by Kris Shankar, Volunteer Storyteller

Eastern Washington State is much like the rest of rural America. It is a socially conservative place where religion and traditions still guide the beliefs and outlook of most people. When Cindy Nover, Associate Professor of Social Work at Eastern Washington University and EOLWA board member, stands up to speak at a Lions Club meeting in Spokane about choice in death with dignity and medical-aid-in-dying (MAID), there is understandably a lot of confusion among her audience. It’s early 2022 and over 12 years since Washington State became the second state in the nation to pass medical-aid-in-dying legislation. The legislation stipulates that terminally ill patients with less than six months to live can request to use a lethal dose of medication to end their lives, provided they are sound of mind, and at least two doctors have testified that their illness is terminal. However, Cindy’s audience doesn’t know this. Is she talking about suicide? Or euthanasia? Aren’t both illegal, not to mention immoral?

When they learn that Cindy offers a facility for patients to consume the medication that will end their lives, the reactions are mixed. The pastor, who opened the meeting with a prayer, wants to know if a patient can bring along members of their religious community to support them in their last hours, which Cindy confirms is perfectly ok. It’s after lunch, when Cindy is getting ready to leave, that people really get comfortable and begin to open up. One by one, they come up to her and whisper their story about how a family member, when faced with a terminal illness and acute suffering, wanted to explore MAID but didn’t get support from the rest of the family. Even those whose reservations stem from religious beliefs open up more to death with dignity and MAID when it is presented as a matter of preserving individual choice.

It’s understandable that people are not comfortable talking about death, let alone MAID. In our society, it is taboo. Over the last 100 years, lifespans have significantly increased. The medical system views any life lost to disease as a failure. We are not as familiar with death as our great-grandparents’ generation. Our discomfort with the topic is such that less than half of all Americans have a legal will that describes how they would like their money and estate to be handled after their death. Cindy is an exception. She is one of those rare individuals who has had an advance directive – a legal document that explains how you want medical decisions about you to be made if you cannot make the decisions yourself – since she was a young adult. For much of her professional career, she has had to talk with people about difficult things. In a former role at a pediatric intensive care unit and kidney transplant center at Georgetown hospital, she has had to speak to parents about the possibility of their kids dying and help them through difficult steps like filling out their own advance directives. As she puts it, “it comes naturally to me to sit with people at such times and to be able to have these difficult and heart-wrenching conversations.”

In many ways, her own personal losses have led Cindy to become an advocate for Death with Dignity and MAID and offer her home as a facility for patients who have chosen to end their lives. Cindy’s home sits on a pretty little lake, and in 2019, that’s where her dad lived out his last days on hospice, looking out at the lake. Just a little after, Cindy was present at the unexpected passing of her tenant, an older gentleman. Shortly before he passed, he had shared with Cindy, “I don’t want to die in a hospital. I’d like to just walk out in the woods and die one day.” That’s when the idea for Sagebrush Crossing was born. Cindy started thinking about offering her home as a facility for terminally ill patients who want the freedom of choice to die with dignity, without prolonged and unnecessary suffering. Sagebrush Crossing is now a registered social purpose corporation whose services are available to any patient with a need.

Today, Cindy’s mission is to share her knowledge of the law and the process of opting for MAID and provide Sagebrush Crossing as a facility for those who need it. In rural America, knowledge of End of Life and MAID is poor. There aren’t many qualified providers since most general practitioners in rural areas are physician assistants or nurses. Per current law, only MDs and Doctors of Osteopathic Medicine can be attending physicians to patients who have opted for MAID. However, there is clearly interest and a need, even while conservative and religious values can be a barrier.

Cindy wants to get the word out. In her review of the academic literature, there are almost no articles published about the law, the processes that patients need to follow, and the roles that social workers and medical professionals can play in the context of Death with Dignity and MAID. As she puts it, if her understanding of these details can be made available to social workers and medical professionals in Washington and elsewhere in America, it’s a win. Cindy hopes to see the day when more people open up their hearts and homes to the terminally ill, just like she has done with her organization. Starting with the germ of an idea, Sagebrush Crossing has now taken root and is offering a scarce and much-needed service amongst the farmlands of Eastern Washington.