Michael Saum, a 39-year-old California resident, is the first publicly known terminally ill person to identify as transgender in the United States who wants to use medical aid in dying. He is also one of the last living terminally ill advocates for Compassion & Choices who urged California lawmakers to pass the state’s 2015 End of Life Option Act.

Michael was diagnosed with a brain tumor in 2001 and had surgery to attempt removing it, but the doctor determined it to be inoperable. Six years later, in 2007, his tumor had progressed. Michael endured 18 months of chemotherapy with severe side effects. “If I didn’t quit the chemo, the doctors told me it was going to kill me,” he says.

On August 21, 2019, Michael’s doctor determined that he had six months or less to live. Michael immediately enrolled in hospice and is eligible to use the California medical aid-in-dying law that he fought for four years ago.

Without the option of medical aid in dying, Michael’s doctors say he would likely die painfully within the next few months from brain cancer. Currently his organs are shutting down, and he has lost most of his vision as a result of the tumor. He suffers from daily excruciating headaches and sometimes spends much of his days vomiting. His tumor has also affected his speech. “It’s hard for me to get out the words, but I know exactly what I want to say,” he explained.

Since enrolling in hospice, Michael’s pain has become more tolerable, although not completely controlled, with the increase in pain medication. Before hospice, it was difficult for Michael to function. “He would spend many of his days throwing up or laying in bed in the fetal position because his stomach hurt, his legs hurt, all the hallucinations and everything that goes with all of this; now, he gets a little bit of peace,” his best friend, Julia Solis, shared.

In September, Michael started the process to access the End of Life Option Act. “I have asked my doctor in hospice for a prescription that I can decide to take that will allow me to end my suffering and die peacefully,” he said.

Michael has been asked why at such a young age he’s willing to take aid-in-dying medication. He says, “I think some people don’t understand that even though I look healthy, I’m suffering. I explain that it’s not what I look like, it’s how I feel.”

For Michael, besides the sense of control having his aid-in-dying medication in hand will provide, he’s grateful that he will have the option to die peacefully, to end the pain he’s endured for nearly half his life.

Michael’s loved ones support his choice and understand that he is ready for the pain to end; his closest friends plan to be with him on his last day. Michael is also helping plan his own funeral, currently writing letters that he would like to be read at his services.