Prescription Medicine Bottle with PillsIn September 2017, I was involved with a patient who enacted the Aid in Dying Act. It was my first time.

Since June 2016 California law permits physicians to prescribe a lethal medication to patients who request it and meet specific criteria: he or she must be an adult, have a life expectancy of six months or less, have the mental capacity to make the decision and be able to self-administer the drug.

Clinicians in California are in the early stages of creating policies and procedures. We are not fully prepared to deal with all the questions and ramifications surrounding such a decision. Even the composition of the lethal compound is left to individual doctors.

The idea of hastening death is uncomfortable for many health care practioners. In its original version, the Hippocratic oath states, “I will not administer poison to anyone when asked to do so, nor suggest such a course.” The American Medical Association, the nation’s largest association of doctors, has been formally opposed to the practice for 23 years. But, its ethical and judicial council recently started to study the issue once again.

As of today over 780 of the End of Life drugs have been dispensed according to California records. Data is still being collected regarding how many patients have actually used the medication. I have been involved with three of these disbursements. Two of these patients have already self-administered the medication and have consequently passed.

One of those patients invited me to her home where she planned to swallow the fatal slurry of barbiturates. On the appointed day, I arrived to find a house full of people who didn’t want her life to end. However, they were there to support and respect her well-considered decision.

“She was ready to have her life end, and no amount of support or medication or counseling would change the situation,” I keep hearing myself repeat these words.

Over the course of the day, friends and family said their goodbyes, and then withdrew to leave her with her closest relatives and her hospice nurse.

Her son mixed the solution and she swallowed it, no simple task for someone with advanced cancer. She lost consciousness almost immediately and died a few hours later.

I felt honored to be there and participate during the final hours of her very dignified life. However, I am still processing and questioning my hand in the process…

Knowing that patients who suffer for so long are able to make some determination in their life is somewhat comforting. However, the memory lingers as does the ethical concerns and questions continue. The answers, I have learned, are so much more complicated than the numbers and facts would have us believe.

Please share with me your thoughts on this subject.