Shmuel Thaler | A good death: A personal account of my mother and medical aid in dying
My mother, Pat Koch Thaler, died in much the same way she lived — with vigor, purpose and with a desire to have a lasting positive impact on the world.
A few weeks ago, on Nov. 16, my 92-year-old mother was surrounded by her loving sons, daughters-in-law and two of her grandchildren as she ingested a cocktail of morphine, diazepam, phenobarbital, digoxin and amitriptyline and drifted off to sleep. She took her last breath a few hours later.
Sam Roberts wrote in the New York Times about my mother a day after her death: “After 22 years of fending off cancer, she had run out of miracles. Twice the disease had gone into remission, only to return. One kidney had been removed. She had been bombarded by radiation, chemotherapy and ablation. Finally, the tumors had been declared inoperable.”
My mother reached out to Roberts to bring attention to her imminent death. She wanted to let others know about why she chose this way to end her life. To shine light on a way to reduce pain and ease people’s final journey.
About a decade ago, my mother learned about the option of a physician-assisted death (alternately referred to as medical aid in dying). She immediately knew that this was the path she wanted to take, if needed. At 92 years old, with no diminishment of her mental acuity, she made a brave decision. When her untreatable advanced renal cancer returned, she embraced the concept of a hospice-aided, and physician-directed way to hasten the end and to eliminate further suffering. This ending was solidly consistent with the life she led.
Simply put, she lived well, and she died well.
The Jewish principle of Tikkun Olam — repairing the world — was front and center in the way my mother led her life. She spoke about injustice and committed to leaving the world a better place than she found it. She protested to end the Vietnam War, she marched for civil rights, and she rolled up her sleeves to work for women’s rights.
She told me recently that “I’ve always been active.” She described her involvement, at age 84, when the Women’s March happened in 2017. She said, “I organized the women’s march for people in my area. There were 1,500 people who came out for that march. I was sort of overwhelmed. But that’s the kind of thing I’ve done all my life. I can’t sit back, I tend to take a leadership role.”
She was a dean at New York University and served on the New York City Commission on the Status of Women. She authored five books and wrote numerous magazine and newspaper articles. She was clearly the matriarch of our family and did all this with a smile on her face and a twinkle in her eye. She lived life on her own terms.
She said to me several times in the weeks prior to her death that 92 years was a “really long time.” The decision to use medical aid in dying to end her life was her way of facing mortality head-on and deciding when the time was right. She felt that she had lived an incredibly productive and rich life.
Pat Koch Thaler was the daughter of Louis and Joyce Koch and the baby sister of Ed and Harold. She grew up in Newark, New Jersey, and Brooklyn, New York. When my mother was 28 years old, her mother Joyce died.
It was a seminal event in my mother’s life and played a role in the final decision she made. “My mother died in agony,” Pat recalled. At age 62, my grandmother Joyce was misdiagnosed and underwent an operation to remove her gall bladder. When surgeons opened her up, they found her body riddled with cancer. Joyce suffered for weeks before she succumbed to the disease and died on Oct. 25, 1960.
My mom watched other friends and family die prolonged deaths filled with pain and suffering. She told me that she wished she could have done something to hasten the end for the dying people she loved.
Her husband of 52 years, my father Alvin, spent his last three months in hospitals and rehab facilities following a fall in their New York City apartment. For the last weeks of his life, Alvin was in pain, and drifted in and out of consciousness.
In the United States, the practice of physician-assisted death is legal in 10 states and the District of Columbia. Oregon was the first state to legalize the ability for people who are terminally ill to end their lives through voluntary self-administration of lethal medications. The state’s Death with Dignity Act was enacted in 1994 and implemented in 1997. In California, the End of Life Options Act (SB 128) went into effect in 2016.
In New Jersey, where my mother lived, Gov. Phil Murphy signed the state’s Medical Aid in Dying for the Terminally Ill Act into law in 2019. It allowed terminally ill patients to request aid in dying in certain clearly defined situations.
When speaking about her coming death, my mother said, “Make sure that we use the right terms. I am not committing suicide; I am using medical aid in dying. I am not coming to the end of my life by choice.”
Anita Hannig, author of “The Day I Die: The Untold Story of Assisted Dying in America,” wrote, “How we name something determines how we think about it. Until just recently, the primary term in the English language for the purposeful, voluntary death of oneself was ‘suicide.’ Besides martyrdom or sacrifice, there was no other way to refer to an intentional self-death. Equating assisted dying with suicide isn’t only antiquated or misleading – it’s actually harmful.”
Hannig continued, “From their inception, assisted-dying laws in America were designed to mobilize the tools of medicine to ease suffering at the end of someone’s life. These laws draw a clear line between assisted dying and a suicidal act.”
Physician-assisted suicide, suicide and euthanasia are often terms that are used to describe the practice of medical aid in dying. This is misleading and factually incorrect. Medical aid in dying is fundamentally different from euthanasia. While both practices are designed to bring about a peaceful death, the distinction between the two comes down to who administers the means to that peaceful death.
