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.