The Interior Experience of Prescribing Medical Aid in Dying: Carly Zapata and Dani Chammas

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GeriPal - A Geriatrics and Palliative Medicine Podcast 52 min 3 speakers 8 chapters transcribed 10 hours ago

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What is the overall focus of the episode on medical aid in dying?

Eric Widera 0:00

This podcast is CME eligible. To learn more about CME, Alex, what do they do?

Alex Smith 0:05

They can either go to the CME tab associated with this episode, or they can go to jerrypal.org backslash CME.

Eric Widera 0:14

And on to the show. Welcome to the JerryPal Podcast. It's Eric Modera. This is Alex Smith. And Alex, today's topic, it's gonna be one we get uh probably a couple emails about.

Alex Smith 0:25

We just got one this morning from our 400th podcast about this. We always get emails when we address this topic.

Eric Widera 0:30

We're gonna be talking about the interior experience of prescribing medical aid and dying. What's it like for a healthcare provider actually being part of that process? And who do we have to share this discussion with today?

Alex Smith 0:42

We're delighted to welcome back two guests, Doctor Carly Zapata, who's a palliative care doctor, practices inpatient and outpatient palliative care and is director of the palliative care fellowship at UCSF, Carly. Welcome to Jerry Powell.

Carly Zapata 0:56

Glad to be here.

Alex Smith 0:57

And we're delighted to welcome back frequent guest Danny Shamas, who's a psychiatrist, palliative care doctor. She practices outpatient palliative care at UCSF's Cancer Center, and she writes frequently about psychological dimensions of life-limiting illness. Most recently in the New England Journal of Medicine essay titled Where Do I Put This?

Eric Widera 1:18

We will have links to that and our other podcast with Danny. Danny, welcome.

Danielle Chammas 1:23

Thank you. Glad to be back.

Eric Widera 1:25

Uh Alex, I'm a little bit nervous because every time we have Danny on, she quizzes us. Yeah, there could be a quiz today. I should have listened to that. Oh no. Uh okay. Before Danny starts quizzing us, who has the song request for Alex? Carly Carly.

Carly Zapata 1:46

We ha we had a a unanimous you can say that about two people, a unanimous request for the same song.

Eric Widera 1:52

What song is it?

Carly Zapata 1:54

The song is I Will Follow You Into the Dark by Deathcad for Judy, which seems like a throwback to perhaps Danny and my generation of uh pop culture music.

Eric Widera 2:05

Why did you choose this song?

Carly Zapata 2:08

Well, uh in full disclosure we were talking about how this was actually maybe my like fifth or sixth choice because four hundred songs and the other ones had been uh chosen already given the topic of this podcast. And so this was one song in the long list of songs that are about uh about love and relationships and mortality and as Danny pointed out nicely about accompaniment, which really um all of those themes are a huge part of I think uh the decision to participate and made or at least to consider it for those of us for whom this topic comes up here.

Eric Widera 2:42

Thank you. Hi, Alex.

2:55

Love of mine, someday you will die, but I'll be close behind, I'll follow you into the dark, no blinding light, no tunnels to gates of white, just our hands clasped so tight, waiting for the hint of a spark. If heaven and hell decide that they both are satisfied Illuminate the nose on their vacancy signs. If there's no one beside you when your soul embarks, then I'll follow you into the dark.

Eric Widera 3:48

That was lovely.

Illia Polosukhin 3:50

Mm-hmm.

Eric Widera 3:51

Very apropos song for this discussion. Now we've had many discussion about medical aid and dying. Um and I know that it's a uh polarizing topic. You have a lot of people who are very anti and a lot of people who are very pro. Today we're not gonna be talking about that.

Alex Smith 4:09

Right. Today we're gonna be talking to two people who prescribe maid. And about their interior experiences. One of the reasons I wanted to do this is actually came up when I was reading one one of the my co like Greenwall faculty scholars fellows is an abortion provider and writes about her interior experience as an abortion provider. And she coined a term for this and she calls it danger talk. Like Most people feel like you gotta be all the way one way or the other way. And it's a false dichotomy. You're either entirely pro or entirely against. That's the email we got this morning from people who were entirely against. And that doesn't leave room. It like silences people who are feeling like moral ambiguity or moral ambivalence.

Alex Smith 4:54

And so we wanted to give a space on this podcast, some room for that to breathe. Yeah. And we were for our fortunate to be joined by two wonderful guests who are willing to talk about it.

