Americans have started thinking seriously about how to die.
This past Monday, October 5, California became the fifth state to allow doctors to prescribe life-ending drugs to patients with terminal illnesses, joining Washington State, Oregon, Vermont, and Montana. In an unusually confessional signing message, Governor Jerry Brown explained his decision to sign the legislation, writing: “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill.”
The passage of the End of Life Option Act capped a tumultuous process that began more than 20 years ago, when Californians roundly rejected an aid-in-dying ballot initiative (the first of several efforts), and accelerated only recently alongside shifting currents in the broader culture. New books such as Atul Gawande’s Being Mortal have been raising vital questions about personal agency, the culture of modern healthcare, and the end of life. Award-winning documentaries like How To Die in Oregon have drawn attention to the real-life responses to death-with-dignity legislation. And recent cases like that of Brittany Maynard, the 29-year-old with a brain tumor who chose to move to a state where aid in dying is legal, have fascinated the media. Maynard famously relocated from California to Oregon so that she could die a more peaceful, dignified death than the one fated by her cancer.
Ann Neumann, author of the forthcoming The Good Death: An Exploration of Dying in America, attributes the new openness to discussions about death and dying to a mix of demographic, cultural and even medical shifts. Americans are living longer, she told The Nation, but many of those extra years are proving to be a series of long, slow and disabling medical problems. “Independent, control-focused baby boomers are taking care of their elderly parents and beginning to worry about what will happen in their own end years,” she said.
But the new openness to end-of-life care is running up against one of the complexities of America’s healthcare system. Catholic hospitals supply an indispensable and growing share of the country’s healthcare services. These hospitals now make up 10 of the 25 largest healthcare networks in the United States and, in some places and for some people, they are the only realistic option. But Catholic hospitals don’t do “death with dignity.”