Assisted-suicide law legalizes common but secretive practice in California

California's new assisted-suicide law is expected to allow hundreds of terminally ill people across the state to end their lives.

It also might bring to a close the post-retirement career of Carole van Aelstyn.

For the past 16 years, the former Santa Rosa Memorial Hospital oncology and private hospice nurse has advised stricken adults on their end-of-life options, including how to kill themselves.

She has instructed terminal cancer and ALS patients on where to buy life-ending drugs on the internet, counseled them on how to prepare the sedatives and sat by their sides as they carried out their final acts.

All told, she has witnessed about 50 people hasten their own deaths through lethal drugs.

“It's very peaceful and beautiful,” said Van Aelstyn, a volunteer with the Denver nonprofit Compassion & Choices, aid-in-dying advocates tracing their roots back to the old Hemlock Society. “People say their goodbyes. They are looking forward to it. It's a big sigh of relief when they breathe their last. They got what they asked for.”

The word-of-mouth service has largely flown under the radar and appears similar to work by euthanasia groups that have been prosecuted in other states for assisting in suicides.

Van Aelstyn maintains her help is totally legal because she doesn't physically participate. The patients administer their own drugs, often with supportive family members nearby. In some cases, they stop eating and drinking until they die.

As with aid-in-dying laws in California and other states, her patients must be adults with less than six months to live and be deemed mentally competent, she said.

“It's not against the law to kill yourself in this state,” she said. “They get the drugs over the internet. We tell them where to go and how much to get.”

Legal experts said such assistance is made easier in California where there is little political will to prosecute advocates.

Supporters said the practice of assisting terminally ill people who want to kill themselves is more widespread. Dennis Pocekay, a retired Kaiser Permanente physician, said cancer doctors confided in him they prescribe lethal medications at patients' requests “two to three times a year.”

“They give patients pills and say, ‘Take this much and you'll die,'” said Pocekay, who also volunteers with Compassion & Choices. “It's done every day in this state.”

Also, people stockpile medications that they later take in fatal doses. It's risky, though, because if not done properly a patient could survive and be left in worse condition.

Advocates say California's new law, the End of Life Options Act, brings assisted death out of the shadows and regulates it.

“This is happening, but it's happening behind closed doors,” said Bay Area resident Dan Diaz, whose late wife, brain cancer patient Brittany Maynard, 29, traveled to Oregon in a high-profile bid to get a lethal prescription and sparked the new law in her home state. “This legislation brings it to the light of day.”

But years before the bill was even considered, terminally ill patients could turn to Van Aelstyn for advice on how to end their lives, she said. The longtime nurse said she devoted herself to it in 2000 after a career spent watching “too many people die badly.”

“People don't want to wait around,” she said. “You see yourself getting eaten alive by pain and cancer.”

The sentiment isn't lost on Ernest Spadafore, 76, of Guerneville. The retired commercial real estate investor consulted with Van Aelstyn after undergoing radiation treatment for vocal cord cancer. If his condition worsens, Spadafore said he won't allow himself to “become a zombie” on prescribed pain medication but will instead hasten his death with a lethal dose of drugs.

“I've got a pretty good life, thank God,” said Spadafore. “I want to die as peacefully as I can.”

For those who are of sound mind, Van Aelstyn said she points them to online sources for Seconal or pentobarbital. Patients must be able to lift a glass themselves or press a plunger on a device inserted into a feeding tube, she said.

“I stay there while they mix it up and they die,” Van Aelstyn said. “We instruct (caregivers) to call hospice and say they walked into the room and found the person dead.”

For certain patients, the window for self-administering drugs can close, she said. One of the worst diseases is amyotrophic lateral sclerosis (ALS), or Lou Gehrig's disease, which attacks cells that control the muscles.

“ALS is the cruelest disease I've known,” she said. “The problem is, your mind stays clear.”

With the advent of the new law, Van Aelstyn, 76, will likely retire. However, she'll still be around to help as providers and patients work out any kinks.

“We will not be needed but people will call us and get advice,” she said.

You can reach Staff Writer Paul Payne at 568-5312 or paul.payne@pressdemocrat.com. On Twitter @ppayne.