More precedes this excerpt and more after – very thoughtful and detailed read
My mother, as far as I can tell, might have been the first D.C. resident to take her own life under the Death With Dignity Act. (Mary Klein found her peace the following month.) If true, that would make her happy. But I also know that she would wish that no terminal patient would have to endure the uncertainty and delays she encountered, or be unable to afford the expense of the prescription. All her life she was deeply aware of the privileges and advantages she was blessed with and did her best to give back as much as she could: helping resettle Soviet Jews in America; practically adopting two young women who worked in the ambassador’s residence in Yugoslavia as it descended into civil war, and bringing them to the United States to live in her house and go to college; teaching at and supporting a school on the small Puerto Rican island of Culebra. She could be very gruff, but she had a soft heart. For her, making death easier for terminal patients was the obvious and compassionate response to terrible diseases. She knew she wouldn’t be around to fight that fight but considered her death a way of pushing back against the idea that patients have to suffer and endure until their bodies finally give in.
Earlier this fall, I called Don Fukuzawa to see how aid-in-dying has progressed in the District since Teeny took her life. He told me that he had requests for prescriptions but that he hadn’t been able to fill any. Bausch Health, the sole manufacturer of Seconal in the United States, stopped making the drug at the end of last year. Bausch hasn’t said why, or if and when it will resume making Seconal, which is the most popular aid-in-dying drug nationwide. I called Bausch Health to see if I could get any information. Lainie Keller, a spokeswoman, left me a voice message: “Unfortunately, given the topic of your article and the fact that it is in regard to an off-label use of our product, I’m not able to provide a comment.”
Fukuzawa told me that he hadn’t been able to procure the four-compound alternative either. Foer’s compounding facility, where the drugs in the alternative formula could be blended together, is in Maryland, where an aid-in-dying bill fell one vote short of passage in the Senate. Fukuzawa had reached out to some D.C. pharmacies that also compound drugs, which requires special equipment and precise regulatory standards, but they had declined. “Nobody was comfortable doing it,” Fukuzawa explained, adding that their reluctance wasn’t so much discomfort with the Death With Dignity Act but lack of familiarity with the formula and the dosages of the specific drugs involved.
David Grube, the national medical director for Compassion & Choices, says that the four-drug compound has been a satisfactory alternative to Seconal and assures me that there is a pharmacy in the District that will prepare it. Compassion & Choices also notes that a compounded prescription can be ordered from a state like California or Oregon — where pharmacies are more experienced with aid-in-dying prescriptions — and shipped to D.C., as long as the out-of-state pharmacy has a D.C. license. “The compound is not complicated or confusing, and the results are the same,” Grube says. “The person generally just falls asleep and dies quietly within 30 to 40 minutes.”
Of course, a patient, pharmacist or doctor would still have to reach out to Compassion & Choices to get the contact information through their confidential networks, which is a reflection of the fact that our society still has trouble grappling openly with the idea of assisted death. Ideally, patients seeking to use the law could simply consult a public registry of physicians and pharmacists who choose to help them. That would save patients time, anxiety and potentially unnecessary pain. But we aren’t there yet. “We’re very careful of keeping the information confidential,” Veronica Longstreth, the D.C. Department of Health program manager who oversees the Death With Dignity Act, says. “There are still some stigmas.”
Grube explains that the D.C. Death With Dignity law is simply going through the same problems similar measures in other states have encountered when they first took effect: “I believe that D.C. has the normal experience. It is a new thing for D.C., and pharmacies are not sure. They didn’t really do their homework and get prepared, and when the law becomes active they don’t have a policy. But then it evolves.”
In other states that have similar new laws, however, terminally ill patients seem to be having an easier time obtaining the drugs. Last year in Colorado, where the End of Life Options Act has been in effect since December 2016, 125 people filled a prescription, a rate of one for roughly every 45,000 residents. That’s more than three times the rate at which prescriptions are being filled in the nation’s capital. Hawaii has a brand-new law, and 2019 is the first year it’s in effect. If Hawaii continues to fill prescriptions at the same rate it did from January through May, then about 19 of its residents will receive aid-in-dying drugs. That’s a rate of one prescription for every 74,000 residents, about twice the rate in D.C.