Medical Aid in Dying Is Not Assisted Suicide

Brittany Maynard’s story about having to move to Oregon to access its death-with- dignity law to end her agony from terminal brain cancer elevated the public conversation about dying and end-of-life options to a new level. Her family’s advocacy created a unique opportunity to change the law in California.

But as we prepare to promptly implement the End of Life Option Act that Brittany inspired, it is critically important Californians understand the difference between the option of medical aid in dying and assisted suicide.

Assisting a suicide still is illegal in California, Oregon and other states that authorize the option of medical aid in dying for terminally ill adults.

Medical aid in dying only is an option for mentally sound adults who want to live, but can’t because their terminal disease is killing them. These people request medical aid in dying, not out of despair or depression, but to maintain some dignity and comfort in their final days, to ease their pain and suffering, and to help them pass peacefully.

Obviously, the implementation of the End of Life Option Act will be too late for Emily Rose, who died last year.

Dr. Olvera holding a photo of his daughter, Emily Rose, who died in 2014.

Dr. Olvera holding a photo of his daughter, Emily Rose, who died in 2014.

I wish my sweet 25-year-old daughter, Emily Rose, would have had this option so she could have died gently in her sleep. Instead, she was forced to spend her last four months confined to a bed, blind, gasping for breath, suffering from excruciating headaches that no hospice or palliative care medication could relieve.

But it should not be late for other terminally ill Californians to end their intolerable dying process by utilizing the new law in 2016.

That is why it is so important to understand the difference between medical aid in dying and assisted suicide.

California’s End of Life Option Act as well as the Oregon, Washington
and Vermont death-with-dignity laws authorizing the option of medical aid in dying for terminally ill, mentally sound adults emphasize that: “Actions taken in accordance with [the Act] shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law.”

Under these laws, if a terminally ill person utilizes medical aid  to end an unbearable dying process, the death certificate does not say the cause is “suicide.” It says the cause is the underlying terminal illness, just as it does when a terminally ill adult utilizes palliative sedation to end their suffering. This procedure involves medicating the terminally ill person into a coma, and then withholding fluids and nutrition until death occurs, usually days or weeks later.

In addition, the nation’s largest medical organization, the American Public Health Association, “Supports allowing a mentally competent, terminally ill adult to obtain a prescription for medication that the person could self-administer to control the time, place, and manner of his or her impending death, where safeguards equivalent to those in the Oregon DDA [Death with Dignity Act] are in place … Rejects the use of inaccurate terms such as ‘suicide’ and ‘assisted suicide’ to refer to the choice of a mentally competent terminally ill patient to seek medications to bring about a peaceful and dignified death.”

The American College of Legal Medicine, American Academy of Hospice and Palliative Medicine, American Medical Women’s Association and American Medical Student Association have adopted similar policies opposing the use of the terms of “suicide” and “assisted suicide” to describe death with dignity and the option of medical aid in dying.

Finally, it’s offensive and hurtful to hear people say my daughter was suicidal when all she wanted was medication to provide a peaceful death. My daughter wanted to live, but not in prolonged agony.

I applaud Gov. Brown for signing the End of Life Option Act after he acknowledged that he didn’t know how he would respond if he faced a terminal illness.

“I do not know what I would do if I were dying in prolonged and excruciating pain,” Gov. Brown wrote in his bill-signing message. “I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others.”

Gov. Brown never referred to the End of Life Option Act as assisted suicide. And neither should you.

Robert Olvera, MD, is a retired, Harvard-trained physician from East Los Angeles who lives in Orange County.

Voice of OC is interested in hearing different perspectives and voices. If you want to weigh in on this issue please contact Voice of OC Engagement Editor Julie Gallego at jgallego@voiceofoc.org.

  • James Leonard Park

    Yes, I believe it will still be against the law of California to ‘assisting suicide’ after this right-to-die law comes into effect. Here are four basic differences between irrational suicide and voluntary death: http://www.tc.umn.edu/~parkx032/CY-IS-VD.html

  • Steve W.

