On the afternoon of October 23rd, in the presence of his family, trailblazing San Diego surfer Bill Andrews ingested medication prescribed to end his life. Within a few minutes the 73-year-old had fallen asleep, and over the next quarter hour his breathing slowed, gradually, until it stopped altogether.
Andrews is often credited as the first to surf the celebrated waves of La Jolla’s Black’s Beach, and a photograph of him doing so appeared on a 1965 cover of Surfer magazine. By all accounts, Bill Andrews enjoyed a vigorous life as an action sports enthusiast, entrepreneur, engineer, photographer, father, and grandfather.
However, in 2016 he was diagnosed with amyotrophic lateral sclerosis, more commonly known as ALS, or Lou Gehrig’s disease. The neurodegenerative disorder destroys nerve cells.
Those afflicted with the disease become progressively paralyzed to the point they can no longer walk, move their fingers, speak, swallow, or, eventually, breathe. While the disease advances at different rates for different people, there is no cure. Despite outlier cases such as Stephen Hawking — who recently passed at 76, after 55 years enduring a variant of ALS — it’s roundly considered a terminal diagnosis, with as little as two year life expectancy.
For Andrews, the symptoms progressed rapidly, his loss of motor function compounded by acute pain due to a lifetime of broken bones and other sporting injuries. Facing paralysis and suffering in the imminent future, Andrews chose instead to schedule the end of his own life, with the assistance of a physician.
After decades of controversy and public debate, the legal ability to do so has been available in California since mid-2016. Advocates have used several names to describe it: physician assisted suicide, medical aid in dying, death with dignity, the right to die.
Whatever the terms used, the California Department of Public Health reports 191 people acquired prescriptions to end their lives in the last seven months of 2016. At least 111 are confirmed to have taken the medication and perished.
But it’s still a new practice, and most of what we know about how the law is being put into practice is anecdotal. Just like the unsettled vocabulary involved in taking a prescription to take one’s life, the ways it’s being applied, both from a business perspective and a cultural standpoint, are starting to come into focus.
The End of Life Option Act became California law in June 2016 when it was passed by the state legislature and signed by Governor Jerry Brown. It states that a patient diagnosed with a terminal illness may request life ending medication from a licensed medical doctor. But due to the controversial nature of the law, it’s loaded with safeguards against patient abuses.
First of all, the patient must be deemed of sound mind, and not expected to survive a specified illness for more than six months. The patient must first make an oral request for life-ending care to his or her attending physician — alone; that is, without any loved ones or caregivers present to exert influence or duress. The physician must make the patient aware of all alternative treatment options, including hospice care. After a mandatory 15-day waiting period, a second oral request must be made under the same conditions, followed by a written request, signed in the presence of two witnesses.
The patient must also consult with a second physician to confirm the terminal diagnosis, and independently corroborate the patient’s mental state. Due to the soundness-of-mind requirement, Alzheimer’s patients or anyone affected by dementia are disqualified.
Once the medication is secured, a patient must ingest it him- or herself. The preferred prescription, used by Bill Andrews, is for a controlled overdose of the barbiturate seconal, a powerful sleeping agent. One hundred capsules are prepared into a liquid solution for the patient to drink.
A doctor cannot pour it down a patient’s throat, nor a family member. In some cases, the end of life option may boil down to whether a person can suck the medication down a straw and swallow it. At any time, even at the last moment, a patient may simply decide not to take the medication, choose to take it later, or simply keep the medication on hand while allowing a disease to take its course.
A few days prior to taking his fatal last drink, Bill Andrews frankly discussed his illness, and his decision to die on a podcast recorded by his doctor. “Just a year and a half ago I was in Peru surfing,” he said from inside his room at a San Marcos assisted living facility. By contrast, he characterized his present-day life as “horrible” and sedentary. “I get fed. I wear diapers. I’m kind of confined to my bed.”
With the support of his family, he planned how his death would go. “The thing that’s the most incredible thing to me,” Andrews said, “is being able to choose when you’re going to die… I’m choosing the time. I’m choosing the place. I’m choosing the environment. I’m choosing the company. And for me…” he added, “I can’t think of anything better.”
The avid surfer, motorcycle racer, and adventure traveler would find a gentle, painless end, surrounded by people he loved, having said his last goodbyes and tied up all his loose ends. “I’ve kind of been a pioneer in a lot of things,” he told his doctor on the podcast, explaining why he decided go public with his story. “I think this can do a lot of good.”
The doctor assisting Bill Andrews with his death was Bob Uslander, known to his patients as Dr. Bob.
Uslander established his practice, Integrated MD Care, in early 2016. Its primary purpose — then and now — is to provide in-home palliative care. Hospice. “The vast majority of what we do is take care of people in their homes,” he says. Some of his patients aren’t dying, rather they’re enduring prolonged recoveries from serious illness or injury. “A lot of our patients are older, they have dementia. Or they’re just frail, and they need someone to be there to take care of them.”