Last Flight Home

“It was like light from a lighthouse,” says David Timoner of the call he got from End of Life Choices California (EOLCCA) when he and his family were facing the toughest time of their lives.

“The wisdom we got from those final days we will carry with us forever.”

LFH Oscar shortlist pic

David’s 92-year-old father Eli was in the hospital. He had reached a point at which advanced COPD, CHF, and other health issues had become intractable and meant he would have to transfer to a care facility. But Eli knew he wanted to die at home surrounded by those he loved, and he asked about medical aid in dying. His family understood and supported his decision but didn’t know where to turn for help. Vaguely aware of a California law, they still had no idea what to do next.

“The day is a blur,” David says. “I think I googled something like ‘How to end your life legally . . .’ and EOLCCA popped up right on top. I called the number, left a message, and had a call back within the hour.” Lynne, the volunteer at the other end of the phone, was everything David needed at that moment: “Calm, empathetic, and with the answers to all of our questions. Lynne explained how the California law works and reviewed the eligibility requirements.” These, in brief, include the requirement that the patient must be diagnosed as terminally ill, with a six month or less prognosis by two doctors, must make the request himself, be able to self-ingest the medications, and be of sound mind. “Lynne also recommended that my father consider enrolling in hospice care,” David says. She was able to recommend two hospices in our area that she knew had doctors who participate in medical aid in dying. We chose one and brought Dad home.”
Ondi Timoner, an award winning documentary filmmaker, decided to record those days during the then 15-day waiting period mandated after Eli first requested aid in dying medication from the hospice doctor, until he could receive the prescription. She initially intended just to have a family remembrance. After all was over, however, she realized she had the makings of something important.

Ondi’s remarkable film, Last Flight Home, tells the full story. In the ensuing weeks, the Timoner family – Eli and his wife Lisa, their children David, Ondi and Rachel, their grandchildren and friends–would spend invaluable time at home together celebrating Eli’s unique life’s journey. The profound, intimate, loving farewell afforded Eli and his family by California’s medical aid in dying law, is the outcome we at EOLCCA wish for anyone who reaches out to us for similar help and information. That this Southern California family’s experience would be recorded by daughter Ondi and edited into a powerful documentary now being released to widespread acclaim, is a visual testament to the value of medical aid in dying.

At a screening in New York, daughter Rachel told a New York Times interviewer, “And then there is the idea that this film could change laws.” Many of us with EOLCCA worked hard to get the California law passed, and we continue to support expanding the law throughout the U.S. To have had a part in helping Eli Timoner and his family gain peace at his life’s end, and to know that they now join the fight for everyone to be able to make such a choice, is doubly gratifying for EOLCCA.

California is one of a small number of states fortunate to have a law which enables its residents to access this compassionate end-of-life option for the terminally ill. But, from call after call we receive every day, it’s clear that few terminally-ill Californians are even aware of the law, or know enough about it to even begin the process of requesting medical aid in dying from their physician.

Last Flight Home is a film we hope will receive all the top accolades in the film industry for its many-layered and beautiful story. The story behind the film has been well documented in the New York Times. It is one we urge our readers to see as soon as possible and then recommend to friends and family everywhere.

‘Last Flight Home’ is a film we urge our readers to see and recommend to friends and family everywhere.

EOLCCA Lynne with 'Last Flight Home' Director Ondi Timoner and family

From Left to Right: Lynne Calkins with Ondi Timoner, Rachel Timoner, and Lisa Timoner at a recent screening

Asked for advice she might now pass on, Ondi says simply, “Be with your loved ones now. Don’t wait for them to be dying. But there is an incredible quality of life when a person is transitioning. The wisdom we got from those final days we will carry with us forever.”
Perhaps the most profound lesson Eli’s family learned was the simplest. It has to do with summing up life itself – as we humans do so often by looking at accomplishments and honors and all those treasures we accumulate. But no, says Ondi Timoner as she reflects on her family’s journey and the creating of Last Flight Home.

“Look at it as a way to measure our lives,” she says. “Measure our lives with love.”

We hope Last Flight Home will reach the countless families and individuals in situations similar to that of Eli and his family, so that others may learn about the California law in time to make a difference in their own end of life if facing a terminal illness. Our EOLCCA volunteers are always ready to help. Call us at 760-636-8009 or visit our website.

Click here for more information about the film director, Ondi Timoner, and Interloper Films.

Click here to stream it on Paramount+ 

Paramount+ logo

 

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A lifelong newspaper and magazine writer, EOLCCA Board Member Fran Moreland Johns has published fiction, nonfiction, and several books. Her focus on end-of-life issues includes many volunteer years, numerous articles and one book, Dying Unafraid. She holds a BA in Art from Randolph-Macon Woman’s College, and currently blogs at Medium.com and franjohns.net. Her short story collection, Marshallville Stories, was released in April 2022.

Thanksgiving. Giving Thanks. Giving. Thanks.

There are so many inspirational quotes and phrases about Thanksgiving focusing on gratitude and thanks, one quote from Erma Bombeck stands out to me: “I come from a family where gravy is considered a beverage.”

