Seventeen years ago, Oregon became the first of five states to offer what became known as death with dignity. Now a renewed effort is underway to add California to the list.
Past attempts have failed here, but Compassion & Choices, the nonprofit organization involved in the Oregon aid-in-dying movement, has hired staff in California and has begun recruiting supporters in Santa Barbara and San Mateo counties.
The group has held community meetings, lobbied local public officials, and is hoping to find California prosecutors who will agree not to prosecute doctors who prescribe life-ending medication to terminally ill patients who request it and are able to self-administer it. A ballot measure is also a consideration.
It's not going to be easy to pull this off, proponents concede, and the process could take years. In the past, statewide attempts have been shot down by heavily financed religious groups — primarily the Catholic Church — and some physicians. But advocates are encouraged by a recent poll of 500 likely voters, conducted for Compassion & Choices, that asked this question:
"The Death with Dignity Act would give a terminally ill person, who is mentally competent, the right to request and receive a prescription for life-ending medication from a physician. If the election were held today, would you vote to favor or to oppose this ballot measure?"
Nearly two-thirds of those polled said they were in favor, including 53% of Republicans.
"I think our polls indicate the state is ready," said Rev. Ignacio Castuera, a United Methodist minister in Pomona. Castuera said he thinks the gathering storm of baby boomers who grew up in "the age of Aquarius" are likely to want the freedom to make such personal choices when they near the end.
Castuera, a Compassion & Choices board member, said he became an advocate decades ago, when he ministered in Hollywood during the AIDS epidemic.
"I was given the rare honor of being present at times when people made decisions to not go the way of their friends who had horrible deaths," said Castuera.
Those who had the means would purchase medication, call their friends together, and put an end to their suffering, Castuera said, in what became known as "bon voyage parties."
As for the faith-based opposition that is sure to surface if the death-with-dignity movement gets any traction, Castuera said he, too, is motivated by faith.
"As a Christian I believe God is love ... and the God of love would not want any of God's creatures to suffer undignified situations, especially at the end of life," said Castuera. "Death," he added, "is not the final stage for humans," but a deliverance to God.
Anita Freeman, who grew up in the church of Latter-day Saints in Utah, doesn't see this in religious terms, but in human terms. She watched her sister die what she described as a horribly painful death in July.
"She was my younger sister, my best friend, and we raised our kids together," Freeman said of Elizabeth Martin, who temporarily beat colon cancer four years ago in a grueling fight that involved several surgeries.
But the cancer returned with a vengeance this year, spreading through her body. Martin went from home to hospital to nursing home to hospice as the cancer advanced, and no amount of morphine brought relief.
"She was telling me, 'I don't want to be in pain anymore.' She said that a hundred times. 'Just let me go to sleep so I don't have to endure this pain,'" said Freeman. "She called it the magic pill. 'Get me the magic pill so I can go to sleep.'"
Freeman said her sweet sister became violent, paranoid and delusional, running barefoot down the street on two occasions, only to be returned by police. By this time there were lots of painkillers in the house, and Freeman thought about gathering them up and letting her sister take what she needed to end her life. But she feared that she'd botch the job.
"It's an awful feeling to be scared that maybe you're not going to get the job done, and she's going to be worse," said Freeman, who also worried that she could be prosecuted for aiding in her sister's death.
Eventually, Martin was drugged into palliative sedation at a nursing home and died seven days later. But the overall ordeal, said Freeman, was gruesome.
"It wasn't peaceful. It wasn't dignified. She would be horrified to know that she became so delusional and out of control ... like she was possessed."
Barbara Coombs Lee, a former nurse and president of Compassion & Choices, said a significant percentage of patients have similar reactions to morphine, and so did her own mother as she neared death. I asked her why a lethal prescription is necessary in such cases, as opposed to the palliative sedation Freeman's sister underwent.
"For some patients," she said, "ending their lives in unconsciousness, and bargaining away the conscious mind for relief of pain, is an unacceptable bargain."
In states that have death with dignity laws, those who sign up often don't end up using the right to take their own lives. But people "are resolute in their desire to have the option available," said Coombs Lee.
As I wrote after my father's long, slow demise, I'd like that option for myself. If I can't manage my basic needs, or if I'm merely prolonging death rather than extending life, I would hate to be a burden to my loved ones.
"What a nightmare it can turn into, and how helpless and terrible you feel watching someone suffer needlessly," said Freeman. "It's not humane. It's just not."