Dr. Lonny Shavelson was ready when California’s End of Life Option Act became law last week. Hoping to combat what he calls “unregulated, dark bedroom suicides,” Shavelson opened a Berkeley clinic to serve terminally ill adults who want to end their lives legally, when and where they choose.
Shavelson opened his Bay Area End of Life Options clinic on June 9 after debuting its website in April. He now consults with physicians whose patients request the medication, and also with individual patients.
“I have believed in this for many years,” he said in a phone interview. “Though this law addresses a rarely needed option, it’s good that people in California now have it. Dying is normal — it happens to everyone — and the process should be normalized so that people’s final wishes are respected.”
Jewish law (halachah) prohibits the taking of a life, and asking for help in dying is controversial. (J. covered the topic in the Oct. 8, 2015, issue.)
“The beginning and the end of life are divinely determined,” said Rabbi Joel Landau of Adath Israel Congregation, an Orthodox synagogue in San Francisco. “Our position is that actually causing death is going over a boundary. Just because we can doesn’t mean we should. Orthodox Judaism rejects that after the body dies, the person ceases to exist. The soul is eternal, and because God has a mission for each soul, it is only God who recalls the soul.”
Rabbi Daniel Feder of Peninsula Temple Sholom, a Reform synagogue in Burlingame, agreed that Jewish traditions affirm the sanctity of life. “Impediments to death must not be created and the person must be allowed to die in peace, but the knowledge that one will die doesn’t give us warrant to hasten death,” he said.
“Reflecting on that, I am uncomfortable with the new law. But what tugs at me is that I realize there may be situations where pain and anxiety for the patient is uncontrollable and intractable, and I could see myself supporting the law because of the narrow writing of it.”
Feder added that he would like to see people use hospice and palliative care as intended, for longer durations, and his hope would be that doctors “could handle not just curing but caring for patients.”
Shavelson, 64, who was brought up in a Reform Jewish home, said what matters is how a patient’s belief system affects his or her decision about asking for help with dying.
“For some reason, people uncomfortable with the idea of letting someone choose to die two or three weeks before they would otherwise think we’re somehow interfering with God — as though we don’t do that with many other decisions.”
He noted that doctors routinely respect patients’ wishes to stop chemotherapy or dialysis, refuse surgery or turn off a ventilator.
“Legally, morally and ethically, it is the patient’s choice,” Shavelson said. “We observe and listen everywhere else in medicine, yet when it comes to providing a legal overdose of medication at the end of life, we’ve created a special evil little corner.”
Shavelson charges $200 for an initial consultation. Patients who wish to continue will pay $1,800 for additional visits and evaluations, filing paperwork with the Department of Public Health and prescribing the aid-in-dying medication. Patients also pay for a required second opinion on diagnosis and prognosis, a mental health exam if requested by physicians and the cost of the medications. Some insurance companies cover the drugs.
A native of New York, Shavelson earned his medical degree at U.C. San Francisco and worked for 29 years as an emergency room doctor in Berkeley and seven years as a primary care physician in an Oakland clinic. He also is a professional photographer, a filmmaker and the author of six books.
Shavelson’s “A Chosen Death: The Dying Confront Assisted Suicide,” published in 1995, follows the stories of people with terminal illnesses who were considering assisted suicide.
“My research unveiled a horror story. People were hoarding pills and then taking the wrong medications at the wrong time, or family members helped and then felt tortured for years about whether they had done the right thing,” he said.
“It was unregulated, dark bedroom suicides and it was completely wrong, but the medical profession had abandoned these people, told them to do it yourself. I knew then the issue needed to be brought into the clear air, regulated and made a part of end-of-life care.”
Shavelson said he has no reason to assume the “assisted-suicide underground” has disappeared since he researched it two decades ago. “Maybe better hospice care quieted it down; maybe not,” he said. “Hopefully, legalization and bringing the practice into the light of day will now end the underground practice.”
The new law, which took effect June 9, applies to California residents 18 or older with “an incurable and irreversible disease” that two doctors determine will result in death within six months. It gives them the right to ask a doctor for a lethal dose of medication.
The practice is available only to people with “the physical and mental ability to self-administer the aid-in-dying drug.” Patients must submit a written statement declaring their intention within the 48 hours preceding their ingestion of the medication.
Oregon, Washington, Vermont and Montana also have “aid-in-dying” laws, which once were known as “physician-assisted suicide” laws. Some advocates call the practice Death with Dignity. Records show that in 2014, 155 prescriptions for the medication were written in Oregon and 105 people used it to end their lives.
Often, Shavelson said, what people who want to end their lives sooner rather than later really need is better medical care, including better pain management. And he noted that people who filled a prescription for life-ending medication, but then didn’t take it, reported that dying was a more comfortable experience because they had the choice.
“If this law works as intended, I won’t be busy. Patients will work with their own physicians to move toward a death that works for them without using life-ending medications,” Shavelson said. “But if patients aren’t able to have satisfactory conversations with their doctors, I am here as a backstop to protect their rights.”