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Dr. Tony Back, who is co-director of the University of Washington’s Cambia Palliative Care Center of Excellence, said that after a similar aid-in-dying law passed in his state, more doctors realized that they “couldn’t just push it off on somebody else.”
As van Zyl struggles with her own reactions to the new law, she continues to have those tough conversations with one patient after another, every day.
On a recent day, more than two dozen names were listed on a white board in her hospital offices — all of them patients referred to her team for care. A 33-year-old woman with metastatic breast cancer. A 50-year-old with pancreatic cancer that had spread to her lungs. A 20-year-old man with a fast-growing brain tumor.
One patient van Zyl visited that day was Jose Garcia Flores, a gaunt, 60-year-old with advanced stage colon cancer. The former electrician had been diagnosed in the spring and was back in the hospital because of pain and nausea.
Van Zyl told him that there was a possibility that doctors would no longer be able to continue chemotherapy because of a complication. Van Zyl asked what he valued more — living longer, no matter what that looked like, or not living as long but being able to spend quality time with family at home.
“There is no right answer,” she said, promising to do everything she could to ease his pain and control his symptoms, regardless of whether he wanted to continue treatment for his cancer.
Garcia Flores paused and looked over at his wife standing next to the hospital bed. “I would prefer… to enjoy time with my family,” he said in Spanish.
“This isn’t fair — any of this,” she told him. “You are very brave.”
Van Zyl said that none of her patients have asked yet about the aid-in-dying law, which takes effect next year. She wonders if many of them even know about it.
A native of South Africa who used to work in emergency medicine, van Zyl said she recognizes that her views on the new law are hypocritical. “I don’t have a logical answer why I would want it for myself but not want to offer it to my patients,” she said. “I don’t know why I am still sitting on this fence that is increasingly pointy and uncomfortable.”
Part of it, she believes, is simple: “I’m deeply afraid of dying.”
Yet she knows, as a doctor, that death doesn’t have to be scary. Some problems, she says, have medical solutions — there are effective medications for pain and anxiety, for instance, so people can die peacefully. Van Zyl says her patients have always stopped asking to have their lives shortened once their symptoms were controlled.
Van Zyl believes medical providers, regardless of specialty, can be taught how to provide palliative care. That’s part of her job. And on this day, she stood before half a dozen medical residents, reviewing the best treatments for nausea, pain and shortness of breath. But suffering isn’t always physical, she said. Patients and families also need help coping with emotional suffering, she said.
“It is possible to screw up a family for life with a bad conversation,” she said. Van Zyl urged the residents not to run away from direct and honest — though hard — discussions. “Don’t do what so many doctors do, which is crumble.”
Then van Zyl brought up the aid-in-dying law. “What will you do when your patients says, ‘Can you kill me?'” she asked the group. “Somebody, at some point, is going to ask you to do that.”
One resident said that for her, prescribing lethal medication would be on a case-by-case basis. She would want to make sure the patient’s symptoms and pain were under control first. Another said she worried about how her own family would view her decision to help patients end their lives.
A third, Roshel Graham, said that no matter what, she hoped the law will help raise awareness about the benefits of palliative care. “I don’t think a lot of people even know palliative care exists,” she said.
As time goes on and doctors in California begin prescribing medicine to help people hasten their deaths, van Zyl said, perhaps her own views will become less conflicted.
“Maybe my position will evolve,” she said. “I could imagine one bad death tipping me over.”
By Anna Gorman, Kaiser Health News
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Kaiser Health News is a nonprofit national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.
