That same night, Mark's family gathered around him. He now had his attending and consulting physicians' compliance forms. He'd made his two oral requests, 15 days apart. He needed only to submit a written request, signed by two witnesses, one not a relative or heir, then wait 48 hours to get his prescription. He'd asked Margaret to serve as the nonrelative witness, but Mt. Hood Hospice policy wouldn't allow that, so instead he chose his daughter's boyfriend.
Mark picked up a pen. The boldface title on the document before him read, "Request for medication to end my life in a humane and dignified manner." Below that were the words "I, Mark Kobayashi, am an adult of sound mind. I am suffering from colon cancer . . . . I have been fully informed of my diagnosis, prognosis, the nature of medication to be prescribed and potential risks, the expected result, and the feasible alternatives . . . . I request that my attending physician prescribe medication that will end my life in a humane and dignified manner." Mark signed his name.
The next day, Joan delivered copies of the document to Dr. Lapin and Compassion in Dying, making sure to get them dated and time-stamped. Then, to Teresa, she asked: Do you know a pharmacy in our area that will cooperate?
This was no small question. The law allows pharmacists, like doctors, to refuse participation in an assisted suicide, and many in Oregon have done just that. As a result, doctors and families involved in the first assisted deaths sometimes had to call a long list of pharmacies until they located a cooperative one. Just as Compassion in Dying found it necessary to develop a "circuit" of willing doctors, so too did they need to identify willing pharmacists.
They'd done this by the time of the Kobayashi case. Teresa passed Joan's query to Compassion in Dying. Within 15 minutes she had the name not just of a pharmacy but of a particular pharmacist. Within an hour, Teresa was faxing his phone numbers to Dr. Lapin's office. This pharmacist, Teresa advised Lapin, would be working the night shift alone for the next eight days.
Two more days passed--the 48 hours the act required between Mark's written request and receipt of the lethal dose. It was now Friday. Mark was weakening rapidly. He couldn't sit up through a meal. His eyes closed often during conversations.
"Keep talking," he told his visitors in those moments. "I can still hear you."
He could also still speak. He thought the process required by the Death With Dignity Act could be quicker; he didn't know how he could use the law without Compassion in Dying; he felt lucky to have this option. "No," he said, "I don't have a particular time planned to take the medication. I just want to have it available in case."
A television set hung from the wall at one side of his bed. Occasionally, his eyes traveled to the screen, where a college basketball game unfolded. His daughter, Anne, 29, lay curled beside him on the edge of the hospital bed. His son, John, 31, stood near the foot of the bed. His wife sat in a chair in the corner. Every few minutes, Mark launched into a volley of heaving coughing, evidence of the growing lung tumors. Responding quickly each time, Joan and Anne gently clapped him on the back with cupped hands as he tried to hold himself up by the overhead bars. He winced with the effort. "Pain is an issue," Mark said.
A nervous tumult filled the Kobayashi home. Visitors arrived. Strangers asked questions. The phone rang. Joan walked from room to room in their modest suburban house, trying to address everyone and everything. The Kobayashis didn't know what was supposed to happen next. They'd cleared all the act's hurdles. They hadn't heard from Dr. Lapin, though. They weren't sure they wanted to.
Even now, near the end, they had tried to talk Mark out of his plans. This just managed to anger him; it was the most upset they'd seen him in these last days. "Why try to talk me out of this when you know this is what I want?" he asked. After that, they stopped trying.
"I don't want my dad to do a physician-assisted suicide," John said, standing in their living room. "I don't like the whole idea, laying about, waiting. I prefer the natural way. But Dad wants this. It's so important to him. He wants to talk about it, too. This is what he focuses on. When doctors and others call regarding this, he says, 'Give me the phone.' He likes to makes lists for projects--what to buy, what to do--then check items off. That's what he's done with this. He feels he's doing something with a purpose. It energizes him. This has become the most important thing to him."
Joan, passing through the room, added her thoughts: "It's also a cultural thing, an Asian thing. He thinks he's lived a full life, but when it's time to go, it's time . . . . This requires a person willing to take responsibility. I think the law is for strong people, not weak. It's not an easy way out. Not at all."