Dr. Lonny Shavelson recently opened an unorthodox medical practice in Berkeley, Calif. His Bay Area End of Life Options may be one-of-a-kind in the state.
Unsure how many doctors will participate in California’s new right-to-die law, which takes effect today, Shavelson will specialize in consulting with physicians whose terminally ill patients request aid-in-dying, and will confer with the patients who are considering the lethal drug option themselves.
“I want to get as few patients as possible, then I’ll know it’s a success,” says Shavelson, who was drawn back into medicine this year after Governor Jerry Brown signed the End of Life Options Act last fall. The law permits mentally competent, terminally ill patients who meet certain standards to request a lethal prescription if their suffering becomes intolerable. They must administer the drug themselves.
Largest State Yet for Law
California is the fifth and most populous state to allow its residents who face a terminal illness to control their fate. Shavelson says the law is intended to have terminally ill patients talk with their doctor — whether it’s a family doctor, oncologist or palliative care physician — who would explain end-of-life options, from hospice and palliative care to physician aid-in-dying.
Few people think California would have enacted an aid-in-dying bill without what's being called 'the Brittany Maynard effect.'
Although many doctors will not be participating (they can opt out for a variety of reasons), Shavelson says he stepped up because “there will probably be a need for backup for certain patients who don’t have a doctor to listen to their fears about dying. The fewer patients I get, the more I’ll know California doctors are serving their patients.”
For Shavelson, writing a lethal prescription for a terminally ill patient will be “a last resort. My main job for the few patients I get will be to maximize their end-of-life care, not write them a prescription to die.”
The goal, he said, is “a good death,” something the former emergency room doctor, primary care physician and photojournalist didn’t witness much nearly 25 years ago when he began researching his book, A Chosen Death: The Dying Confront Assisted Suicide. While tracking the decline of five terminally ill patients who contemplated ending their lives, Shavelson was with each of them when they died.
“What I found during the 1990s was a horror show — people hoarding medicine, afraid of how they were going to die; doctors secretly assisting people in dying; family members tortured by the memory of helping someone in their family die,” Shavelson said. “It was the equivalent of back alley abortions. I was calling it dark-bedroom suicide.”
His book argued that “now that we’ve seen what’s going on underground,” the “death anarchy” as he called it “has to see the light of day. We need to legalize it and regulate it.” So two decades later, “thanks to the efforts of a whole lot of people more persistent than I, the right-to-die law was passed in California.”
Shavelson said: “It felt as though someone said, ‘You asked for it. Now make it work.’”
There’s a lot riding on the successful implementation of a right-to-die law in a state that is often the trendsetter for the rest of the nation.
“California is crucial,” Shavelson says. “We are seen as the advance of things. We need to show that our state has improved overall end-of-life care because of this bill and then other states will follow.” There are 17 other states and the District of Columbia currently considering aid-in-dying laws.
Where It Began
It’s been 20 years since Oregon became the first state to allow doctors to prescribe life-ending drugs to terminal patients. In the intervening years, only three others — Washington, Montana and Vermont — have adopted right to die laws.
But in 2014, it was a 29-year-old Californian who ignited a national movement. Brittany Maynard, stricken with a brain tumor, explained in a video her decision to move to Oregon because of its aid-in-dying laws. Few people think California would have enacted an aid-in-dying bill without what’s being called “the Brittany Maynard effect.”
Compassion & Choices, the Denver-based nonprofit advocacy group that has pushed for aid-in-dying laws, calls June 9 a “monumental day” in the aid-in-dying movement. Mark Whitaker, California state director for the group, says: “Based on the experience with similar laws in other states, less than 1 percent of terminally ill Californians will need to utilize medical aid-in-dying. But simply having the option gives them a peace of mind that often has a palliative effect.”
Opponents Fear the Worst
Those who oppose aid-in-dying laws won’t be rooting for California’s success, though.
For example, the last thing disability advocate Marilyn Golden wants is for right-to-die laws (what opponents call “assisted suicide”) to sweep the country. “Where assisted suicide is legal, some people’s lives will be lost without their consent through mistakes and abuse,” says Golden, the senior policy analyst at the Disability Rights Education and Defense Fund. “No safeguards have been enacted or proposed that can prevent a death that can never be undone.”
Golden also worries that terminally ill patients will feel pressure to end their lives when so-called assisted suicide becomes “the cheapest treatment in our broken profit-driven health care system.”
One news website this week disparaged Shavelson’s medical practice with the headline Bay Area Doctor Opens Euthanasia Business, something Shavelson shook off as the product of ignorance. And he doesn’t seem concerned that the kind of violence that has been visited on abortion providers will be repeated against doctors like him who help the terminally ill get the best end-of-life care.
“I will not go the route of abortion doctors with armed guards,” Shavelson says. Then he asks rhetorically, “Will I wear a bulletproof vest? No.”
Shavelson says, “This is not about being a death doctor. This is about being a ‘good death’ doctor.”