As a family physician, in practice now for almost 40 years, I have cared for many people as they reached the end of their lives. Death comes in many forms — sometimes quickly and painlessly and sometimes prolonged or with great suffering.

My desire to address this suffering led to my interest in hospice and palliative care. I became board certified in 2007. I practice hospice in California and Nevada. It was a great relief to me when California passed the End of Life Option Act of 2016. This act gives physicians the ability to offer people who are suffering and close to dying the option to control the manner of their passing. Physicians age with their patients and suffer when their patients suffer and I knew this was something I needed to be able to offer my patients. 

Medical aid in dying is a safe and trusted medical practice in which a terminally ill, mentally capable adult with a life expectancy of six months or less to live, may ask their doctor for access to a prescription medication that they can choose to self-ingest to bring about a peaceful death. Many voters and health care providers support medical aid in dying as an end-of-life care option for terminally ill adults to peacefully end unbearable suffering. No person is required to use it. No health care provider is mandated to provide it. A second health care provider will need to agree with the life expectancy and a mental health provider may need to agree that the patient is mentally capable. 

The patient is in charge from the initial request to self-ingestion. They can choose to use it, just not take it or return it. Knowing they have access to this medication gives a sense of peace to people slowly dying from a terminal illness and to their families. It is so hard to see a loved one suffer. 

Most people, when they receive a terminal diagnosis, want to know their prognosis. When given this information, most aren’t looking for a new chance at life, just for a little more time to be with loved ones. Medical aid in dying supports the opportunity for closure. One does not request to end their life without thinking deeply about it, and reflecting on their life and their legacy. Our hospice chaplains are invaluable in supporting their journey. In my experience, having the control within their hands has helped patients to grieve, to process, to embrace difficult conversations while they are still lucid.

As experienced hospice team members know, some people prefer not to acknowledge that the end of their lives is near, even in the last few hours. Others, when they reach the last days, require such heavy doses of medication to control their pain that they aren’t able to have these conversations. 

In my years of prescribing medication to assist patients in ending their lives, I have not witnessed anyone using it to avoid facing the questions that often arise as one prepares to die. In fact, quite the opposite,I have witnessed the most profound and beautiful transformations in patients’ lives as a part of the process of obtaining life ending medication. The soul searching and reckoning and opportunities for repairing or forgiving or thanking people in their lives is taken quite seriously. 

These are the reasons that I supported SB239 in 2023. The bill passed our Legislature in that last session; unfortunately the governor vetoed the bill. 

Thankfully, Sen. Edgar Flores (D-Las Vegas) and Assm. Joe Dalia (D-Henderson) are bringing the bill back this year. 

Death is a sacred event in the world of hospice/palliative care physicians, just as it is in the world of all who attend to the dying. 

If I were experiencing prolonged and excruciating pain at the end of my life, I do not know if I would choose medical aid in dying. I am sure though, that it would be a great comfort to know this option was available. Nevadans should have that choice. 

Dr. Johanna Koch is board certified in family medicine, hospice and palliative care.

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