The mother watched as her 34-year-old son ingested a lethal medication to end his pain and suffering after a five-year battle against terminal cancer.
Naperville native Drew Flack was surrounded by family members and close friends in his California home as he fell asleep on Nov. 16, 2022, taking his final breath a few hours later.
His last words were “I’m happy,” according to his mom, 64-year-old Suzy Flack of Naperville.
“I felt an incredible peacefulness to know that he had died on his own terms,” she recalled in a recent interview with the Tribune. “And there was just a calm sense — almost like a gratitude — that things were how he wanted them to be.”
She said she was grateful her son was able to decide the moment and manner of his death, after exhausting all other treatment options. She only wishes he could have returned to Illinois, where most of his family resided, and been permitted the same end-of-life choice here.
Illinois could become the 11th state to legalize medical aid in dying — often referred to as physician-assisted suicide or medically assisted death — which would give mentally competent, terminally ill adults the right choose the option of ending their lives. A controversial bill filed in the General Assembly last month would allow these patients the right to access life-ending prescription medication, which they could then self-administer at a time of their choosing.
The legislation, which was introduced by state Sen. Linda Holmes, D-Aurora, includes requirements that the patient be at least 18, an Illinois resident and have a fatal illness, defined as a prognosis of six months or less to live.
Medical providers would be allowed to choose to refrain from “practicing medical aid in dying care,” according to the bill, which cites provisions of the state’s Health Care Right of Conscience Act.
Proponents of the proposed law, including Suzy Flack, say it’s an option that could end tremendous suffering for some ill patients in their final days. The nonprofit Compassion and Choices, which advocates for the proposed Illinois law, says the measure would only apply to a narrow group of patients and strict regulations are designed to prevent misuse or abuse. The organization contends that “there have been no substantiated cases of abuse or coercion” since Oregon’s law went into effect in 1997, according to a statement on the Compassion and Choices website.
Yet opponents fear the Illinois measure could pave the way for coercion, discrimination and abuse.
The proposed law is opposed by the Catholic church and some disability rights advocates, as well as some medical practitioners who say medically assisted death is antithetical to their life-saving mission.
To Dr. Kevin Garner of downstate Granite City, the measure is inherently in conflict with the role of a doctor.
“As physicians, we’re healers. Primum non nocere. First do no harm,” he said. “We’re here to educate people as to how they can optimize their health and optimize their lives, not end their lives.”
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Garner, who practices internal medicine and is also a palliative care and hospice specialist, added that he “didn’t go into medicine to help people die.”
“That bothers me that physicians would be put in that role,” he said.
He also warned that medical prognostication can be very inaccurate when it comes to individual patients.
“Statistically it can be very accurate — following guidelines, protocols and algorithms,” he said. “But for the individual patient it is notoriously inaccurate. Even predicting patients at the very end of life, if they’re hospitalized. I’m often wrong on when they’re going to die. … Not just me, but all physician prognostication is quite inaccurate, for the individual.”
Ten other states as well as Washington, D.C., already have so-called right-to- die laws. Oregon was the first state to allow the practice, after the passage of its Death with Dignity Act roughly 30 years ago; the practice is also legal in California, Colorado, Hawaii, Washington, Maine, Montana, New Jersey, New Mexico and Vermont.
Several other states are considering similar measures, including one recently introduced in the Minnesota legislature.
As for Suzy Flack, she said many family members and friends uprooted their lives to be with her son in California at the end of his life. But she knows not everyone has the financial means or ability to travel to other states.
Throughout the course of Drew Flack’s illness, she asked him to move back home.
“Since Illinois didn’t provide access to medical aid in dying, he always declined,” she said.
He spent the last year of his life advocating for this end-of-life option to be legalized in Illinois.
“Now I feel very strongly about the cause and carrying on his legacy,” his mother said.
Loving life, comfort in death
Suzy Flack said her son loved living.
“I don’t want to die,” she recalled him often saying. “I want to live.”
Drew Flack survived kidney cancer at the age of 4. He graduated from Naperville Central High School and went on to become a high school special education teacher, following in the footsteps of his mother, who retired from the same profession.