Ok, maybe not the most consequential thought, but as we at End of Life Choices California (EOLCCA) consider our work around the weighty (Thanksgiving meal pun alert!) issues surrounding death and dying, living and dying with dignity, and controlling our own fate, it’s important to remember that sometimes humor –  puns, physical humor, even gallows humor – is something that can sustain us during difficult times.

Particularly during the holiday season, as our thoughts often turn to loved ones no longer with us (family, friends, Dick Clark on New Year’s Eve…), we encourage you to take a moment to recall a heart-warming and humorous memory of a loved one and appreciate the smiles and joy shared.

Thankful

We are thankful for the many people associated with EOLCCA:

    • the hundreds of Californians who have reached out to us this year for information, guidance, and support as they or a close friend or family member seek control and dignity at the end of their lives.
    • the over 45 Client Volunteers throughout the state who are there every day to answer questions, guide people through their end-of-life journey, and even be present at their bedside as a knowledgeable and calming influence on the day of a planned death.
daughter and father
    • the health care, hospice, and medical professionals who refer their patients and clients to us for additional information and support.
    • our donors, who allow us to keep the lights on, raise awareness, and continue to provide these important services, all provided at no cost to the client.
    • our board members who work hard to keep us on track and all contribute their time and talent serving on one committee or another. 

The pyramid falls without the strength, compassion, and support from each of these groups.
A collective THANK YOU to all of you!

Looking Ahead

In giving thanks for what has transpired over the last year, we also turn an eye to the future. For us, that means:

  • developing and offering an Advanced Training to certified Doulas from anywhere in the country on all the end-of-life options, including Medical Aid-in-Dying
  • recruiting and training more volunteers to serve the increasing demand for our services in more rural and medically underserved areas of California
  • expanding our speaker program to hospice staff and to the community at large
  • screenings of relevant movies to provide education and information to the general public about medical aid in dying.

During this season of Thanks, we also ask you to consider Giving.

We are a small but growing organization so every donation counts and is impactful!  You can make a secure online donation here or you can send a check to 153 S Sierra Ave #30, Solana Beach, CA 92075.  We can also accept donations of stock (a good tax strategy if applicable to you) or from your Donor Advised Fund.  We are a 501c3 nonprofit organization, Certified GuideStar Gold, EIN 83-3560210.

Thank you

One final Thank You to YOU for reading!

On behalf of the Board and Staff of EOLCCA, we all wish you a peaceful and fulfilling holiday season, however you choose to observe,

Judy Epstein
Executive Director


EOLCCA supports a strong team of experienced volunteers throughout the state, ready to help anyone, anywhere in California free of charge with information and support regarding all end-of-life planning and choices, including aid in dying through the California End of Life Option Act. You can find comprehensive information on our user-friendly website. EOLCCA is a 501(c)(3) non profit organization and we rely on donations from individuals and foundations. To support our work, or request an educational presentation, please visit Ways to Help.  Thank you!

MAiD MYTHS

In California, we are very fortunate to have won the right to medical aid in dying (MAiD). With the California End of Life Option Act (ELOA) in effect since June 2016, MAiD has been legal and available for more than seven years. The law provides the ability of a physician to write a prescription for life-ending medication for a terminally ill patient, and for that patient to self-ingest the medication. Since California’s law was passed by a legislative vote, and not by a public referendum on the ballot, surprisingly few people in a state as large as ours know about this option.

Additionally, because we live in a time of widespread misinformation and disinformation, EOLCCA receives a lot of inquiries from people who believe many of the myths circulating about medical aid in dying.


The purpose of this article is to dispel those myths and provide you with the facts, according to the ELOA.

Fact versus myth road sign with two arrows on blue sky background. White two street sign with arrows on metal pole. Two way road sign with text.

Myth #1: It is complicated to access MAiD.

FACT: It is not complicated once you have the required two physicians to work with (an attending physician and a consulting physician). Often the attending physician has a consulting physician already at hand. The law requires oral and written requests of two physicians who agree that you are eligible (meaning life expectancy of six months or less), just like the eligibility requirements for hospice. One of the services we provide to people who reach out to us is helping them talk with their own physician about prescribing and, if the physician will not participate as allowed by the law, we help them find a new physician who will prescribe.

Myth #2: MAiD requires too much paperwork.

FACT: The requesting patient only needs to complete a one page form. The REQUEST FOR AN AID-IN-DYING DRUG TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER form can be found on our website.

Myth #3: You must open and mix 100 capsules of medication.

FACT: This used to be the case, but now the medication arrives at the home in the form of a powder in a small bottle, dispensed from a compounding pharmacy. It consists of a combination of medications to which two ounces of water or apple juice are added, just prior to taking. Once mixed, it becomes a milk-like liquid. After consuming all the medication within two minutes, the patient generally falls asleep within five minutes and goes into a deeper and deeper sleep, and dies peacefully, the way most individuals say they wish to die. If the patient cannot swallow, there are other ways to self-ingest the medication according to the law. A knowledgeable physician can discuss these options.

Myth #4: A medical professional (MD, RN)  must be present when the MAiD medication is taken.

