In his prime, Tom House was a sturdy, independent type, a private pilot and former Marine who ran an insurance business in the Bay Area for decades. Well into his 80s, he was still jogging several miles a day, chopping wood, making meals, doing his own laundry at his retirement home in Sonoma County.
But four months ago, his once-robust body began giving out. Hobbled by heart disease, colon cancer and failing eyesight, House, at age 94, decided it was time.
Last Monday, under a doctor’s prescription, he swallowed about 90 capsules of a barbiturate dissolved in apple juice, then washed it down with a whiskey martini. Within 15 minutes, he was asleep; within 45, he was gone.
“It was very peaceful,” said his son, Steve, choking up at the memory. “He was used to running his own show, but his body was betraying him. ... The law happened at the right time for us.”
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That law is California’s End of Life Option Act, which went into effect two months ago, on June 9. Enacted after years of contentious debate, it allows terminally ill patients with less than six months to live to request a lethal prescription from their primary care doctor. The process is precisely laid out, requiring two oral requests and one written request by the patient, as well as signoff by two physicians.
House passed away at home with his son, daughter-in-law and family pastor at his bedside. He is among the first Northern Californians to take his life legally under the new law.
Compassion & Choices, an advocacy group that promotes aid-in-dying choices, estimates 1,500 Californians will request a lethal prescription in the first year of the law. But it’s difficult to say how many terminally ill Californians have requested – or ingested – an end-of-life prescription so far. The California Department of Public Health declined to comment. The department is required to issue its first annual aid-in-dying report, detailing the number of prescriptions and deaths, by July 1 next year.
A few patients have chosen to share their stories publicly. One of the first was San Diego resident Eurika Strotto, a 54-year-old woman who was on a respirator and used a wheelchair in the final stages of ALS, known as Lou Gehrig’s disease. According to multiple news reports, she and her doctor completed the required paperwork ahead of time so she could obtain her prescription on June 9, the day the law went into effect. Four days later, with her wife at her side, Strotto sat in her living room recliner and drank the prescription combination provided by her doctor.
In late July, Betsy Davis, a 41-year-old artist in Ojai who also used a wheelchair and had ALS, invited friends to a two-day celebration at her home. It culminated, according to an Associated Press story, with her being driven to a hillside bed where she watched her final sunset and swallowed a life-ending prescription.
Two months in, California is well ahead of where Oregon was when it launched its aid-in-dying program nearly 20 years ago, according to Matt Whitaker, director of Compassion & Choices for both states.
“California is ahead of the pace, in terms of access. Many of the struggles Oregon had have not materialized, because health systems have stepped up to make sure their physicians are educated and there are structures in place for patients.”
He was used to running his own show, but his body was betraying him. ... The law happened at the right time for us.
Steve House on the death of his father, Tom
Participation by doctors and hospitals is entirely voluntary under the law. Faith-based hospital systems, such as Catholic-affiliated Dignity Health, have opted out, as well as some community hospitals.
Whitaker said his group has focused on helping in areas of the state where hospitals have opted out of providing aid-in-dying medications. One spot is the Palm Springs area in Coachella Valley, he said, where three large health care systems have opted out.
“Patients have to drive hours to Los Angeles to find a physician” willing to discuss end-of-life options, he said. “We’ve had 20 to 30 calls in the last week from people asking what they can do.”
In Sonoma County, House’s primary physician, a Kaiser family medicine doctor, was not available to comment.
But Dr. David Conant, a San Rafael physician who is co-director of Kaiser’s end-of-life program in Northern California, said each of its 21 regional centers has a designated medical leader. “While we don’t have an estimate of the number of patients who may consider the options under this new law, we are confident that we will be able to accommodate all requests for counseling and prescriptions,” Conant said in an email. “So far, we have not encountered any unexpected challenges in meeting the requirements of the law.”
Perhaps the biggest hurdle for California physicians and pharmacists has been figuring out the right combination of medications to prescribe. California’s law does not specify which drugs should be used. For years, pentobarbital was the preferred drug for assisted dying. But in 2011, the drug’s Danish manufacturer halted bulk sales of pentobarbital to U.S. states that practice capital punishment.
The alternative, Seconal, is often expensive, costing as much as $3,000 for the required dose. In Tom House’s case, the prescribed 90 tablets, which were individually crushed and mixed with juice, cost about $2,200, according to his son.
Some insurers, such as Blue Shield of California, and the state’s Medi-Cal program cover the cost of an end-of-life office visit and the prescription itself. But not all do.
“The drug situation is a little difficult,” said Jon Roth, CEO for the California Pharmacists Association. “Right now patients are working with their physicians and insurance companies to try to get the medication covered.”
To find lower-cost solutions, Roth said some doctors are prescribing a combination of medications, such as morphine, anti-anxiety drugs and chloral hydrate.
In June, Californians Against Assisted Suicide, a coalition of disability and other groups opposed to the aid-in-dying legislation, set up an online page where the public can report “examples of mistakes, misuse, coercion, and abuse” involving the law. It’s part of the Patients Rights Action Fund, which opposes assisted-suicide legislation across the country.
Opponents such as Marilyn Golden, senior policy analyst in Berkeley with the Disability Rights Education & Defense Fund, said she’s hugely sympathetic to anyone dealing with a terminal illness. However, millions of Californians are “threatened by the danger of this law, which is a perfect recipe for elder abuse,” she said in an email.
Also in June, a group of six physicians, along with the American Academy of Medical Ethics, filed a lawsuit in Riverside Superior Court, seeking a preliminary injunction to halt the law’s implementation.
“There just aren’t enough safeguards. What do you do in cases where the (terminal illness) diagnosis was incorrect? Now this person is living with lethal drugs in their home,” said Alexandra Snyder, attorney with the Napa-based Life Legal Defense Foundation, which filed the case.
She said the lawsuit also is based on equal protection claims that terminally ill patients may not be protected from coercion or could suffer from depression or mental illness that might affect their decision to seek a lethal prescription. The next hearing in the lawsuit is Aug. 26.
Life is a gift. ...We don’t usually have a choice in the how and when of dying. What this law has given us is choice.
The Rev. Jeanie Shaw
Meanwhile, an unknown number of Californians are quietly proceeding with their choice.
Those who were with House in his final moments say it was deeply peaceful. “He lived life his own way and passed his own way,” said his son.
Sacramento resident Jeanie Shaw, a longtime Presbyterian pastor and family friend of House, also was at his bedside when he slipped away.
She called it “a tender beauty” for his family to see him pass as he wished. “For his family, they knew this is what he wanted: To have the quality of the end of his life be of his choosing,” she said.
As a minister, Shaw said she has been present at many deathbeds and seen the pain and suffering that patients and their families endure. “Life is a gift. ...We don’t usually have a choice in the how and when of dying. What this law has given us is choice.”