Tag Archives: terminal

California’s End of Life Option Act takes effect June 9

Starting June 9, terminally ill Californians with six months or less to live can request a doctor’s prescription for medications intended to end their lives peacefully.

If that sounds simple, it won’t be.

California’s End of Life Option Act creates a long list of administrative hurdles that both patients and their doctors must clear.

For instance, you must make multiple requests for the drugs, orally and in writing, and provide a written attestation within 48 hours of taking the medication (you must be able to take the drugs yourself, without help, to qualify).

Two doctors must confirm your diagnosis, prognosis and ability to make medical decisions, and you must prove you’re a California resident.

And more.

“This will not be an on-demand service,” says Sarah Hooper, executive director of the UCSF / UC Hastings Consortium on Law, Science and Health Policy.

“The patient has to jump through a lot of hoops before accessing the prescription. Those hoops are designed to ensure that the patient has really thought about this and is making the decision voluntarily.”

California will be the fifth state to implement an aid-in-dying law, and the Golden State’s version of it is considered the most stringent, says Sean Crowley, spokesman for the advocacy group Compassion & Choices.

Rather than list every requirement, I’m going describe a few potential challenges you might face if you or a loved one is considering asking for these medications — from doctors who are unwilling to write prescriptions to the cost of the medications themselves.

Let’s start with the doctors.

This law is voluntary “every step of the way,” says Democratic state Sen. Bill Monning, co-author of the law.

That means everyone — patients, physicians, health systems and pharmacies — gets to choose whether or not to participate.

Nothing requires patients to take the drugs once they have obtained a prescription.

Since Oregon implemented its law in 1997, more than one-third of people who obtained prescriptions didn’t take the medications, according to data compiled by the Oregon Public Health Division.

“You can still at any point decide, ‘I’m not going to need this. The hospice care is effective. The palliative care is effective,’” Monning says.

But before you can make that decision, you must first get a prescription — and that might take some doing. That’s because not all health care providers will be on board with the new law. It will be up to you to find the ones who are.

“Patients and families should expect that they will have to be a little proactive in asking questions and getting educated about their care,” Hooper says.

For instance, the Kaiser Permanente system will participate, and patients will be paired with a coordinator to guide them through the process, says spokeswoman Amy Thoma.

If your Kaiser Permanente doctor chooses not to participate, which is his or her right under the law, your coordinator will connect you with a physician who does, Thoma says.

But U.S. military veterans who receive health care from the U.S. Department of Veterans Affairs will have to look elsewhere for participating doctors, because federal law prohibits the use of federal money for such a purpose, Hooper says.

Nor will the 48 Catholic and Catholic-affiliated hospitals in California participate, including their doctors and staff, says Lori Dangberg, vice president of the Alliance of Catholic Health Care.

Dangberg insists that those providers will not abandon any patient who chooses to end his or her own life. “We will be with that patient and continue to care for that patient throughout their diagnosis and their dying process,” she says. “We just cannot participate in any action that would intentionally hasten a person’s death.”

If your doctor doesn’t participate, ask him or her to refer you to one who does. If your doctor won’t provide a reference, “call us and we can probably help,” says Crowley of Compassion & Choices. That number is 800-893-4548.

Another potential obstacle is the cost of the drugs. Your insurance might not cover them. California’s law does not require health insurers to cover the medications, Monning says.

In Oregon, Washington and Montana — states where aid-in-dying is legal — some health plans cover the cost and some don’t, he says. He expects the same to occur in California.

Insurers “are currently working on how they will implement this law,” says Nicole Kasabian Evans of the California Association of Health Plans.

If you have questions about coverage, she suggests you contact your insurer directly.

Medi-Cal, California’s version of the federal Medicaid program for low-income residents, will cover the cost of the drugs without relying on any federal money, says state Department of Health Care Services spokeswoman Katharine Weir.

If affordability becomes an issue, Compassion & Choices again urges you to call. “We try to work with people to find a way for them to access the law, through any challenges,” Crowley says.

If you need more step-by-step guidance about the law, tap into these resources:

  • Compassion & Choices has online guides for consumers and doctors at www.EndOfLifeOption.org. You can also call the group’s help line at 800-893-4548.
  • The UCSF/UC Hastings Consortium on Law, Science and Health Policy has a helpful fact sheet at http://bit.ly/248Z2l6.
  • The California Medical Association, which represents doctors, has a detailed, 14-page document at www.cmanet.org/endoflife. You’ll need to register on the site to read the document.
  • Once the law takes effect, or soon thereafter, you will be able to find the forms you and your physician need to sign at the Medical Board of California’s website: www.mbc.ca.gov.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation. Kaiser Health News is national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

First same-sex couple marries in Illinois

In a short ceremony inside their Chicago apartment, two beaming brides made Illinois history this week as they became the first gay couple to wed under the state’s new law legalizing same-sex marriage.

The law approved last week doesn’t go into effect until June, but one of the women – Vernita Gray – is terminally ill with cancer, so she and her partner of five years, Patricia Ewert, were granted an expedited marriage license by a federal judge’s order.

