In the end, it wasn't easy for Aaron McQ to decide when to die. The 50-year-old Seattle man a former world traveler, triathlete and cyclist learned he had leukemia five years ago, followed by an even grimmer diagnosis in 2016: a rare form of amyotrophic lateral sclerosis, or ALS.

An interior and urban designer who legally changed his given name, McQ had been in pain and physical decline for years. Then the disease threatened to shut down his ability to swallow and breathe. "It's like waking up every morning in quicksand," McQ said. "It's terrifying."

Lethal Drugs

Last fall, McQ decided to use Washington state's 2009 Death With Dignity law to end his suffering. The practice, approved in seven states and the District of Columbia, allows people with a projected six months or less to live to obtain lethal drugs to end their lives.

Although the option was legal, actually carrying it out was difficult for McQ, who agreed to discuss his deliberations with Kaiser Health News. He said he hoped to shed light on an often secretive and misunderstood practice.

Deaths

More than 3,000 people in the U.S. have chosen such deaths since Oregon's law was enacted in 1997, according to state reports. Even as similar statutes have expanded to more venues including, this year, Hawaii it has remained controversial.

End-Of-Life

Supporters say the practice gives patients control over their fate in the face of a terminal illness. Detractors including religious groups, disability rights advocates and some doctors argue that such laws could put pressure on vulnerable people and that proper palliative care can ease end-of-life suffering.

Last November, doctors told McQ he had six months or less to live. The choice, he said, became not death over a healthy life, but a "certain outcome" now over a prolonged, painful and "unknowable"  end.

Many people who opt for medical aid-in-dying are so sick that they take the drugs as soon as they can, impatiently enduring state-mandated waiting periods to obtain the prescriptions Data from Oregon show that the median time from the first request to death is 48 days or about seven weeks. But it has ranged from two weeks to more than 2.7 years, records show.

Neurodegenerative diseases like ALS are particularly difficult, said Dr. Lonny Shavelson, a Berkeley, Calif., physician who has supervised nearly 90 aid-in-dying deaths in that state and advised more than 600 patients since 2016.

Palliative Care

There was part of him that was hoping there were some other alternatives. McQ considered several dates and then changed his mind, partly because of the pressure that such a choice imposed. Along with the pain, the risk of losing the physical ability to administer the medication himself, a legal requirement, was growing.

They just all gathered around him, each one touching him," DeRoche said. It was just like one fluid motion," DeRoche said. "He drank the medication, he went to sleep, and he died in six minutes. I think we were all a little surprised he was gone that fast."

Decision

In the months since her friend's death, Robinson has reflected on McQ's decision to die. It was probably what he expected, she said, but not anything that he desired. It's tough to be alive and then not be alive because of your choice. If he had his wish, he would have died in his sleep.