This article originally ran in the Washington Post on December 25, 2018. You can read the original here.
The government form lay on the dining room table in Mary Klein’s home in Northwest Washington. At the top, in bold letters, was a simple declaration: “REQUEST FOR MEDICATION TO END MY LIFE IN A HUMANE AND PEACEFUL MANNER.”
“I need two witnesses for my application,” Klein’s friend Kelly Saunders recalls her saying. “Would you be a witness?”
Saunders knew this moment was coming.
It had been nearly four years since doctors had diagnosed Klein’s ovarian cancer. She had shed 20 pounds, her voice was softer, and her hair thinner and grayer. She had decided to stop chemotherapy months earlier.
At 70, Klein had become the public face of an effort to legally permit doctors in the nation’s capital to help terminally ill patients die.
Even as her health deteriorated, Klein worked for two years to lobby local lawmakers as well as members of Congress — who can overturn D.C. laws — to allow a practice that is now legal in seven states. She prevailed, and the law took effect last year.
And now, Klein wanted to become the first person in the District of Columbia to use the law.
Saunders picked up a black pen and checked off a box verifying that her dying friend “appears to be of sound mind and not under duress, fraud or undue influence.” She signed her name.
Stella Dawson, Klein’s partner of 37 years, stepped out of the kitchen where she was clearing out cabinets and preparing for a contractor’s visit. She offered Saunders a box of macaroni and cheese to take home.
It felt incongruous.
“Here we were talking about her death, but we were in the kitchen getting ready to have the kitchen renovated,” said Saunders, an architect.
The signature brought Klein closer to fulfilling her goal of controlling the final moments of a terminal disease.
But even after the public pleading, the quiet lobbying and the politics surrounding the vote — and the paperwork — it wasn’t a done deal.
Klein’s oncologists didn’t want to prescribe the drugs for the fatal dose. And social conservatives in Congress vowed to stop the District’s program.
And it was uncertain whether death would come from the cancer overtaking her body, or at her own hands, at her own time and in the comfort of her own home.
Klein, a former journalist and artist who trained dogs in retirement, noticed stomach pains while traveling to compete with her German shepherd, Adina, in summer 2014. She blamed her irregular diet and figured she would feel better when she returned home.
X-rays dated Oct. 2, 2014, showed tumors growing in her uterus.
Klein sat her wife down in their living room soon after and explained the grim outlook.
“We’re going to do this well,” Dawson recalls Klein saying.
From the diagnosis of the Stage 3 ovarian cancer, Klein was thinking about the end.
She wanted to decide when the pain became too intolerable to continue living, but her options were limited.
For decades, activists have pushed to allow terminally ill patients to legally end their lives, saying people with no hope of recovery deserve the option to avoid needless suffering in their final days.
Some doctors say helping patients die violates the Hippocratic oath to do no harm. Religious leaders say preservation of human life is sacrosanct. Advocates for people with disabilities and the elderly fear they could be pressured into premature death.
Even the name of the practice is controversial. Supporters prefer “death with dignity” to “assisted suicide,” and the main advocacy group rebranded itself from the Hemlock Society to the softer-sounding Compassion & Choices.
Oregon became the first state to legalize the practice in 1997 and was followed by Washington state and Vermont by the time Klein discovered her cancer. And a 2009 Montana Supreme Court ruling said nothing in state law prohibited the practice.
The week of Klein’s diagnosis also marked a turning point for the national movement.
Brittany Maynard, a 29-year-old with brain cancer who moved from California to Oregon to end her life, became an international media sensation profiled in People magazine and on national television before her death.
Maynard’s story and lobbying by her relatives helped an aid-in-dying bill become law in California in 2015.
Meanwhile, advocates were preparing to mount an effort to pass a similar law in the District.
It would be a huge symbolic win as the nation’s capital, and the first victory in a jurisdiction with a large number of African Americans, a demographic among the most skeptical of the practice.
But they needed a public face.
Klein went to her first meeting of Compassion & Choices volunteers in the District on Aug. 9, 2016. She introduced herself to the group as a cancer patient but didn’t say she wanted to end her life.
Donna Smith, an organizer with Compassion & Choices, talked about how it needed a persuasive spokesperson for the legislative push in the District.
Klein didn’t volunteer. She told her wife about it over dinner that evening.
“We joked that a 69-year-old lesbian sure wouldn’t pull at the heartstrings the way Brittany, a young, vibrant woman freshly married with newly diagnosed brain cancer, would,” Dawson said.
As the vote on the D.C. legislation neared in fall 2016, Klein took a break from chemotherapy, cut short a vacation to Chincoteague Island to lobby lawmakers and gradually stepped into the spotlight.
“I have advanced ovarian cancer that cannot be cured. I want to live,” Klein wrote in an Aug. 17 email to D.C. Council member Brianne K. Nadeau (D-Ward 1). “During the past two years I’ve had aggressive surgery that took 42 industrial strength staples to stitch me up, and nearly continuous chemotherapies resulting in nerve damage making it difficult to walk far, a hospital ‘super infection’, huge blood clots, pain, and numerous trips to the hospital ER for these and other life-threatening chemo side effects.”
Klein showed up unannounced at a September news conference to rally support for the bill, asking to speak.
“Here she was, this rather private person, willing to go public on this issue,” D.C. Council member Mary M. Cheh (D-Ward 3), the bill’s author, said in an interview. “She had her good days and her bad days. She gave us her good days.”
The bill passed in November 2016 by a surprising margin, 11 to 2. Mayor Muriel E. Bowser (D), a practicing Catholic who did not publicly weigh in on the debate, signed it into law despite earlier misgivings by her administration.
Council member Brandon T. Todd (D-Ward 4) had been a firm “no” on the bill until he met Klein.
An Episcopalian, he believed life is a gift from God and that only God could take it away.
He knew Klein from community meetings and had knocked on her door when he was canvassing for reelection. She asked Todd’s position on the bill; he said he was opposed but agreed to come back and have a longer conversation. They spoke in her living room for an hour, and Todd voted yes.
“It wasn’t easy for me to come to the decision,” Todd said in an interview in his office.
“But her story just — it stuck out. I thought to myself, well, somebody in my family could be in this position. I could be in this position. I don’t know what I would do . . . But I think having the option, I think it’s okay. I think it’s okay.”
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