After graduating from Illinois State University, he “loaded all his worldly possessions and his dog,” and moved to Oceanside, California, his mom said.
Yet when Drew Flack was 29, he fell ill again, losing weight and growing so lethargic that the avid hockey player couldn’t finish even mild exercise. A colonoscopy in 2017 revealed stage 3 colorectal cancer.
“It was very devastating news,” Suzy Flack said, though she remembers her son remained optimistic that he’d beat cancer once again.
He went through several rounds of radiation, chemotherapy and surgery. But by 2019, he learned the cancer had spread significantly throughout his pelvic region.
After one surgery to remove a tumor “the doctor recognized that (his) cancer had spread to other areas of his body and the tumor was so oddly shaped that they were not going to be able to remove it,” Suzy Flack recalled.
The cancer was determined to be terminal. That’s when his oncologist informed him of the medical aid in dying law in California, his mother said.
“And Drew had said he was very comforted by that fact, that he had an option be able to steer, control his death. The process of dying,” she recalled. “Because at that, point he knew the cancer was going to kill him.”
According to the Illinois legislation, a terminally ill patient would have to make two verbal requests for the medication, with at least a five-day waiting period in between. The patient must also submit a written request for the drug, which at least two witnesses have to sign; one witness must be someone who is not a relative or an individual who could benefit from the patient’s estate.
Two physician assessments are mandatory and they must determine the patient has been diagnosed with a terminal disease, is mentally capable of making an informed health care decision and the request “does not arise from coercion or undue influence,” according to the proposed law.
A mental health evaluation is required if either doctor has concerns about patient mental capacity. The legislation would also make it illegal to coerce a patient into requesting life-ending medication, or for insurance companies to deny or alter health care benefits that would otherwise be available to a patient with a terminal illness because the medically assisted death is an option.
Yet some disability rights advocates warn that the measure could put vulnerable populations at risk, including seniors, disabled folks and people with mental health issues.
“An option that’s meaningful for a few will create a lot of problems for a lot more people,” Amber Smock, vice president of advocacy for Access Living, a Chicago-based disability service nonprofit said during an interview with the Tribune. “There are safeguards but they won’t protect everyone from unintended consequences from this particular bill.”
Folks with disabilities often face discrimination and bias in health care, and they are already at risk of criminal neglect or abuse, Smock said.
She worries that patients could be steered or coerced into ending their lives, particularly by insurance companies, who she fears might view physician-assisted suicide as a cheaper alternative to more expensive treatments or care.
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“There is simply almost no way to ensure that a person with a disability who asks for (medical aid in dying) is not somehow being coerced by family, their doctor, or insurance companies,” she said in a written statement. “Furthermore, existing (medical aid in dying) programs tend to set a high level of burden of proof on the patient to show that they have been coerced. (Medical aid in dying) supporters claim that there is no evidence that people are ‘steered’ or coerced; that’s because it’s hard to meaningfully report it.”
A National Council on Disability 2019 report on the nation’s medically assisted suicide laws said that “insurers have denied expensive, life-sustaining medical treatment, but offered to subsidize lethal drugs, potentially leading patients to hasten their own deaths.”
The report also argues that misdiagnoses of terminal illness can scare patients into hastening death; while fear and depression often spur assisted suicide requests, “referral for psychological evaluation is extremely rare,” the National Council on Disability said at the time.
“As someone who has battled cancer and been given weeks to live and am still thriving years later, I know firsthand that well-intending doctors are often wrong,” Neil Romano, the National Council on Disability’s chairman at the time, said in a statement. “If assisted suicide is legal, lives will be lost due to mistakes, abuse, lack of information, or a lack of better options; no current or proposed safeguards can change that.”
Smock added that Illinois residents already have other end-of-life options such as advance directives, filling out “do not resuscitate” forms and refusing medical treatment.
“In the future, Access Living will continue to oppose (medical aid in dying) as we believe that the ableism we experience in life will translate in discrimination in death,” she said in the statement.
‘Better way forward’
Drew Flack didn’t take the medication immediately, his mother recalled.