FACT: A person may take their medication with anyone present whom they wish. Anyone, including you, may mix the medication. But we feel that no one should die alone. We provide experienced, highly trained volunteers who are available to be with clients and their families to offer support, if requested.

Myth #5: You must have resided in California for at least six months in order to access MAiD.

FACT: The ELOA says nothing about the length of the residency requirement. Any place of residence in California, whether on your own or with family/friends, is sufficient to seek medical care in the state.

Myth #6: MAiD is euthanasia.

FACT: Euthanasia involves the administration of lethal medication to an individual by a medical professional. MAiD laws in the US require the individual to self-ingest, by swallowing or pushing a plunger by themselves into their digestive system.

Myth #7: MAiD is suicide.

FACT: MAiD allows an individual who would otherwise wish to continue living but cannot due to a terminal diagnosis without any chance of recovery, to plan for the day, time, and place when they may die peacefully. Suicide is committed by someone who is usually not dying and often suffering from mental illness. The ELOA states MAiD is not suicide in four separate places in the law.

Myth #8: Life insurance will not pay out for someone who uses MAiD.

FACT: By law, life insurance, wills, and contracts are unaffected by someone who chooses MAiD. The death certificate states the cause of death as the underlying disease (cancer, heart failure, COPD, etc.), never MAiD or suicide.

Myth #9: If I go through the process and receive my MAiD prescription, I must take it.

FACT: You can always change your mind, even on the planned day. You are in control. One-third of Americans in states with medical aid in dying who obtain the MAiD prescription never take it because they can relax significantly, knowing they have the medication if they ever need it.

Please feel free to call or email us anytime with questions or concerns at 760-636-8009 or info@endoflifechoicesca.org. Our volunteers are available to help you and we do not charge for our services.

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Lynne Calkins is a founding director and current board member of End of Life Choices California in addition to serving as an active client volunteer. She developed EOLCCA’s client services volunteer program, launched EOLCCA’s MAiD Bereavement Group, and is a frequent speaker to a wide variety of audiences on end-of-life options. She campaigned vigorously for the passage of California’s End of Life Option Act in 2015 and is eternally grateful for the legacy of Brittany Maynard that helped make this law a reality for all Californians. She is passionate about the individual’s right to choose a peaceful death at the end of life.

EOLCCA supports a strong team of experienced volunteers throughout the state, ready to help anyone, anywhere in California free of charge with information and support regarding all end-of-life planning and choices, including aid in dying through the California End of Life Option Act. You can find comprehensive information on our user-friendly website. EOLCCA is a 501(c)(3) nonprofit organization and we rely on donations from idividuals and foundations. To support our work, or request an educational presentation, please visit ways to help.  Thank you!

Eggs in Purgatory Book Review

Spoiler Alert: We know that parts of this book review are hard to read, but we believe it is worth sharing. The reality is that self-medications can go wrong, not all hospices are the same, and every experience is unique. EOLCCA was founded in large part to address and try to alleviate all of these issues and more, by providing information and support to people who contact us.

What if your elderly parent wanted to end his suffering – but didn’t have a terminal diagnosis?

What if you were honoring a loved one’s wishes – but began feeling, guiltily, that maybe you “just wanted him to die”?

Award-winning author Genanne Walsh examines some of the most complex questions that confront terminally-ill individuals and family members wanting to help and support them.  Facing life’s end is no easy task. Walsh’s father Gene faced his own end fearlessly and early, but when it arrived there were roadblocks for him, as well as for his loyal and supportive daughter, that they could never have anticipated.

 

Favorite breakfast dish

In her excellent new book, Eggs in Purgatory (the title references a favorite breakfast dish), Walsh leads readers through and around those obstacles with her. The tale takes barely 80 pages of text – it’s more long-form essay than hefty book – but brings valuable lessons and insight.

“All my life,” Walsh writes, “I could count on two things from my father: love and upheaval. I felt acutely when he was dying that it was my destiny to walk that road with him . . .”

Raised Catholic, Gene Walsh served as a priest for ten years. After meeting his future wife at a Catholic university in upstate New York, he left the priesthood and the church. But he remained deeply spiritual. Part of that spirituality was a view of death and afterlife his daughter describes as a belief that “his spirit would continue: stardust, essence, universal oneness.”  It supported his emphatic wish for a quick exit from this life, with no intervention to extend it when the time came. To that end, Gene Walsh did all the right things: wrote down his instructions, talked with his physician and his daughter – nobody was in doubt about his end-of-life wishes. (See the Planning tab on this website for help with your own!) But this is not always enough.

 

She dialed 911

Eggs in Purgatory opens with the story of Gene Walsh’s suicide attempt. Finding her father snoring but unresponsive, an empty bottle of over-the-counter “sleep aid” pills on the bedside table and vomit on his shirt, his daughter could not leave him to whatever might come next. She dialed 911. The call led to a weeklong hospital stay that began with a psychiatric hold and ended with diminished mobility added to his already failing hearing and eyesight and a list of other non-life-threatening afflictions. Discharged with instructions about getting better, he had little enthusiasm for living.

