La Jolla Lawyer to discuss end-of-life options at free library presentation

Hemlock Society of San Diego board member Bill Simmons said he first got involved with end-of-life issues in 2009.

“I felt everybody needed to have a written advance directive stating their wishes for end of life,” he told La Jolla Light.

He started volunteering with hospice, “And in the process of working with them and going out and seeing patients, I came to the conclusion that (family) conversations are more important than the advance directive.”

Simmons will discuss “The End of Life Option Act: Physician aid in dying for the terminally ill,” alongside Hemlock Society president Faye Girsh, 10-11 a.m. Monday, July 10 at La Jolla Riford Library, 7555 Draper Ave.

An advance health care directive is the legal document where a person describes the kind of decisions they wish to make when they no longer can speak for themselves because of illness or incapacity. In California, the document is typically composed by a lawyer, then signed by two qualified witnesses or acknowledged before a public notary.

Simmons, a La Jolla resident since 1998, believes family conversations are more important than the advance directives because “first, the fact is that in an emergency situation, doctors don’t have time to go find your advance directive, it may be in your records somewhere. Secondly, they tend to naturally talk to the people, the family that’s standing by.

“As a lawyer, this is really hard to take,” he continued. “I’m trained to put everything in writing. Is a mantra in law school, ‘Get it in writing!’ ”

To illustrate his point, he gave an example. “A person may have survived the 12 first hours (after a health event), some family members are there and they’re discussing the next steps. One family member says, ‘I know my mother under this circumstances wanted no further treatment.’ And a sibling says, ‘Oh we can’t do that. We need to do everything we can to save her.’ And the doctors are often caught in a family conflict, where they don’t know who to listen to. The advance directive can help with that, but family conversation is the way to deal with that.”

He elaborated, “I want my whole family to know what my wishes are.”

Asked about ways to get the conversation started, Simmons said, “Let’s say, I’m sitting down with my elderly parent and the younger person says, ‘I see in the newspaper that Bob Hope died yesterday of this and that.’ (You may use) someone that they know. ‘If you were in his circumstances, how would you want to end your life?’ So you can use events out of the news to kick it off. And that’s the easiest way. Another one is, they come back from a medical appointment, ‘Did the doctor discuss what would happen if something happens to you and so on?’ You can find wedges to start the conversation. It’s the wedge you’re looking for, because the conversation will flow typically pretty well once you get it started.”

In June 1, The New England Journal of Medicine published the article “Delegalizing Advance Directives: Facilitating Advance Care Planning” by Joshua Rolnick, M.D., David Asch, M.D. and Scott Halpern, M.D., that agrees with Simmon’s notion. “Clinicians will rarely provide end-of-life care that conflicts with the stated preferences of family members, even when a formally executed advance directive is available,” the article reads.

“The POLST (Physicians Orders for Life-Sustaining Treatment),” Simmons continued, “often says, ‘Do not resuscitate me if you find me on the floor passed out, because I’m having my third heart attack and I don’t want to deal with that anymore, let me die.’ That’s extreme, and that doesn’t have to be notarized, doesn’t have to be witnessed. Why does the advance directive need to be witnessed?”

Simmons said he is a member of the Hemlock society because, “Medicine has advanced so far in the past 50 years that we no longer die of pneumonia in four or five days, we start to decline in a number of years, and then the incline gets steeper and steeper, so death is prolonged, when it didn’t use to be. My parents didn’t have to face this kind of dilemma, prolonged dying.

“My goal is to let people know that there’s a choice, and what that choice is completely up to you. But I don’t want anyone telling me how I need to die.”

Hemlock Society of San Diego

  • A non-profit providing education about end-of-life choices in San Diego
  • Mission: ‘Choice, dignity and control at the end of life’
  • Monthly meetings with speakers, movies and discussion
  • All-volunteer organization
  • To attend a board meeting call (619) 233-4418 or e-mail