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Chapters

8 chapters

1 What is the overall focus of the episode on medical aid in dying? 0:00–7:11 2 How do Carly Zapata and Dani Chammas describe their personal journeys into prescribing MAiD? 7:11–16:52 3 What are the key legal differences between California and Canada that affect MAiD use? 16:52–22:53 4 How does the availability of MAiD providers influence patient access in California vs. Canada? 22:53–29:17 5 What kinds of moral distress and moral residue do prescribers experience? 29:17–34:45 6 How do the guests use ethical frameworks and teaching methods to navigate MAiD dilemmas? 34:45–41:31 7 What challenges and growth do trainees face when learning to handle MAiD cases? 41:31–48:37 8 What practical take‑aways and future directions do the hosts and guests suggest for clinicians? 48:37–52:00

Speakers

3 identified

Eric Widera 7 min Alex Smith 7 min Illia Polosukhin

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Topics in this episode

Canada 1 Alex 1 Alex Smith 1 UCSF 2 New England Journal of Medicine 1 VA 1 Harry Hahn 1 James Tulsky 1 Sean Morrison 1 Elizabeth Cobbs 1 Carrie Levy 1 Hartford Foundation 1

Source

Recorded14 May 2026

Publisherrss.libsyn.com ↗

Transcriptspeaker-named · 100+ languages

Handlerec:20524460

Show notes

I had the privilege of learning from fellow Greenwall Faculty Scholar Lisa Harris about a term she termed, "dangertalk." As an ob/gyn and abortion provider, Lisa found the debate around the legality of abortion so polarizing that it created a false dichotomy: you're either for or against. Any talk about misgivings, uncertainty, ambiguity, or ambivalence was silenced. Talking about these issues in the face of polarization was deemed dangerous and undermining to one side or another. "How could you?" For Lisa's work in finding common ground and embracing nuance she was awarded the 2023 Bernard Lo Award for forging connections across divisions. In today's podcast we focus on the equivalent experience of moral uncertainty, distress, and residue among prescribers of medical aid in dying. We are joined by Carly Zapata and Dani Chammas, prescribers of medical aid in dying in California. We discuss: Their journey prescribing medical aid in dying, and reasons for choosing to prescribe The legality of prescribing in California. We compare California to Canada, as we have previously on this podcast. We discuss new limited survey data suggesting that legal barriers may not explain the remarkable 20 fold differences in use of medical aid in dying between California and Canada; rather, Canada has 6x the number of providers per capita as California, and much greater awareness of the legality of medical aid in dying. We talk about cases that are not as clear - e.g. people who have voluntarily stopped eating and drinking. Moral issues, including ambiguity and ambivalence, distress and residue. For example the moral distress created when a patient requests medical aid in dying due to what is clearly a systems failure (see this Atlantic article for clear examples from Canada). We ask if they sometimes feel frustrated that more people who are in favor of medical aid in dying are not prescribing, instead leaving prescribing responsibility to a relatively small group of clinicians. How core ethical ideas might lead to very different conclusions about medical aid in dying, and ways Dani teaches ethics to trainees. Psychological models that can help navigate this complex terrain with patients and families, including formulations and countertransference. And I can't believe I haven't played, "I will follow you into the dark" previously - but google couldn't find it - really? In 400+ GeriPal podcasts? Great song. So fitting. My son Renn plays guitar on the audio only version. -Alex Smith Additionally, some take home points, sent by Dani after recording: (1) Holding the dialectic: On one hand, people deserve the highest level of attention to their personhood and their suffering—an effort that, at times, can soften or even resolve a desire for hastened death. And on the other hand, some people will authentically experience this as the most values-aligned way of dying, given their circumstances. (2) Learning to accept that while laws create the safety rails, within those boundaries, morality is pluralistic. Both patients and clinicians bring deeply held moral frameworks to these decisions—and those frameworks deserve to be acknowledged and respected. (3) We have to be willing to ask the hard questions—and to show up for one another as we do. Because this work, more than almost any other, has taught us the profound impact of not feeling alone when navigating grey terrain. I view the discussion as an invitation for our field to not necessarily to become more certain, but to be willing to wrestle with the hard questions—while still showing up with rigor and compassion. And to remember that our patients are people before they are cases. If we can stay close enough to truly know them, we're much more likely to respond in ways that honor both their suffering and their dignity—whatever path that ultimately leads to.

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“What did the council decide on item 42?” — answered with the speaker and the moment.