A wish to quickly die

After his wife’s death, Gene had moved to California, into a downstairs apartment below the home of his only child, daughter Genanne, and her wife Lauren. It was there, at Christmas, not long after the suicide attempt, that he explained his decision to stop eating and drinking – invoking the California End of Life Option Act and believing that he would then quickly die. A sympathetic physician honored that decision and referred him to hospice care.

Author Walsh writes of what followed in a wrenching tale of good end-of-life plans gone awry. Gene left his physician’s office almost euphoric. The family joyfully received the hospice nurse, a gentle, empathetic young man who outlined the care that would follow. But joy came to an abrupt end when the nurse called his office to get a sign off from the attending physician. That doctor, after reviewing the case, decided that Walsh lacked a terminal diagnosis as required by the California law and was therefore displaying “suicidal behavior.” This required a report to local authorities, a visit from the police, and a narrowly escaped return to the psychiatric ward.

Eggs in Purgatory Book Cover
Happy ending

There is a happy ending to author Walsh’s small book. It’s no spoiler to say that her father eventually gets the death he welcomed. What she leaves us with are cautionary lessons, and a wealth of insight into questions that can arise when we or a loved one is facing death.

When calls for help and information come to EOLCCA, our trained volunteers work with clients like Gene Walsh and his family to connect with a sympathetic hospice and get the support needed. We are grateful to author Walsh for sharing her story in order to help others avoid the pitfalls her family encountered.   

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A lifelong newspaper and magazine writer, EOLCCA Board Member Fran Moreland Johns has published fiction, nonfiction, and several books. Her focus on end-of-life issues includes many volunteer years, numerous articles and one book, Dying Unafraid. She holds a BA in Art from Randolph-Macon Woman’s College, and currently blogs at Medium.com and franjohns.net. Her short story collection, Marshallville Stories, was released in April 2022.

EOLCCA supports a strong team of experienced volunteers throughout the state, ready to help anyone, anywhere in California free of charge with information and support regarding all end-of-life planning and choices, including aid in dying through the California End of Life Option Act. You can find comprehensive information on our user-friendly website. To support our work, or request an educational presentation, please visit ways to help.  Thank you for your support!

Gifts & Lessons Learned Through Loss

Note: Alison Clay Duboff is a volunteer with End of Life Choices California. Her husband used medical aid in dying on August 3, 2021. Here are some of her reflections after going through the experience.

As sentient beings, we attempt to find meaning in loss. We desperately search for celestial answers to the mysterious reasons “why” to assuage our pain. 

Occasionally a purpose, an enlightened drive, arises from the ashes of grief, bringing meaning to the unimaginable. And that is the true gift.  

Through the loss of my terminally-ill husband, I found that my bestowment was writing. Be it scratching words across a page, speaking into my telephone when the words hit me at inconvenient moments, or sitting at my computer and letting my fingers loose amongst the letters on the keyboard. 

Writing not only brought me immeasurable pleasure and release, but it took on a life of its own and began helping others in my same situation as I shared my innermost, deep, dark, and light emotions to my community online.

This newfound vehicle of helping others morphed into being compelled to help as many people as I could and that is how I became a mouthpiece for personal choice and a volunteer for End of Life Choices California. I’m pleased I strongly encouraged the agency to start a bereavement group for families that used medical aid in dying.

A few times every week, people will stop me on the street and ask me if I am “Alison,” the lady who lost her husband. My collection of words has reached people near, far, and have brought comfort and understanding or a sense of mutual understanding, of being heard, and for me this is the greatest legacy I could have ever imagined or asked for. 

I have learned that the simple gift of a hug from a stranger, or to a stranger, is a beautiful thing in and of itself; surprising and deeply fulfilling, I call it, “humanity.”

I’ve learned repeatedly during my period of grief that people need and seek connectedness and are able to exchange energy even when the topic is uncomfortable.

We are slowly coming out of the dark ages of denial and into the light where we accept the ominous elephant in the corner of the room: Everyone will die, yet when those we love pass away, we are taken aback, surprised and shocked. 

I yearn to help others recognize that the day, the year, or the manner of death might be shocking and unexpected, yet death will come often when we least expect it, too often when we are completely unprepared for that inevitability. But with exception, and if fortunate enough, like my husband, one can choose the day, date, and time of death.   

I see the inevitability of death hiding behind the curtain on opening night. Death is there waiting backstage for the curtain to be pulled apart and to make its grand entrance. If we can learn to entertain the notion that our time on earth is transient, I believe we will live the remaining balance of moments in a much more gratitude-filled existence.

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Alison Clay Duboff is an active real estate agent in Manhattan Beach. She’s the author of Living with Veracity, Dying with Dignity, a book about the experiences with her husband. The book is available on Amazon.

EOLCCA manages a strong team of experienced volunteers throughout the state. We are available to help individuals and their familes in California, free of charge, with information and support regarding all end-of-life planning and choices.  This includes medical aid in dying through the California End of Life Option Act and bereavement support and resources. Find comprehensive information on our user-friendly website. To support our work, or request a speaker, please visit ways to help.  Thank you.