“We both felt that the time would come when he would just intrinsically know, ‘I have just had enough,’” Suzy Flack said.
His final months were a whirlwind of visits from relatives and friends who came to California to say goodbye. By this point, he couldn’t sleep or lay down comfortably, because of painful open wounds on his backside, she said.
She believes her son hung on to attend a September wedding for a close friend in Streator; he flew back to Illinois and stood up in the ceremony, taking his mom as his plus-one. But after the wedding, his health deteriorated even further; cancer had ravaged his body to the point where he couldn’t walk to the refrigerator to get something to drink anymore, his mother said.
On Nov. 16, 2022, with his immediate family and roommates by his side, Drew Flack determined it was time.
Around sunset, he recited his favorite poem, “Desiderata” by Max Ehrmann, which begins: Go placidly amid the noise and the haste, and remember what peace there may be in silence.
Then he ate a raspberry sorbet laced with the medication, his mother said.
“Drew was licking the spoon. I didn’t think he would give it back. … You would think he had never tasted sorbet,” Suzy Flack recalled.
She kept her hand on his arm. Soon he dozed off to the sound of a playlist he’d saved for his last moments, which included “Let it Be” by the Beatles and “Into the Mystic” by Van Morrison. He began to snore, which was a comfort to his mother, because he hadn’t been able to sleep well in so long due to the illness.
Drew Flack died at 7:57 p.m., according to his death certificate.
Suzy Flack said her son’s death was so different compared to to the death of her father about nine months prior; her dad was hallucinating, crying and in pain, which left her feeling scared and helpless, she recalled.
“And then to contrast Drew’s death with that, I can’t imagine anyone not supporting medical aid in dying,” Suzy Flack said. “Because Drew was at peace.”
In a testimonial for Compassion and Choices, Drew Flack said he’d decided early in his illness that he wouldn’t view himself as a victim of cancer.
“I choose to see it as cancer providing me with opportunities — opportunities to become closer to family and reconnect with old friends, opportunities to be involved with modern medicine, opportunities to meet amazing new people, opportunities to reach my physical and mental limits and push beyond those limits, opportunities to reflect on my own beliefs,” he said, “And, finally, the opportunity to educate and advocate about end-of-life options.”
For some terminally ill patients, this right is a matter of bodily autonomy, said Khadine Bennett, director of advocacy and intergovernmental affairs for the American Civil Liberties Union of Illinois, which supports the Illinois legislation.
“They know that, for a lot of them, at the end of their life they might be in severe pain,” she said. “They want to be able to make this decision, because it’s the right decision for them and their families.”
The Illinois legislation says patients must be counseled on all potential medical treatments as well as other end-of-life options, such as hospice and palliative care. Even when patients request and receive the prescription, they are at no point required to take the medication, according to the proposed law.
As of 2020, just over 5,300 American adults had died with medical assistance, while around 8,450 had received a prescription for the medication; of those who chose to take the drug, more than 95% were white and nearly three-quarters were cancer patients, according to a 2022 study in the Journal of the American Geriatrics Society. The median age of patients was 74, the study found.
The Illinois measure is opposed by the Catholic Conference of Illinois, which argues that medically assisted death isn’t just a private matter, because these types of decisions impact society as well as the patient.
“The state gives the message that it is permissible to end one’s life,” the Catholic Conference of Illinois said in a statement. “Suicide is already a major public health problem; legalizing assisted suicide will not help address that problem.”
Catholic Conference of Illinois Executive Director Robert Gilligan said he’s also worried about the potential for abuse and believes there aren’t enough safeguards to ensure patients are taking the medication voluntarily. He also fears some of the restrictions in the proposed Illinois measure might be loosened over time.
In 2021, Canada expanded its medical assistance in dying law to patients suffering solely from mental illness, though the controversial expansion has been delayed from taking effect until 2027.
“The Catholic Conference of Illinois just thinks there’s a better way forward than legalizing assisted suicide,” Gilligan added. “Things like expanded and improved palliative care would be very important for the state to embark on. And increased mental health and behavioral health options for people.”
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The Associated Press contributed.