More than 100 Marin residents have used euthanasia law
At 1 p.m. on May 1, Marianne York drank a lethal cocktail of drugs and died peacefully, surrounded by loved ones, on her patio at the Marin Valley Mobile Country Club in Novato.
“I don’t think anyone embraces the idea of dying to begin with,” York said in a video she made in the days leading up to her death. “I mean I’m accepting the fact that I’m dying now because it’s a fact, but I’m not sure I’m embracing it.”
Later in the video, York added, “I feel free and liberated and that it is OK for me to go because you know I’ve had a good life.”
York is not an outlier. Since the California End of Life Option Act took effect five years ago, at least 111 Marin residents have exercised their rights under it, according to By the Bay Health, formerly known as Hospice by the Bay and Hospice of Marin.
The End of Life Option Act allows terminally ill patients age 18 or older to request and obtain a prescription for medication to end their lives. Patients must be mentally competent and suffering from a terminal illness with a prognosis of six months or less to live. The law requires that patients administer the drugs themselves.
York, who was 74 when she died, was diagnosed with stage 4 metastatic colon cancer in November 2019, nine months after the death of her husband Mike.
“She went through six rounds of chemotherapy and eventually they just couldn’t do anything more for her,” said Michael Hagerty, a neighbor who helped York navigate the legal stipulations of the End of Life Option Act.
Hagerty, 70, said the days before York ended her life were difficult ones.
“She had just a horrible week,” said Hagerty, who leads pain management and meditation groups at the neighborhood. “The hospice people couldn’t reduce her pain as much as she needed.”
That Sunday, York told Hagerty she was ready to go.
“So I called up 30 of her friends, and they all were there meditating quietly when she took the potion,” he said.
In fact, it was Hagerty, who studied to be a priest before going on to become a professor of psychology at the University of California, Davis, who mixed the lethal cocktail of diazepam, digitalis, morphine and propranolol.
Hagerty said he has no reservations about the role he played.
“For two years, Marianne had been very clear that this is what she wanted,” he said. “She wanted to end her life with dignity. I was really glad to be able to help her get that.”
Hagerty said York lost consciousness five minutes after drinking the mixture and was declared dead within 30 minutes by a hospice nurse.
“It was all very harmonious. Very quiet,” said Aneesha Dillon, another neighbor who helped York use the End of Life Option Act.
Dillon, 73, has been training in end-of-life doula work for some time now. She became friends with York after York took an end-of-life class she offered at the neighborhood.
“I felt really honored and blessed to be invited to be with her when she took the medicine,” Dillon said.
John Feld, 77, another neighbor present at the death, said he is glad York had the legal option of avoiding a prolonged, painful death.
Feld said his mother found a way to end her own life while living in Italy, despite the fact that Italian law doesn’t sanction voluntary euthanasia. He said his mother had very bad emphysema and could barely breathe when she made her decision.
“I knew she had been considering it for quite a long time,” he said. “I had no problem with it at all. I was very supportive of her.”
Marin Valley residents Stephen and Tara Plocher also attended.
“A bunch of us sat in silence. I guess some people were meditating,” said Stephen Ploucher, 70. “I can’t say I felt her spirit leave or anything like that, but it was a very calm, sunny, beautiful afternoon. It felt really peaceful and easeful.”
Hagerty, Feld and the Plochers were also part of a large group in attendance on Oct. 31, 2018, when Joan Nelson, another neighbor, exercised the end-of-life law.
Nelson, who suffered from a rare terminal cancer called leiomyosarcoma, had planned to end her life earlier that year but was temporarily blocked from proceeding when Daniel Ottolia, a Superior Court judge in Riverside County, ruled the law invalid because the Legislature had passed it during a special session limited to health care issues. A state appellate court vacated Ottolia’s decision in November 2018.
Tara Plocher said she was a close friend of Nelson, whom she met at a women’s group.
“I didn’t want her to do it,” Plocher said, “but she was in a lot of pain. I realized I had to let go. It was just hard to do. I’d never been close to someone before who did that.”
Plocher said now she might consider doing the same thing if she faced a similar situation.
“We talk about it a lot. My views are changing,” she said. “Where we live, it is all people 55 and over and a lot of people are dying, and people are in pain and having a lot of cancer. I think it is a good thing because then you can be in control of your own life.”
Dillon said that together with Hagerty she has formed a “circle of friends” group at Marin Valley to discuss end-of-life issues and prepare for the inevitable.
“We’re creating a community, a dying circle really,” Dillon said, “just to be there for each other as we pass on.”
Until recently, the law required a patient to make two oral requests to their attending physician at least 15 days apart as well as a written request. The written request had to be witnessed by two adults and only one could be a relative.
However, Senate Bill 380, which took effect in January, amended the act, shortening the waiting period between the first and second oral requests from 15 days to 48 hours. The bill also changed the law to require health care providers unwilling to prescribe end-of-life drugs to provide referrals to providers who will.
Both MarinHealth and Kaiser Permanente allow their doctors to prescribe such drugs for their patients.
“SB 380 has had a remarkable impact on the number of referrals we’ve seen in the first half of this year,” said Dr. Kai Romero, chief medical officer for By the Bay Health.
While the organization’s doctors can’t prescribe the lethal drugs, they are allowed to serve as consulting physicians in the process. Under the law, before an attending doctor may write a lethal prescription, the patient must be examined by another consulting physician, who verifies the diagnosis and that the patient is capable of making an informed medical decision and acting voluntarily.
Still, there is no way to know how many California residents are using the law to end their lives. That is because the law specifies that such deaths not be deemed as suicides and the California Department of Public Health has advised local officials not to indicate when deaths occur pursuant to the End of the Life Option Act.
Romero said if the deaths were classified as suicides some life insurance policies would be invalidated.
Roger Fielding, the Marin County chief deputy coroner, wrote in an email, “If a person follows the provided directions, the death is not reportable to the coroner, and the death is certified by the person’s physician as a natural death with cause of death being opined by the certifying physician of record. The terminal illness would most likely be indicated as the cause of death or other significant contributing condition leading to death.”
Romero said since the law took effect, By the Bay Health has helped 256 terminally ill patients in the Bay Area end their lives, and 111 lived in Marin.