New Report on Medical Aid in Dying in California

We are pleased to share with you the California Department of Public Health’s (CDPH) newly published 2022 Data Report on the use of the state’s End of Life Option Act (ELOA).  The report reflects several key changes that went into effect on January 1, 2022 (via Senate Bill 380) that made the law more patient-friendly in allowing physicians to prescribe medical aid in dying (MAiD) for their terminally ill patients who are eligible under the law. 

One critical provision that went into effect shortened the waiting period from 15 to 2 days (48 hours) between the two oral requests required of the patient to their physician for a MAiD prescription. EOLCCA strongly supported this modification as many terminally-ill individuals who wished to use MAiD endured unnecessary suffering that the law (originally passed in 2016) was specifically intended to alleviate. In this new report, we are gratified to learn that:

“Out of the 1,204 individuals who started the end-of-life option process in 2022 and received a prescription during 2022, 947 individuals, or 78.7 percent, waited less than 15 days between the two verbal requests.”  

Almost 50 percent increase

Equally important to EOLCCA is the fact that the number of people who obtained a MAiD prescription increased by almost 50% compared to 2021. Universal knowledge that California has this law is a critical missing element that persists as a major roadblock for those who might request medical aid in dying. 

Too many people who might qualify remain woefully uninformed about the possibility of MAiD at key health care decision points in their end-stage terminal illnesses.

One of EOLCCA’s primary objectives is to continue to reverse that trend through comprehensive targeted education programs about the ELOA to hospices, medical practices, diverse local community organizations, houses of worship, and retirement communities. This year alone, our Speakers Bureau has already provided 42 educational presentations around the state. Please visit our Speakers Bureau webpage to learn more about this program.

volunteer at bedside
More good data

Several other data points of the report include: 

  • The vast majority (over 95%) of those who used MAiD in 2022 were receiving hospice and/or palliative care.
  • Those who utilized MAiD were numerically more white and had completed more education than the state’s diverse population. This is an area of extreme importance to EOLCCA as we work to expand our outreach and education efforts. 
  • About one-third of the people who receive a prescription never use it. 

To this last topic, anecdotal evidence we’ve accumulated through our counseling of scores of patients, indicates to us that having the prescription in hand has its own palliative effect, giving a measure of comfort and control to the patient. As a result, their anxiety goes down, their pain level goes down, and they are more able to relax into their dying process and never feel the need to take the medication. What a wonderful gift for people to have. 

I encourage you to read the report for yourself. It discusses in much more detail what peoples’ diagnoses were, their demographics and many other interesting factors. The report can be accessed here.

The report also showed that 84.5 percent of those who utilized MAiD in 2022 informed their family of their decision. In keeping with August designated as National Make A Will month, if you need assistance in preparing your own Advance Care plans, to better inform yourself or facilitate end-of-life discussions with your loved ones, please contact us.

In conclusion, while the results of this report show some encouraging advances, there is still much more work to be done. If you wish to inform, educate and help more terminally ill people access a peaceful death on their terms, please learn morevolunteer, or consider supporting our work by making a donation here

End of Life Choices California—Here for You

Watching things bloom this time of year makes me think a lot about End of Life Choices California and how we too are growing. 

I am pleased and honored to share that I am no longer the “acting volunteer executive director” which I have been since our humble beginnings, as the Board of Directors recently voted to appoint me as our official Executive Director.

When the other founding directors and I started EOLCCA back in the spring of 2019, our vision was to help people access a peaceful death. Big vision! We were driven by the daunting realization of how few people, doctors, and hospices knew about California’s at the time newer End of Life Option Act legalizing medical aid in dying (MAiD), as well as all the other end-of-life options.

On our YouTube channel

As part of our ongoing effort to educate the public and health care providers about the law, we have created a short video designed to reach a broad audience. I am delighted to share it with you here.

Please take 3 minutes to learn about the positive impact we have on peoples’ lives.

I invite you to share it with your own networks so more people can be aware of this law and how to reach us.

To educate and empower

We continue the work we started back in 2019 with high hopes and dreams of continued growth and the ability to reach, educate and empower Californians so they know what all their end-of-life options are, and how to access them. One of our greatest satisfactions has been the specialized presentations we have provided to hospices. We have had the privilege of providing education to dozens of hospices throughout the state – from their MDs, RNs and MSWs to their bereavement counselors and volunteers.

To schedule a presentation, please contact our Speaker’s Bureau coordinator at speaker@endoflifechoicesca.org

Dedication

Day to day, on the ground, our dedicated cadre of Client Volunteers provide the backbone of our operation. In 2023 alone, we have already fielded calls and emails from nearly 500 people. Our amazing volunteers offer support and guidance to empower individuals to navigate the medical system and effectively communicate their end-of-life wishes. We have built a rich resource center over the years so they can provide information about physicians willing to prescribe MAiD, supportive hospices with physicians who prescribe MAiD, and other pertinent support services in their community. In addition, our volunteers are skillfully trained and honored to be present bedside to support the family or loved ones on the day the client chooses to take medical aid in dying.  

“During a period of time when we were in desperate need of guidance and information and a resolution, we came across the organization (EOLCCA) and it helped us every step of the way.”