Euthanasia is an intentional act by which another person (not the dying person) administers the medication. By contrast medical aid in dying requires the patient to be able to take the medication themselves and therefore always remain in control. Euthanasia is illegal throughout the United States.
The criteria in most states for medical aid in dying, known in California as physician aid in dying or the End of Life Option Act, are clear. The person much be at least 18 years old, have a terminal illness with a prognosis of six months or less to live, must be of sound mind and able to make medical decisions for themselves and not be impaired by a mental disorder and must be able to take the medication on their own.
Dr. Lonny Shavelson, a national expert on assisted dying and a co-founder of the Academy of Aid in Dying told me this week, “Dying is complicated and people want a dignified and comfortable death.” He cautioned people considering medical aid in dying to feel comfort knowing that it is an option, but it may or may not be the correct way to die or the option they choose.
My mom had a few dates over the past few months that she thought would be the day she would die. Those days came and went without her taking action. She felt good on those days and decided to live a bit longer.
Oregon’s Death with Dignity Act specifies that “actions taken in accordance with (the act) shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law.” Patients who pursue medical aid in dying are no longer looking at an open-ended life span. To qualify for an assisted death in states with these laws, they must already be on the verge of dying – that is, within six months of the end of their life. These patients don’t face a meaningful decision between living and dying, but between one kind of death and another.
When my mother received her last diagnosis, she knew that she would die soon. Her breathing became more labored and exhaustion was her constant companion. My mom’s remaining kidney began shutting down and her lungs weren’t providing the oxygen her body needed.
She registered with her nearby hospice and made sure her financial affairs were in order.
She informed our family about her prognosis, and after serious deliberation she began the process of getting ready to end her life. The thought of losing our family’s matriarch was daunting and painful. However, as a family we unanimously supported her decision to reduce the suffering that would lay ahead.
About a year and a half ago, in May 2023, I had my first experience with someone I loved choosing assisted dying to end their life. My dear friend, Aryeh Richard Nanas, had Angiosarcoma of the scalp. It is a rare, incurable cancer and he had gone through a variety of chemotherapies and complementary treatments.
His wife, Rabbi Paula Marcus, told me recently, “My husband Aryeh did everything he could to stay alive for his friends and family. In the end, we both agreed that when the time came, we would do what we could to be conscious about how he would approach the end of his life.
“As a Buddhist and Jew, he learned about how he could see his life as a natural process of aging with awareness. We agreed that instead of prolonging suffering, we would decide together how he would die.”
Nanas spoke to a few of his closest friends and invited them to speak at his funeral. He chose the music for the funeral service and Marcus was able to share, with him, his eulogy that she would soon deliver at Temple Beth El in Aptos. Surrounded by his family, Nanas took the medication and after close to an hour, took his last breath.
Marcus said, “His grace and wisdom was a blessing to all of us. We miss him, and we are grateful to him for modeling compassion, love and acceptance.”
In September, Dorothy Zimmerman, one of my mother’s dearest friends, died. Rabbi Jennifer Schlosberg of the Glen Rock Jewish Center officiated at the funeral. Then in October, once my mother decided that Nov. 16 would be the date of her death, she requested that Rabbi Schlosberg officiate at her own funeral because she was comforted by how elegantly and sensitively the rabbi memorialized her friend.
Schlosberg, in her eulogy of my mother, said, “It’s not often that I meet with people who help me plan and write a eulogy for their own funeral — this may even be my first time. It says a lot about Pat, though. The courage, agency and strength that she modeled during these last days of her life were, and continue to truly be, an inspiration.”
As my mother sat on her bed on Saturday morning, Nov. 16, she was surrounded by family. Each of us had a private moment with her. We leaned in and embraced her.
She took our face in her hands and kissed each of us. We were able to tell her we loved her.
I had the privilege of telling her how much I appreciated her bravery and thank her for being a loving presence in my life. I let her know how much of a role model she had been for me. As we locked eyes, she said, “I know.”
A little past 11 a.m., after we each had our time with her, Dr. Robin Plumer brought in the lethal cocktail. Plumer, a former emergency room physician, founded Compassionate Endings NJ in 2020 to assist with her patients’ end of life. The doctor mixed the compounded medicine with apple juice and handed the cup to my mother.
My mom took a last glance at those of us surrounding her bed, connecting one-by-one with each of us one last time. And then, without any hesitation, she drank the liquid in the cup.
She had been warned by her hospice nurse Jerrica and by Plumer that the drink could taste very bitter. After swallowing the liquid, she looked up with her trademark smile and said, “I’ve tasted worse.”
We held her hands and rubbed her arms and legs. Within 10 minutes, she fell into a deep sleep. We continued holding her, both physically and emotionally as, over the next nearly six hours, her body shut down.
A little before 5 p.m. on Nov. 16, 2024, Plumer said, “She hasn’t had any respiration for the last 90 seconds. I think this is it.”
Pat Koch Thaler died peacefully and gracefully, surrounded by her loved ones after living a full life. As we say in Jewish tradition, may her memory be for a blessing.
Shmuel Thaler is a Santa Cruz Sentinel staff photographer.
