to their family, friends and caregivers.
“That is very telling, certainly when you are looking at the economic diversity across the board,” Rosales said, referring to the pressure some low-income residents may feel about leaving their families with mountains of medical bills.
Not much use
But the data from those states also reveal that relatively few people each year use the law, and about one-third of those who receive prescriptions never take the medication.
Of 218 prescriptions written in Oregon in 2015, 132 people had died from taking the medication as of mid-January.
Similarly, of 176 prescriptions written in Washington in 2014, 126 patients died after ingesting their medication.
Given California’s larger population, state officials estimate that 1,500 residents annually will seek lethal prescriptions.
For 91-year-old Stewart Wobber, the law simply gives him “another choice.”
Until three years ago, the retired Los Altos Hills businessman was still active in his community, helping to raise money for different causes, from scholarships for low-income high school students to services for at-risk children.
But a few years ago, a chronic lung disease worsened and left him confined to his bed, relying on hospice care, and dependent on oxygen tanks and nasal tubes to breathe.
“My lungs are collapsing,” said Wobber, who has six grandchildren and four great-grandchildren. “I lay in bed wondering how to find out how to close my life if I want to.”
The patriarch said he has brought up the subject with his doctor and his children, but only briefly. For now, he just wants to understand how the law will work if he decides to consider using it. And he would like to be familiar enough with the process should any friends ask him to explain it to them.
“I get calls from people asking me about many things,” Wobber said. “I’d like to be prepared to answer their questions.”
Resident weighs in
In Santa Cruz, Calif., Allyne Hammer also is reviewing the law, recalling memories from working as a hospice volunteer with Bay Area AIDS patients 35 years ago.
The images of that time – and the lack of any medical aid-in-dying mechanism that could have helped those victims – still haunt her.
“People were suffering and dying horrible deaths, and looking for help,” the 74-year-old former union activist said.
Now it is Hammer, diagnosed in 2010 with incurable blood cancer, who is preparing for her own mortality. When her time comes, she said, she can turn to the End of Life Option Act if needed.
“I am comforted by the fact that I can control my suffering in the end,” Hammer said of her disease, which is slow-moving. “That’s what the law offers me.”
Hammer’s only sibling, Dr. Douglas Hammer, a family physician in Raleigh, North Carolina, said his sister has mentioned the law to him and told him she would consider using it.
If that’s her choice, Hammer said, she should have that right. But with palliative and hospice care, he said, doctors can help terminally ill patients control their pain, allowing them to die “fairly peacefully and fairly comfortably.”
“You don’t have to rush them along,” he said.
For Matt Chaney, the decision has been made: Stay alive as long as possible.
Diagnosed with Lou Gehrig’s disease in 2001, the 55-year-old has little control of his arms and hands, and his speech is almost unintelligible.
His breathing has gotten worse over time, and some day he will be unable to breathe on his own. But waking up every day to the love of his wife and two grown sons makes every day a miracle.
Eventually, however, he will get to a point when he will need to decide on an invasive breathing regime, 24-hour care and what he fears would be a “huge financial burden on my family.”
“Being able to end my life on my terms is an option I’d like to have available,” Chaney said.
Yet, Chaney knows that by the time he has a six-month window to live, he likely will be unable to meet the law’s self-administering requirement to be able to sign a document or ingest the medication.
“Will a power of attorney or medical directive be acceptable under the End of Life Option Act?” he asked.
Under the law, neither will suffice.
Takes pills, shots
Back in San Francisco, Handelsman continues living to her fullest every day.
She takes some pills and shots that, her doctor said, will keep the cancer from rapidly spreading. She said she hasn’t discussed with loved ones her decision to use the law, if needed.
“My choice is to live whatever time I have out doing as much as I can, and the oncologist I found was perfectly OK with that,” Handelsman said.
Most of her children live in the Bay Area, friends are nearby, and she can still play a mean game of doubles tennis, several days a week.
“I’m not afraid of dying,” said Handelsman. “I’ve lived a good, long life. But I am afraid of having that pain, and I don’t understand why anyone should have to suffer that.”
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