— Matt Mayerson, family member

Matt Mayerson

Sharing and giving

We are so grateful to the many supporters of EOLCCA who are helping us reach a larger audience by sharing our video widely. For more information about how you can support our mission through a tax-deductible gift, please visit our donation page.  Every donation, large and small, is deeply appreciated and helps us reach more people to ensure they are able to access the end-of-life care and dying that they want.

In the words of Henry David Thoreau, “…one must maintain a little bit of summer, even in the middle of winter.”  We feel the work we do provides just that: brings the lightness of summer to an often-wintry time for those facing the end of their lives. 

Best wishes for a lovely summer.

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EOLCCA supports a strong team of experienced volunteers throughout the state, ready to help anyone, anywhere in California free of charge with information and support regarding all end-of-life planning and choices, including aid in dying through the California End of Life Option Act. You can find comprehensive information on our user-friendly website. To support our work, or request an educational presentation, please visit ways to help.  Thank you for your support!

What actually happens during a MAID death.

As an End of Life Choices California (EOLCCA) bedside client volunteer and retired medical professional, I’ve attended both medically-assisted deaths (MAID) and non-MAID deaths. Most people who qualify choose MAID because they want some control over how and when they die once they are declared terminally ill. Their diseases have already taken so much control away from them.

Sometimes people never even take the MAID prescription but feel comforted by knowing they have it in case of need. Other times the disease progresses too quickly, and they lose the capacity to ingest the medication themselves as the law requires.  We advise people not to wait until the last moment to start the process of making their requests for MAID from two doctors. It can take a while to find a prescribing doctor if your physician won’t prescribe (or participate in MAID). Once prescribed, the medication must be prepared by a special compounding pharmacy and it could take up to a week to be prepared and delivered.

Our client volunteers are trained to work with people and their loved ones prior to ingestion to prepare them for the process, so they feel safe in deciding to just have family/friends present if that is their wish.  However, if needed, we are honored to be there the day they take their medication.

peaceful river scene
Questions

We answer many questions in the period leading up to the day of death and on that day itself.
As questions arise, we answer them all. 
Typical questions include:

  • What if the medications don’t work?
    Answer: The MAID medications prescribed by the doctor are lethal and are intended to be fully effective. With the client and their family, we thoroughly review the medications and procedures, and confirm that the client still wishes to take them on the day of death. 
  • How long will it take to die?
    Answer: Within five to ten minutes after ingestion, the patient will fall into a deep sleep and then into a coma and be unaware of anything else. It will take between 30 minutes and possibly up to four hours or so for the patient’s heart to stop beating. The patient’s loved ones may hear a few noisy breaths as the body shuts down. We will be there supporting the family and loved ones during that period and can help explain what may be happening as the patient passes away. 
  • Will patients soil the bed after ingestion or when they die?
    Answer: No, there is no involuntary release of body fluids during this process.
Being present

Most people prefer having two of our trained client volunteers present on the day they choose to take the medication. Emotions can be intense when someone is about to die, and it can help to turn the mechanics of preparation over to an experienced neutral person familiar with the process. It allows everyone else the opportunity to concentrate solely on their person and not be distracted by monitoring timing intervals between ingestion of the anti-nausea drugs and measuring and mixing the final medications, while still being present for their loved one. 

Experiences are as varied as individuals and families can be. Some people have a spiritual advisor offer a prayer or blessing. I’ve seen very quiet deaths where the volunteers withdraw to another room, leaving the group or family member alone at their request. I’ve been at deaths where the TV is on and everyone is reserved and not saying much. EOLCCA volunteers try to support their clients to have the death they want. Often the dying person is so ready for death they say things like, “Let’s get this show on the road.” Or, “I’m tired; I want to do this now.”

Mostly I’ve witnessed profound expressions of love such as: adult children and friends entwined with their dying person or stroking them tenderly, people singing to the dying, beloved pets snuggling next to their owners, last minute forgiveness amongst divisive family members, an aged  taciturn father apologizing to his middle-aged son for being too hard on him, and bikers regaling each other with tales of their escapades. The common threads are deep sentiments of love towards a cherished dying person.  

Dying man with wife
An honor

Afterwards, those present speak of grief, of thankfulness at being asked to be there for such an intimate experience, and recount stories about their now deceased loved one. EOLCCA has formed an online Bereavement Group specifically for family members involved in a MAID death, and we are able to offer them this option to help process their grieving.

All of EOLCCA’s 34 active volunteers consider it a privilege and an honor to help terminally-ill people, whether over the phone or in person, to have as much control as possible over when, with whom, and where they will die.

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Cynthia Tuttelman, an EOLCCA Client Volunteer, is a retired family physician and quilter living in Petaluma.

EOLCCA supports a strong team of experienced volunteers throughout the state, ready to help anyone, anywhere in California free of charge with information and support regarding all end-of-life planning and choices, including aid in dying through the California End of Life Option Act. You can find comprehensive information on our user-friendly website. To support our work, or request an educational presentation, please visit ways to help.  Thank you for your support!