The two made it official on Nov. 27 in front of more than 20 friends at their high-rise home on the city’s North Side. A Cook County judge officiated, and a close friend who deemed himself the “flower girl” tossed red rose petals and the couple kissed several times.

They were pronounced wife and wife.

“So happy, so incredibly happy,” Ewert told The Associated Press after the wedding. “We feel so blessed to have this honor bestowed upon us. I love my partner, my wife now, more every single day.”

When Illinois legalized gay marriage earlier this month, it was bittersweet for the couple, in their mid-60s. They feared that Gray might not live until the law would allow them to wed. They filed a lawsuit, and a federal judge allowed the two women, in their mid-60s, to get an expedited marriage license.

The mood was cheerful and festive Wednesday; Ewert wore a leopard print shawl that belonged to Gray’s mother and Gray donned a dark silky jacket. A friend sang Etta James’ “At Last.” The couple signed papers at the ceremony which was attended by many of the city’s gay rights activists; Gray has long been involved in the movement.

“Vernita goes back in our community. Everyone feels a friendship with her,” said Jim Bennett, the “flower girl” and a regional director for Lambda Legal, the group that helped represent the women in court. “That Vernita helped be the pioneer that leads us to this path was the icing on the wedding cake.”

Their legal battle could be just the beginning and may fuel efforts to change the effective date of the law, which Gov. Pat Quinn signed last week. Sixteen states, most recently Illinois and Hawaii, have legalized same-sex marriage. In Illinois, there’s legislation pending to allow the law to take effect immediately, and it could come up in late January when lawmakers gather in Springfield.

Quinn, who helped Illinois legalize civil unions in 2011, said if lawmakers sent him that bill, he’d sign it.

“I’d say the sooner the better,” the governor told reporters this week. However, it could be a tough vote since the original bill passed by a close margin.

The women filed a lawsuit in federal court earlier this month, citing Gray’s cancer as a reason to get a marriage license quickly. Then on Monday, a judge ordered the license and Cook County clerk officials hand-delivered it.

Lambda Legal officials said marriage means that Ewert will be better protected when it comes to taxes and other federal benefits not guaranteed with a civil union.

The two first met at a work event hosted by the Cook County state’s attorney’s office and soon started dating. They were engaged at Christmas in 2009. Ewert said she was “immediately attracted” to Gray, who worked as a victims’ advocate in the Cook County court system. Ewert works for state Rep. Kelly Cassidy, a Chicago Democrat.

But both women struggled with health issues; both have had breast cancer. Gray was first diagnosed in 1996 and underwent chemotherapy about the same time as Ewert.

However, things worsened for Gray, especially in June when cancer was found in her brain. A tumor roughly the size of a golf ball was removed from her head. It was also around that time when the women watched efforts to legalize gay marriage stall in the Illinois Legislature, which Ewert said was “terribly” disappointing.

The measure first passed the Illinois Senate on Valentine’s Day, but the House sponsor said he didn’t have the votes in his chamber in May and didn’t call it for a vote. He vowed to bring it back and did so earlier this month when it passed through his chamber by a close margin.

The June 1 date has created some headaches for county clerk offices since it’s a Sunday. Some have said they’ll be open for business that day, while others said they won’t have the resources.

Ahead of the wedding day, Ewert said she was happy to see the judge’s quick turnaround.

“Things went so much faster than we expected them to,” she said. “We didn’t expect there to be so much interest. We’re just two little old ladies from Chicago.”

San Francisco airport won’t be named for Harvey Milk

A San Francisco lawmaker said on May 7 that he has abandoned a proposal to rename San Francisco International Airport after slain gay rights leader Harvey Milk and instead plans to pursue getting an airport terminal named in Milk’s honor.

Supervisor David Campos said he gave up on the idea of putting a question on the city ballot asking voters to approve the name change after the plan generated a fair amount of opposition, including from the city’s daily newspaper and Mayor Edwin Lee.

Some fellow politicians, business leaders and members of the public wanted the airport renamed after someone else or no one at all, Campos said.

Campos now plans to introduce an ordinance establishing a committee that would recommend which of San Francisco International’s four passenger terminals should be named for Milk.

The committee, to be appointed by the mayor and the San Francisco Board of Supervisors, will have three months to come back with its recommendation. It also will be asked to suggest other airport structures that could be named in honor of other prominent San Franciscans.

“We wanted to do it in a way that was a unifying thing as opposed to having a political fight,” Campos said of the compromise. “And we believe that is the best way to honor Harvey.”

Milk’s nephew, Stuart Milk, who travels the world talking about gay rights as the head of a foundation named for his late uncle, said he thinks the airport’s international terminal would be the most meaningful choice. Harvey Milk already is recognized abroad, with a gay community center named for him in Italy and a gay rights celebration observed in his honor in Chile.

“We have work to do in the U.S., don’t get me wrong, but where Harvey was 35 years ago is where so much of the world is today, so I think that is what resonates the most,” Stuart Milk said.