Cali-life2There’s a reason that 39 million people (almost 13% of all Americans) have chosen to live in California.  It’s an amazing place to live and explore.   It’s got snow-capped mountains, warm-water beaches, jaw-dropping coastlines, world-class cities, fertile valleys, some of the best national parks in the world and a vibrant economy.   In fact, California has just about everything for everyone, including — as of this month —   a Right to Die law that allows its residents to choose to die with dignity, just as they had lived.   This blog is about how to affordably thrive, live and die in our remarkable state.

How to Live in California

It’s not hard to live in California.   It is a bit harder to live affordably in California.  In order to pay for basic living expenses, a single California resident with no children would need to make, on average, roughly $11.20/hour.  The state boasts some of the most expensive housing costs in the world — precisely because so many people want to make California home.   Yet, California is only the 6th most expensive state in the country — topped by Hawaii, New York, New Jersey, Alaska and D.C.  almost every major metropolitan area in the state has affordable places to live.   And you can use a cost-of-living locator to find some of the more affordable locations.

If you can find a job (and there are plenty of those) and a location, there are a number of things you can do and places you can see for relatively little money.  Trip Advisor’s extensive list of things to do in California include a number of low-cost options that could keep you and your family business for about 20 years!  Southern California, alone, has a number of very cool, free locations to spend a day or two.

How to Die in California

California is the fifth American state to legalize physician-assisted suicide.   A recent law allows doctors to prescribe lethal medications to terminal patients with less than six months left to live.  The law gained momentum this year after the death of Californian Brittany Maynard, a 29-year-old woman with brain cancer who was forced to move to Oregon to take advantage of that  state’s death-with-dignity law.  California now joins Oregon, Washington, Vermont, and New Hampshire in legalizing aid in dying. Most importantly, if a California resident chooses to die, they can do so surrounded by their friends and family, here in California.  Here are some important facts about how aid-in-dying laws work:

1) Aid in dying requires patients to take their own lives.

Existing aid-in-dying laws give doctors the authority to write a prescription for deadly sedatives. These can be prescribed to a terminally ill patient who is deemed capable (by a health professional) to make decisions about his or her own treatment.  Under the California bill, patients will have to make an oral request for the medications twice and 15 days apart. The patient will also submit a written request, and need two doctors — both her primary physician and a “consulting physician” — to approve the request.  The written request must be made in front of witnesses who are asked to certify that the patient is of sound mind and is not being coerced.

2) Less than half of those who seek aid in dying don’t ultimately use the drugs.

Oregon has found with its aid-in-dying law that one in three patients who obtain lethal medications don’t end up using the prescription. Through 2013, the state has filled 1,173 aid-in-dying prescriptions, but only 752 of those have been used.  There’s a clear pattern of some terminally ill patients filling these prescriptions but never using them, although many view the drugs as an insurance policy against a miserable death.

3) Nearly all aid-in-dying patients are using some form of hospice care.

The Oregon data suggests that aid in dying is a complement to hospice care, which aims to make patients comfortable in battling terminal illness, rather than a replacement. In 2013, more than 85 percent of those who used the aid-in-dying law were enrolled in hospice care at the time of death. One poll has found that residents of states with aid-in-dying laws have higher awareness of hospice options than the general public.

4) If you don’t live in one of those five states, you still have options that allow you to die with dignity.

Of course, there are already terminally ill people who live in states right now, with no aid-in-dying policy at all. In many cases,  doctors, largely oncologists, located in those states almost certainly end up participating in different versions of assisted suicide.  One survey of more than 3,000 oncologists found that over 10 percent said they had, at some point in their career, assisted with a patient’s suicide. The real number might be much higher. There are legal ways for doctors to help patients end their lives. Assisting patients in ending eating or drinking, for example, is one way to guarantee death. But that can be a painful end. Patients can become delirious with thirst. If they ask for water, should a doctor chalk it up to delirium and continue denying hydration, or cede to the patient’s demands?