California’s End of Life Options Act, which allows doctors to write life-ending prescriptions for terminally ill adults who meet strict eligibility requirements, went into effect two years ago. In May, a judge halted the law on a technicality; an appeals court recently reversed that decision. As complicated and lengthy court processes continue to unfold, emotional and legal limbo remains.

“It is an American habit to turn complex moral problems into technical legal reasons,” writes Andrew Solomon in A Death of One’s Own (1995), about his mother’s decision to end her life rather than endure the final excruciating stages of ovarian cancer. Solomon weaves his personal story with an in-depth history of the euthanasia movement before aid-in-dying was legal anywhere in the United States. With unfailing empathy and candor, he explores every nuance of the issue, including how relegating it to the shadows compounds the difficulty. He describes the coded euphemisms his mother used with her doctors to secure what she needed. Solomon, his brother, and their father all whole-if-broken-heartedly supported her choice to die on her own terms at home, surrounded by loved ones. The necessity of secrecy heightened their intense isolation and sadness.

An unequivocal supporter of the right to choose, Solomon is also an unblinking chronicler of the ambivalence, sorrow, and potential risk such choice entails. “There is no question that if euthanasia is legalized it will be abused . . . The question is whether these abuses represent a greater crime against life than does keeping alive people who want to die.”

In the 23 years since A Death of One’s Own was published, much has changed. Seven states (including California) and the District of Columbia now allow some sort of physician-assisted dying. The terminology has also changed: “Death with Dignity” and similar monikers have largely replaced “assisted suicide” or “euthanasia.” Although there are still those who prefer the term “murder,” there is a growing consensus among proponents that existing laws are too narrow, excluding those with conditions such as Alzheimer’s and ALS from seeking legal relief.

What of those who suffer from unremitting psychic distress? Why are people with terminal cancer deemed to have good reason to end their suffering, but people afflicted with chronic depression are not? Here the slippery slope steepens.

Rachel Aviv delves deeply into this disquieting territory in The Death Treatment (2015), about Belgium’s law permitting euthanasia for those suffering from severe and unrelenting psychological distress.

Both Solomon and Aviv are beautiful and compelling writers. Each account illuminates the shadows we must explore to grapple with the awesome complexities of life and death decisions. As California’s End of Life Options Act continues on its topsy-turvy legal course, the imperative to bring into the light what it means to be alive and to die—and who gets to decide–continues.

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What are your thoughts and experiences about this topic? What would you want for yourself?

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(Originally published in the Northern California Society for Psychoanalytic Psychotherapy’s “Impulse”)