A friend recommended I watch the new Netflix movie, Paddleton, just out in February.  I found it to be a worthy watch for someone interested in the intricacies of death and dying. Actors Ray Romano (Andy) and Mark Duplass (Michael), depict two middle-aged men who struggle with society and relationships in general, and even more so when one of them is diagnosed with a terminal illness and chooses to access California’s End of Life Option Act and medical aid in dying.

If you’re in a hurry, tired or sleepy, don’t watch this movie.  This is a film to relax into, as it is slow moving. It is an accurate portrayal of the struggle we experience when a loved one is diagnosed with a terminal illness.  The two men have an interesting and somewhat unusual friendship, and we see that in great detail as they grapple with Michael’s dying process and his desire to take medication to hasten his death.  I found it sweet and heart-warming at times, and sad at others.

However, there were some good questions that came out of it too, which I’d like to address:

SPOILER ALERT:  Reading further will ruin the film for you if you haven’t already seen it.

It appeared that Michael was able to easily obtain a prescription from his physician for medical aid in dying.  

This is generally NOT the experience in California, even though the End of Life Option Act has been in place for nearly three years.  Many physicians still will not prescribe, and many people wishing to use the law have great difficulty finding a physician who will. EOLCCA is dedicated to educating physicians about providing medical aid in dying to their patients and is committed to helping patients find physicians who will support them at this fragile time of their lives.

Why did Michael not have more support from health care providers, i.e. Hospice?  

I thought this was an important aspect of serious illness and dying that was missing from this film.  I realize it would have changed the film greatly, but still…. Hospice does wonderful work and provides excellent support both to people who are terminally ill and their loved ones. Hospice staff might have been present when Michael took the medication if the specific hospice allowed it; not all do, but many do allow their nurses or social workers to be there.  One could say that maybe it was a matter of affordability, as Michael did not appear to be particularly wealthy or might not have had good insurance. Those things would not have mattered in a real scenario because hospice care is covered by Medicaid or Medicare.

Why did Michael have to travel SIX HOURS to retrieve the medication?

Under the law, the medicine can be picked up by the patient, a designated individual, or mailed by delivery service (i.e., UPS/FedEx) if needed.  Again this worked well for plot development, but it is not accurate. It’s true that pharmacists, as well as physicians and medical systems, have the right to opt out under the law. So it is conceivable that there was no nearby pharmacy to Michael’s home that would fill the prescription. But it could have been delivered in another way.  

Why did Michael refuse the anti-anxiety pre-medication?

We don’t know what the writers were thinking, but Michael refused the anti-anxiety medication prescribed for him, which is a normal part of the aid in dying prescription protocol.  And he did end up experiencing a great deal of anxiety right before he died. This was his choice of course, and it is not for me, or anyone, to judge. However, it didn’t have to be that way.  The medical protocols that physicians follow in prescribing for medical aid in dying are very thoughtfully put together based on the opinions, experience and knowledge of many physicians and pharmacists in Oregon, Washington and California. They are also continually being improved. Every step is important, and our volunteers support individuals in following the prescription as written. It is the way it is for a reason.

Lastly, what I most loved about the film was the end.  

We all know dying is hard.  And it is difficult and painful to watch a loved one die, no matter the manner of death.  My experience in working with the dying in states where medical aid in dying is legal is that a death under those circumstances is almost always a beautiful death; a peaceful death.  Family members, friends and other loved ones are left with a sad heart, but a warm heart that they witnessed a peaceful passing from this world. I loved that this happened in the film, and that the two men were able to overcome their tremendous social discomfort and what looked like shyness, to share their love for each other.  It was a beautiful moment in the film and when it happens like that, it is always a beautiful moment in real life. I thought the film did a great job of depicting this important aspect of dying with medical support, at the time and the place of one’s choosing.