Since 2009, more than 1,000 Washington residents with terminal illnesses have used the Death with Dignity Act to take some measure of control over their lives and illnesses, and have hastened their deaths by using the law. Now, islanders who are interested in learning more about the act or using it themselves have the option of working with two local volunteers trained to assist with its requirements and processes.
Donna Klemka and Kathryn Crawford have been volunteering for the last year and a half as client advisors with Seattle-based End of Life Washington. The mission of the nonprofit organization, previously called Compassion and Dying and later Compassion and Choices, is to uphold people’s rights to the full range of end-of-life choices, including ending treatment and receiving hospice services, as well as using the Death with Dignity Act.
Washingtonians passed the act in November of 2008, allowing terminally ill adults to end their lives by taking lethal doses of medication provided by physicians. Washington is one of six states and the District of Columbia that has such a law.
Klemka and Crawford say they first became interested in doing this volunteer work two years ago. Islander Kay Longhi, a longtime board member of End of Life Washington, had spoken at a gathering on Vashon called Death Over Dinner. Afterward, each woman approached Longhi, interested in volunteering. Since then, they have been through training with the organization and have assisted six islanders at the end of their lives, work they say that has been rewarding.
“It has been a fabulous thing for me,” Klemka said.
Crawford agreed. She and Klemka live only about a mile from one another, she said, and their volunteer roles feel like neighbor-to-neighbor work. She recalled that one of their first visits as the island volunteer team was to a woman when the power was out. The sun was going down, and it was getting dark in her house.
“It made me chuckle,” Crawford said, referencing the island’s frequent power outages. “I was thinking, we are so familiar with this. We can do home visits with flashlights.”
Crawford, a public health nurse, said she has often been struck by how hungry people are to talk about their situations broadly, not just about whether or not to use the medications to end their life.
When Klemka and Crawford first meet with a client of End of Life Washington, their conversations can vary widely, depending on the client’s wishes, but include information on the requirements of the law.
To work with the women, people should first call End of Life Washington, which will send out an informational packet. Klemka and Crawford say they often meet with people after they have had a chance to read through the material and answer questions related to it. Through the organization, they can assist with practical aspects of the law and its requirements, such as making sure that people make an initial request for the medication, securing the necessary physicians for the process and directing people to a pharmacy to fill the prescription.
“It’s unburdening,” Klemka said about their role. “It’s allowing someone the sense that this is not complicated.”
Also, they often simply allow people the opportunity to talk, Crawford said, which can be rare in a culture where death and dying is not openly discussed.
“The function I often feel like we are serving is people can’t talk to just anybody about it. Apart from the idea of using the medication, it’s the fact that you are really sick, and you are not going to be here long and having that be open. So how do we want this all to be?” she said.
Crawford, noting the nature of the conversations, promised confidentiality, but also said that if people would prefer to work with off-island volunteers, that can be arranged.
One of the benefits of the law, both women say, is that it restores some control for people when illness has taken it away.
“They want to be in control if they don’t have any control over any other factor of their lives. And so one thing left for them is they can organize their goodbyes,” Klemka said.
Former islander Jean Bosch, who died two years ago last month, is among those who “organized her goodbyes” through the Death With Dignity Act, with assistance from End of Life Washington.
Her sister and business partner Leslie Ferriel recently shared Bosch’s story of her illness and use of the act.
“I feel very strongly that people should know that it is an option,” Ferriel said.
Bosch was a well known islander, a real estate agent and someone involved in several aspects of island life, when she was diagnosed with glioblastoma, a fatal brain cancer, and given four months to live.
“It was very much in Jean’s character to say, ‘I will have that, please,’” Ferriel said about the Death with Dignity law. ‘I am not going out the way this disease is going to take me out if it has its way with me.’ She was not interested in that at all.”
Ferriel said she and others close to Bosch have neither broadcasted nor hidden how she died. When she talks to people about Bosch’s death, sometimes they will comment on how well she seemed.
“And then I say, well, Jean started having seizures, and she said, ‘That’s it for me.’”
Bosch lived on her boat — her home — in her final months of life, and not long after her diagnosis determined she would use the Death with Dignity Act, Ferriel said. For quite some time, her symptoms did not progress, but the knowledge that Bosch could use the medication in accordance with the law helped Bosch and those close to her.
“It was easier for all of us, knowing that we had that in our back pocket,” Ferriel said.
Bosch immediately stopped working after her diagnosis and spent a lot of time sitting on her boat, having coffee and meaningful conversations with friends, Ferriel said.
“Jean was very at peace. She was a shining light during that time,” she said.
And then, Bosch had a series of seizures, including a large one the night before she died. Her son and his wife came the next day. The law requires that people administer the medication themselves, and soon the cancer was going to affect Bosch’s ability to swallow, Ferriel said, so a delay was not possible.
That day, she took the contents of 100 Seconal capsules (a sedative) and mixed it with vodka and immediately went to sleep. She died shortly afterward, Ferriel said, on her boat, with friends and family gathered there with her. It was four months after her diagnosis, the amount of time her oncologist had predicted she would live.
Klemka and Crawford were not volunteering at the time of Bosch’s death, but Ferriel said her family received assistance from others involved with End of Life Washington. While people can use the Death with Dignity option on their own, Ferriel spoke highly of the organization’s help, particularly regarding the requirements of the law.
“There are all kinds of things you as a family member do not want to be thinking about at all. And the fact that there is somebody who will help you navigate that is priceless,” she said.
Klemka and Crawford say they will be present on the day someone chooses to take the medication, but they do not need to be — it is up to the individual and their loved ones.
They also say that many people who believe they would like to use the law end up not taking the medication once it has been prescribed. In fact, statistics from the Department of Health, which monitors use of the law, show that more than 1,500 people have obtained the necessary prescriptions since 2009, but hundreds of them died without taking it.
“A lot of people are comforted by that knowledge even if they choose not to use it,” Klemka said, about having access to the medication.
Regardless of how people ultimately use the law, the women say they have one goal: “Whatever assistance we can be, we want to be. And that is only thing we have as an objective, Klemka said.
For more information or to meet with Klemka and Crawford, see endoflifewa.org or contact the office at 206-256-1636 or firstname.lastname@example.org.