Kate Riley shared her story in January of 2023.

In 2014, after over a decade of remission, my mother, Vee, received heart-rending news. Her breast cancer was back and it had metastasized – nine malignant tumors, seven were in her bones which caused excruciating pain from the microfractures they produced.

I had spent decades volunteering for hospice, then trained to become a certified death doula after witnessing my father’s distressing seven-week prolonged decline in the ICU. From the moment I started my work as a death doula in 2007, Vee and I talked routinely about death and dying. She was always clear and accepting of the fact that that which lives will die. 

I thought I was prepared to support my mother at the end of her life, but she challenged what I knew about conscious dying. As she endured nine months of agonizing pain caused by her cancer, Vee explicitly announced her desire for a prescription to die peacefully at home and bring an end to her suffering. Up to that moment, I had never given any thought to medical aid in dying. 

Because medical aid in dying was not, and still is not, an option in Idaho, my mother decided to voluntarily stop eating and drinking (VSED) to control her dying process as best she could. It took eleven harrowing days for Vee to die, throughout which she asked, “Why is it taking so long to die?”

VSED was an important option that preserved some of Vee’s autonomy over her end-of-life journey. Unlike medical aid in dying, VSED is an option for any decisionally-capable adult, no matter what state they live in. Supporting my mom through her illness and ultimate death was a gift for both of us. Yet, she still wished for a more peaceful, compassionate option.

During my years working as a death doula and volunteering with hospice, I have witnessed prolonged suffering. As I’ve sat with families of the dying, I’ve seen them equally tormented. Everything is out of their control and out of the hands of the dying patient. My life’s work is to support the choice of the terminally ill to die a conscious death, on their own terms. 

When I received my own cancer (ureteral cancer) diagnosis in the fall of 2020, it was a shock, like it is for so many people. It was a cold atmosphere – no warmth, just a plan of action full of onerous medical interventions. Suddenly, I was on the other side of a conversation that I had been used to having with people as a death doula.

I felt like my years of experience had led up to this opportunity to express my needs. In the past, I had never given much thought to the directives a doctor shared; I just went along with whatever they said. This time, I felt very differently. Hearing about the surgical procedure, seeing my massive malignant tumor on a screen, I said, “I need to talk this through with you. If I’m going in for major surgery, I need to go in feeling like we’re a team.” I needed a partner in my care, not an authoritative figure.

I decided to move forward with surgery, but before that I needed to ensure my son, who was 29 at the time, understood and supported my advance care wishes, just in case I was facing the end. As a result, we had an intimate conversation about life and death – a conversation we had never had together, despite my 30 years of facilitating these conversations with others. That conversation changed our relationship by allowing me to be open about what living means to me, personally.

After six days in the hospital post-surgery, I faced a difficult recovery at home. As months stretched on, and I still wasn’t feeling like myself, I questioned my limited end-of-life options in Idaho. I called a close friend in Oregon and told her that if my cancer persisted I would like to move to Oregon and die in her company.

My recovery took nearly a year, but thankfully there has not been evidence of cancer since my surgery. Nonetheless, a cancer diagnosis changes your life. Having the option of medical aid in dying became personally important to me. Previously, I had only been passively supportive. Suddenly, I felt like I fully grasped the importance of autonomy. Though, shamefully, Idaho doesn’t provide the option of medical aid in dying, I’m grateful that I am able to initiate a move to our neighboring state of Oregon, where the option is authorized. Having this backup plan continues to provide me peace.