    It’s impossible to have an honest debate when one side turns the plain meaning of words inside out. With all due respect to Dr. Olvera, taking your own life is the definition of suicide, regardless of whether a person does it with or without medical assistance. The only difference here is this law corrupts the medical profession by turning physicians into agents of death.

  • Willam Nat

    Killing yourself is not “suicide”? Ha! I think I’ll redefine stealing so that I can go out and take other people’s money. Maybe I’ll redefine “illness” to “health” and then get well! No, when you redefine words to suit your cause it’s called LYING.

  • Bradley Williams

    Note these loopholes and more work with each other to eviscerate
    intended safeguards.

    By all these OR model laws all family members are not
    required to be contacted, hold that thought.
    A single predatory heir is allowed to steer the sign up and then execute
    the lethal process without a witness.

    A witness is not required to confirm that the dose was so
    called “self administered” (you remember this was one of their lead selling
    points).

    Even as the law provides immunity for all involved and
    demands the falsification of the death certificate (impossible to track trends
    for good public policy) it actually prohibits a public inquiry of any kind
    (remember the family members who were not contacted).

    These loopholes and more are in the OR, WA, and CA’s laws and expand the
    scope of exploitation by predators and predatory corporations for windfall
    profits. However, it serves the
    health insurance corporations very well.

  • Jacki Livingston

    My deepest sympathies and prayers go out to you, on the loss of your daughter.

  • LFOldTimer

    Finally. Now in the State of California I have the same rights as my dog. When’s it’s time to bid farewell I won’t have to lay in a hospice bed on a morphine high with a diaper full hoping that I won’t wake up the next morning. It’s about time. I bet the medical supply and pharma industries fought this bill tooth and nail. My pain is their pleasure. ha.

    • Willam Nat

      Congrats old-timer, you have just lowered your worth to the level of your dog. When you’re in a nursing home and a Dr. Kevorkian want-a-be whispers in your ear “It’s your duty to die” what will you say? The insurance companies will love it when you say “yes” because a $200 poison pill is a heck of a lot cheaper than a hundred thousand in nursing home care.

      • LFOldTimer

        I’ve always been a big believer that we should have full ownership over our own bodies, William. You seem to hold the belief that government has the right to tell us when to die. So you and I are world’s apart and would never come to a compromise. If you want to finance new cars for the pharma people with pills, drips and injections while on your death bed – be my guest. I’d rather that my loved ones get whatever belongings that I leave behind.

        • Willam Nat

          I wonder how many pro-suicide people like you have this “human life is no more valuable than animal life” mentality. It certainly would go a long way in explaining the little value they place on the lives of the elderly poor and people with disabilities.

          • LFOldTimer

            William, if you were a dog you’d have a competely different perspective. That’s the problem with us humans. We have high opinions of ourselves. You think you’re better than a dog. During segregation many thought their skin color made them superior to others. Liberals think they’re better people than conservatives. Skinny people look down on fat people. And on and on and on. No wonder this world is so screwed up. You have no business or right telling somebody else what to do with his or her body unless that person is simultaneously hurting another person or an animal. Stay out of other people’s personal lives. The elderly poor or disabled have nothing to do with this conversation. So stay on topic.

      • Jacki Livingston

        I find it laughable that you are talking about people on life support and disabled elderly in nursing homes. If you knew the conditions in most of the nursing homes in this County, and how the County conspires in organized crime stealing from these patients, you would be amazed.

        But, I do disagree with you. Any person who thoughtfully and carefully makes the choice not to suffer agony, when there is no hope, is not committing suicide. They are taking the reins and controlling their own destiny. They are refusing to suffer for other peoples’ hang ups. The right to die with dignity should be a free will choice. I do agree with you about the insurance companies, it is a slippery slope. I wonder how we can find the compromise that allows a competent adult to check out peacefully, without outside interests abusing it for their own greed.