Getting the Word Out About Dying with Dignity

At End of Life Choices California, one of our major objectives is to spread the word about all of the medical options Californians have at the end of their lives for dying with dignity, including (if they qualify) medical aid in dying. That objective is so important that it sits at the heart of our mission statement:
EOLCCA provides Californians the information and support to successfully navigate their legal end-of-life options.

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Knowing one’s choices is key

It continues to surprise us that few Californians take advantage of the End of Life Option Act. We understand that there are many reasons for that. For example, many individuals (including doctors) may not know about the law, or they may not support it on religious or other grounds. We just want to make sure that, at the very least, Californians know about the law so–if they qualify–they have the choice to use it.

With that in mind, I recorded a Perspective piece for KQED (the public radio station in northern California), about how the law clearly benefited one of our clients, along with mention about how few Californians use the law. By the end of 2021 (the last year for which we have usage data), less than a quarter of 1% of deaths in California resulted from using it that year. 

Looking at the raw numbers, in 2021, 772 individuals had prescriptions written, and 448 ingested and died from the drugs prescribed that year. NOTE: We always see a disparity between prescriptions written and ingestion because many people end up dying on their own–but feel great relief knowing they have the drugs if they need them.

If you would like to listen to my Perspective, here’s the link. And–hey–please spread the word!  Thank you.

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Stewart Florsheim serves on the Board of Directors of End of Life Choices California and chairs its Outreach and Education Committee. He has been an activist and leader in the end-of-life choice movement in California since 2003. During that time he was deeply involved in the effort to successfully pass the California End of Life Option Act in 2015. Stewart has given many presentations on end-of-life choice, including on radio and TV. 

EOLCCA supports a strong team of experienced volunteers throughout the state, ready to help anyone, anywhere in California free of charge with information and support regarding all end-of-life planning and choices, including aid in dying through the California End of Life Option Act. You can find comprehensive information on our user-friendly website. To support our work, or request an educational presentation, please visit ways to help.  Thank you.

Not in the Job Description, Bonus Benefits of EOLCCA Work

“All they really needed,” one volunteer said of a client’s family, “was an outsider’s ear and a little time.” The volunteer had come, after making an appointment on the phone, to talk over end-of- life choices. The client was close to death from cancer and wanted to know about using Medical Aid in Dying (MAiD). One of her adult children, though, was encouraging her mother to begin another round of a new chemotherapy drug.

“And there I was,” the volunteer said. “Not a doctor, not a therapist, just a volunteer with no  skin in this game. So I told them I could only answer questions about end-of-life choices but I’d be happy to listen. Then I sat down in a corner across the room.” For about an hour the mother and daughter talked; the mother saying she was tired of the pain and struggle, the daughter saying she “wasn’t ready” to lose her.

“Occasionally they would look at me,” the volunteer said; “asking about pain, or legal options, or time spans. At long last, the daughter gave her mom a hug and said, ‘I’ll support you, if this is what you want.’ It was a beautiful moment.”

daughter with mother turned to look at her smaller size
A cloud lifted

Another client told his volunteer, early on, that he was worried about his 65-year-old son. The son had been with his mother when she died, and a younger brother when he died. The son was emotionally fragile and his father thought that experiencing one more family death would be devastatingly difficult. 

Over the next several weeks, the volunteer visited with the son repeatedly at his father’s bedside and over coffee at a nearby bistro. After lengthy discussions about MAiD and how it works, the son became comfortable with the idea of saying goodbye to his father well before the latter took life-ending medications. “It was like a cloud lifted for both of them,” the volunteer said; “when it was silently agreed that I would be with the client if requested and the son would not attend his dad’s death. At the end of each visit both father and son would say goodbye with a lot of love and a little finality.”

Being a good listener

The neighbor of another volunteer, hearing she worked with end-of-life issues, asked her to help her daughter talk about them. Within a week, both mother and daughter had their long-postponed advance directives done.

Such experiences are common: times of tenderness for clients and volunteers alike. Clients and families get the care and relief they sought, while volunteers always learn a little more themselves – how to be a listener as well as a doer.

volunteer with patient
Ways we are able to help

One multifaceted happy outcome was experienced by founding board member and almost daily volunteer Lynne Calkins. Calkins took a call from David Timoner and directed him toward a hospice and eventual peaceful MAiD death for his dad Eli. “I remember talking with David about his concern that younger sister Rachel, a rabbi, might be against MAiD. In the end, of course, she was not. She totally came around in support of the family, and the End of Life Option Act. She continues to support MAiD and seeks to educate the Reform Jewish community.”

Eli Timoner’s story became an acclaimed documentary, Last Flight Home, written and directed by his daughter Ondi – one of the happiest bonuses EOLCCA has had in recent years.

These stories – of ways we are able to help, and to expand the benefits of end-of-life choice – are the extra joys that keep every EOLCCA volunteer’s spirits soaring.

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A lifelong newspaper and magazine writer, EOLCCA Board Member Fran Moreland Johns has published fiction, nonfiction, and several books. Her focus on end-of-life issues includes many volunteer years, numerous articles and one book, Dying Unafraid. She holds a BA in Art from Randolph-Macon Woman’s College, and currently blogs at Medium.com and franjohns.net. Her short story collection, Marshallville Storieswas released in April 2022.

