Terminally ill California woman describes final hours before assisted death as UK debates similar law

A 72-year-old California woman with terminal pancreatic cancer described the arrangements for her assisted death and her final hours in an interview published after her death, highlighting the practical and emotional steps some patients take under Medical Aid in Dying (MAID) laws.

Roseana Spangler-Sims, diagnosed 18 months earlier with stage four pancreatic cancer, told the interviewer that she had made peace with her prognosis and was "ready to go. I'm more at peace than I've ever been." The interview, conducted on the day of her death, detailed family gatherings, a living wake and rituals the family organized in the two weeks before she died on Aug. 31.

Spangler-Sims moved from her Vista apartment on Aug. 18 to spend her final weeks near Palomar Mountain, north of San Diego, surrounded by her son, his wife and extended family. The family held a living wake attended by dozens of friends and relatives. She arranged for a death doula to provide emotional and spiritual support, and a psilocybin facilitator to lead a ritual that included sage and a microdose of magic mushrooms, which she said she chose "to bring myself to that peaceful point" and "to feel one with nature."

Under California's Medical Aid in Dying law, which was passed in October 2015 and took effect in June 2016, two independent physicians must confirm a patient has a terminal diagnosis with a prognosis of six months or less. Official figures released in July 2024 show that more than 4,200 people in California have died after ingesting medications prescribed under the law.

Spangler-Sims described the timing of her final hours: she ate a light breakfast because her stomach needed to be empty before taking the prescribed medication, planned to take anti-nausea medication at about 5 p.m. to ensure the MAID medication "goes in and stays down," and intended to drink the lethal solution around 6 p.m. She said she wanted to lie outdoors on a hospital bed, surrounded by family, and asked that the death be as swift as possible. "I want it to go as quickly as possible. I don't want the kids to sit here and look at me half dead for too long. I want to be out," she said. "I feel ready to fade."

Spangler-Sims' case has drawn attention as lawmakers in England and Wales consider similar measures. The Terminally Ill Adults (End of Life) Bill, which would allow adults with a prognosis of less than six months to seek assisted dying, completed its third reading in the House of Commons in June. Supporters, including Labour MP Kim Leadbeater, say the bill would provide "choice, autonomy and dignity at the end of their lives." Opponents, including former minister Sir James Cleverly and Labour MP Diane Abbott, warn of risks to vulnerable people and say the law could lead to avoidable deaths.

The Commons vote on the bill reflected deep division. According to recorded tallies, 224 Labour MPs supported the bill alongside 20 Conservatives, 56 Liberal Democrats and two Reform UK MPs, while 160 Labour MPs opposed it with 92 Conservatives, 15 Liberal Democrats and three Reform UK MPs voting against. The bill passed the Commons by 23 votes, a narrower margin than earlier parliamentary debates, and is set for further scrutiny in the House of Lords.

Proposed safeguards in the bill mirror some elements of California's law: two independent doctors would need to confirm eligibility, patients would have to be over 18, resident in England and Wales and registered with a GP for at least a year, and they would need to demonstrate mental capacity and the absence of coercion. The measure would require two separate declarations of intent and a High Court judge would make a final decision in eligible cases; at least two weeks would elapse after a positive ruling before assisted dying could take place.

Pancreatic cancer, the disease that afflicted Spangler-Sims, is often diagnosed late and has a poor prognosis. Advocacy groups and health organizations note that more than half of people with pancreatic cancer die within three months of diagnosis and that 80% are not diagnosed until the disease has spread, limiting treatment options. The condition's early symptoms can be subtle and are frequently mistaken for other common ailments such as indigestion or irritable bowel syndrome. The charity Pancreatic Cancer UK has said there is currently no widely available early detection test.

Medical aid-in-dying laws vary across jurisdictions, and advocates and critics emphasize different priorities. Supporters underline autonomy and relief from suffering for patients with limited life expectancy; critics warn of potential risks to vulnerable groups and argue for strengthened palliative care and safeguards.

Spangler-Sims' public account of her final day comes amid renewed debate over assisted dying in the United Kingdom and ongoing analysis of how such laws operate where they are already in force. Her family provided the interview in the context of celebrating her life and explaining the choices she made in the face of a terminal diagnosis.

For people in crisis or contemplating self-harm, resources are available. In the United Kingdom, Samaritans can be reached anonymously at 116 123 or via samaritans.org. In the United States, the national suicide and crisis lifeline is available by calling or texting 988 or via online chat at 988lifeline.org.