Cruel rules for dying vets

Terminally ill residents of veterans homes shouldn’t be forced to move out to take aid-in-dying drugs.

NCalifornia enacted a law allowing terminally ill people to obtain life ending prescriptions, the state Department of Veterans Affairs (known as CalVet) adopted an emergency regulation making it clear that residents of its eight veterans homes would not be allowed to take advantage of the new law’s provisions.

The emergency regulation prohibits CalVet staff from providing aid-in-dying drugs or assistance to residents of the agency’s homes, and specifies that any resident who wants to take an aid-in-dying drug, even if it is provided by an outside doctor, must first be “discharged” from the residential facility where they live.

It is cruel and unfair to deny these 2,400 old and disabled veterans the same right afforded other Californians under the 2016 End of Life Option Act. But CalVet officials claimed the harsh regulation was necessary to keep the agency from losing millions in federal funding under the 1997 Assisted Suicide Funding Restriction Act, which prohibits federal funds from being used “to pay for items and services (including assistance) the purpose of which is to cause (or assist in causing) the suicide, euthanasia, or mercy killing of any individual.”

The veterans homes located in Los Angeles and other California cities provide a place to live as well as medical and rehabilitative care to former active-duty military members (and their spouses) who are over 55 or disabled. The homes are also open to homeless vets in need of care. Though primarily funded by the state’s taxpayers, the U.S. Department of Veterans Affairs pays for nearly $68 million of the homes’ $350-million budget.

The federal prohibition makes it clear that doctors in veterans homes should not provide life-ending prescriptions, and though we disagree with that rule, the government has the right to make it; no hospital, doctor or healthcare employer is under any obligation to participate in the right-todie program. But nothing in the text of the federal law indicates that it is necessary to evict sick people from their homes if they wish to obtain an outside physician’s prescription for the life-ending drugs and ingest them on their own.

Indeed, other states that have legalized so-called medical aid-in-dying have interpreted the federal prohibitions in various ways. Like California, Colorado and Vermont require residents of veteran homes to leave the facilities if they wish to end their lives. But Washington and Oregon allow veterans home residents to stay while they get the lethal prescriptions from outside doctors and even when they take them, though staff is not allowed to assist in any way. Oregon’s Death with Dignity Act has been on the books for more than 20 years, and there have been no challenges under the federal prohibition.

Earlier this month, two veterans groups and two residents of a veterans home in Yountville sued CalVet, claiming its restriction is punitive. Dying people may not have the strength or means to relocate to a new nursing home or hospice. Many veterans who move into veterans homes choose to do so because of subsidies for those with limited financial means, and most of them remain in the homes for the rest of their lives.

The groups argued that CalVet could use accounting barriers to comply with the federal prohibition.

California’s End of Life Option Act passed in large part because of the moving story of 29-year-old Brittany Maynard, who was diagnosed with an aggressive and terminal brain cancer. After weighing her endof-life options, Maynard and her family decided to leave the Bay Area and move to Oregon so that she could access that state’s aid-in-dying law. When California lawmakers finally made it legal for physicians to prescribe life-ending drugs the following year, it was with the promise that no dying Californian would be forced to choose between leaving home and suffering in their final days. But CalVet has broken that promise for the men and women living in veterans homes.

CalVet can and should find a way to comply with federal rules without forcing residents of its veterans homes to leave in order to seek aid in dying, as Oregon and Washington have done. Not just to avoid the time and cost of a lawsuit, but because it is the compassionate and correct thing to do.