EOLCCA supports a strong team of experienced volunteers throughout the state, ready to help anyone, anywhere in California free of charge with information and support regarding all end-of-life planning and choices, including aid in dying through the California End of Life Option Act. You can find comprehensive information on our user-friendly website. To support our work, or request an educational presentation, please visit ways to help Thank you.

Medicare wants you to talk to your doctor

You may not be thrilled to have “aged into” Medicare, but there’s a silver lining! Medicare offers significant support for communicating about your healthcare wishes and managing your end-of-life options. 

Talking to your doctor

Medicare also covers the cost of health services meant to improve quality of life when a cure is no longer possible: hospice care during the last six months of a terminal illness, and palliative care, to help manage a serious or terminal illness with a longer term prognosis.  As important – but not well used – is the fact that Medicare covers advance care planning discussions with your physician as part of your annual wellness check.

Advance directives

Advance care planning is something every adult is encouraged to do and complete while in good health, ideally well before a health crisis or terminal diagnosis. Often advance directives are prepared and health proxies determined at the same time as your estate planning documents and power of attorney and executors are finalized. Preparing your advance directives offers the chance for you to have invaluable conversations about your care management and end-of-life wishes with your loved ones as well as your physician, thanks to Medicare.
Medicare also requires hospitals and skilled nursing facilities to ask at the time of admission whether you have an advance directive and to note its existence in your medical record.

Without your documentation, providers who do not know you will be making health care decisions for you.

Palliative care

Palliative care is a notoriously underutilized health service that focuses on managing  pain and symptoms caused by chronic and debilitating illnesses. Under Medicare, palliative care is available to you whether or not you have a terminal disease, although it is most commonly used when you have decided to stop treating a terminal disease. Palliative care can increase your quality of life enormously. Because you’re no longer in such distress, palliative care also helps relieve the distress felt by your family and friends.  Medicare covers the costs of palliative care, so you should ask your doctor about it in order to take advantage of the relief it can offer you as soon as possible. 

 

Hospice care

Hospice is a combination of comfort care services including nursing care, palliative medicines, counseling for you and your family, and a supportive and knowledgeable resource for your immediate caregivers. The key benefit of hospice is being enabled to spend your last days in the surroundings of your choice – usually your home. If, like most of us, you want your death to be as peaceful and calm an event as possible, I encourage you to consider entering hospice as soon as your death becomes reasonably foreseeable rather than in a rush in the last few days.  

Because Medicare covers almost all the costs of hospice, there is no reason to delay once your doctor certifies that you’re eligible. This typically happens once you’re within six months of death, an interval that can be extended if death does not occur within that period.  

Where medical aid in dying (MAiD) fits in

If you live in California and are suffering from a terminal illness with a six months or less prognosis, the state’s End of Life Option Act enables you to request medical aid in dying from your physician. If you’re receiving hospice care, but the path towards death involves prolonged pain and suffering, you can choose to step off that path as long as you meet the legal requirements. To obtain medical aid in dying, you’re required to make two oral and one written request to your doctor; he or she confirms you’re within 6 months of dying; and a second physician must also confirm the attending physician’s opinion. After a 48-hour waiting period, your doctor is allowed to write your prescription for life-ending drugs. 

Even if you’re eligible for and obtain a MAiD prescription, you’re free to make whatever end-of-life plans you wish, including when, or if, you ingest the medication. For some, knowing the medication is there if needed, offers enough relief to let death take its natural course. It’s important to note that aid in dying medication is not covered by Medicare.

Since 2016, Medicare has greatly expanded the range of end-of-life services it covers. These end-of-life services enable you to learn about and choose the care options you want, and to spend the last months of your life with your family and loved ones as comfortably as possible.    

Note: Costs covered by Medicare may require a co-pay or deductible depending on the particular Medicare, Medicare Advantage, or Medicare Supplement plan you have. It’s well worth the time now to investigate what services are available and how you would want your care managed before facing a debilitating or terminal illness.

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Adrian Byam, a member of EOLCCA’s Board of Directors, has been thinking about and researching end-of-life decision-making for the last decade.  After retiring from a 40 year career as an entrepreneur and senior executive in the IT industry in 2012, he began a PhD program in neuroethics – a new field combining neuroscience and medical ethics – at the University of British Columbia (UBC).  His thesis showed that the choices made by surrogate decision-makers for ICU patients often failed to meet patients’ values, and suggested new ways to ensure patients’ autonomy is truly respected. Our social and medical systems today rarely inform us about the choices available to us in the last stages of our lives. By working with EOLCCA, Adrian hopes to help his fellow Californians learn about the choices that are legitimately theirs, and empower them to exercise control over the last days, weeks, and months of their lives.   

 

EOLCCA supports a strong team of experienced volunteers throughout the state, ready to help anyone, anywhere in California free of charge with information and support regarding all end-of-life planning and choices, including aid in dying through the California End of Life Option Act. You can find comprehensive information on our user-friendly website. To support our work, or request an educational presentation, please visit ways to help.  Thank you for your support!