When the state’s aid-in-dying law, the End of Life Option Act, went into effect nearly a year ago, Dr. Frederic Kass was one of the few physicians in town willing to even discuss the matter. If the Legislature voted to give those facing terminal illness the right to end their own lives, Kass — a highly respected oncologist and major player in the South Coast medical community — argued, doctors needed to step in to make sure it was done competently and humanely. The state bill was strictly voluntary: doctors were allowed to participate if they so chose.
In Santa Barbara County, both Cottage Health and Marian Medical — the two big hospitals — declined to participate. Sansum, with which Kass is affiliated, offered to be involved. So, too, did a small number of private doctors. Since then, a small handful of patients have chosen to activate their opt-out clause. At least one was a patient of Dr. Kass’s. This week, the doctor spoke on the End of Life Option Act at a forum hosted by the Alliance for Living and Dying Well. Beforehand, he spoke with Santa Barbara Independent editor Nick Welsh. The following is a transcribed version of their conversation.
When this act was first passed, it seemed that not many providers in Santa Barbara were willing to participate. Yes, only a few of us were willing to say so publicly. I think some physicians didn’t want people coming to them asking: “Can you help me?” Some just wanted to do it quietly for their own patients. No one here wants to be offering this as a service.
Did that happen in Oregon, where assisted suicide has been legal for 19 years? The data from Oregon shows a few group practitioners who [had] a relatively large number of patients for whom they provided this service; yet, if you look at the time from when they met the patient until the time the patient died, it was barely more than the statutory minimum. The implication is that new patients came to them with their plan, and the doctors were willing to do it. It became a concierge service. That is not the kind of service I want to offer.
You have had a patient who requested an assisted suicide. Without revealing the name or any personal details, can you tell what the process was like? This was a patient with whom I enjoyed a long and very close relationship. We had a lot of heartfelt conversations about her condition. I was absolutely sure that it was the appropriate thing to do and that she represented the kind of patient for whom the act was written and passed. But personally, it was … it was extraordinarily difficult. I did it. I think it was the right thing to do. But did I have a lot of second thoughts along the way? Boy, you bet.
And did you try to talk her out of it? No. She was very clear. When her quality of life had diminished and she was at the point where her body would not be able to save itself, she told me: “I don’t want to be just lying in bed waiting for my heart to stop.”
Wow, that is a tough one. It goes from the theoretical to the very real. That is right. In the State of California, this is part of practicing medicine. But, I will tell you that I spend time asking myself: Is this what God wants me to do? And if you ask me, am I sure I know the answer to that? The answer is no. But it was a way to help her with her suffering. And I pray that that’s part of compassionate care.
I really spent time in prayer asking if this was the right thing to do. The patient was someone I’d been taking care of for years, who asked me for something that the Legislature has said should be available in California. I made the decision professionally that I was not going to send my patient to find another doctor. But personally, this was a difficult decision. Ultimately, I was committed to meeting my promise to the patient. But I didn’t presume that it was going to be easy, and it wasn’t.
Do you have other patients who are asking you to do the same? You know I can’t answer that.
What exactly is the process? You issued the prescription. And after that the patient is on his or her own? No. I asked if I could be present because I feel like this isn’t something I wanted to do by proxy.
Oh, man. That must have been really tough. Yeah, but if I am going to take responsibility to do this, I can’t hand someone a prescription and say I am not going to be around for the hard part. Right? If I was going to go this far, then I was going to be present for the whole journey.
So you write a prescription … Right, and of course it is up to the patient to acquire the medication. But once the patient has the drug, I think it is safer if a provider is there. There are questions about how to do this right to avoid mishaps. What you don’t want is for the patient to get sleepy and then not finish it.
Right, so you take like, 100 seconals? So do you have to take apple sauce or … What you do is empty all the capsules, I think there are 90, and then dissolve it in a juice that the patient can drink. But first, the patient takes anti-nausea medication and other things to make sure it will go down okay. And I gave the patient some advice about eating or drinking that day to be sure it would be absorbed. I hate to describe it this way, but like any other medical procedure there is guidance on how to make sure it goes well. The patients, however, have to do this themselves — the voluntariness has to be straight through to the end. The patient has to be on his or her own to the very end taking the medication.
Thank you very much for discussing this. To be honest, Nick, to say it’s not easy is an understatement. This is just really hard. You know, the fact of the matter is that, well, we can’t fix being mortal, can we?
We haven’t figured that one out yet. And I, for sure, think God intends it that way.