The old man blinked again. Someone had combed his gray hair back, away from his forehead, and he wore a brown cotton T-shirt over thin, age-spotted arms. “It’s the prelude to the final attraction,” Bradshaw said at last.

Lonny, who is small and slim, with a receding hairline and wire-rimmed glasses, left his Berkeley home office that morning at 9 a.m., with a canvas medicine bag in one hand and a pair of black dress shoes in the other. He always wore house slippers when he drove, for comfort, and then changed into nicer shoes when he got to the patient’s home. This would be Lonny’s ninetieth assisted death. Everyone said there was no doctor in California who did more deaths than Lonny. He would say that this had less to do with his particular allure as a physician and more to do with the fact that other doctors in California refused to do assisted deaths or were forbidden to do them by the hospitals and hospices where they worked. Sometimes, Lonny said, he got quiet phone calls from doctors at Catholic health systems. “I have a patient,” the doctors would say. “Can you help?”

Lonny drove north, through residential Berkeley, past tidy streets lined with bungalows and blossoming cherry trees, and then along unattractive stretches of highway dotted with drive-through restaurants and Chinese buffets. After a while, the urban sprawl gave way to water-soaked rice fields. Lonny took tiny sips from his water bottle and tried to memorize the names of the patient and his children. I quizzed him until they came easily. The patient was Bradshaw Perkins Jr. and he was dying of prostate cancer.

Three years earlier, when Bradshaw was living with his son Marc and his daughter-in-law Stephanie, he had tried to gas himself to death in the garage. Later Bradshaw would claim that he sat in the driver’s seat for an hour, waiting to die, but that nothing happened. He had messed something up. Marc wasn’t sure if his father had really meant to die that day. Was he for real? Was it a play for attention? “Hard to say,” Marc said. “He always claimed he was never depressed and that it wasn’t an issue. He was just tired of life.”

In the three years since, cancer had spread through Bradshaw’s body with a kind of berserk enthusiasm, from his prostate to his lungs and into his bone marrow. At the nursing home where he had once been happy enough—watching TV, eating take-out KFC, flirting with his nurses—he had grown restless, bored, and despairing of the hours before him. When Marc came to visit, he would find his father staring at the wall. Bradshaw’s body began to ache. His bowels cycled between constipation and diarrhea, so that he always felt either stuffed or hollow. Eventually, after a lifetime of refusing to take so much as an aspirin, Bradshaw gave in to the medication protocols recommended by his hospice doctors. He felt less pain on drugs, but he grew loopy and started falling when he got up to pee. His arms sprouted purple bruises and his left leg felt funny all the time. Nurses had trouble picking him up when he fell, and Bradshaw worried about hurting them. He stopped leaving his bed. In May 2018, doctors told Bradshaw that he was nearing the end and that he likely had just two or three months left to live. Marc was in the room and thought he saw his father smile. “People try to help me,” said Bradshaw. “But I think I am done needing help.”

Bradshaw told Marc that he had lived a good life, but that after eighty-nine years, the bad was worse than the good was good. He missed running. He missed fixing up cars. He missed taking his body for granted. “I want to pass,” he said.

“Whoa-kay,” said Marc. And right there, in his father’s little nursing home apartment, Marc took out his phone and Googled “assisted dying + California.” He found a page describing the California End of Life Option Act, which passed in 2015 and which legalized medical aid in dying across the state. It seemed to both men that Bradshaw met the requirements: terminal illness, close to death, mentally competent.

Bradshaw said he had already asked his nurses, twice, about speeding up his death, and that each time the nurses had said that they couldn’t talk about it because it was against their religion. When Marc called VITAS Healthcare—the national hospice chain that managed Bradshaw’s care, dispensing all the nurses and drugs and equipment that Medicare pays for when someone is within six months of death—a social worker explained that while the company respected Bradshaw’s choice, its doctors and staff members would play no part in it. VITAS had prohibited its physicians from prescribing drugs or consulting with patients in aid-indying cases, as had many other hospices in the area, along with the state’s dozens of Catholic hospitals and health systems. On the phone, Marc asked the social worker whom he should call for more information, but the social worker said she wasn’t allowed to help him with that either. (VITAS’s chief medical officer told me later, in an email, that VITAS staff can in fact “discuss and answer any questions on eligibility requirements” and can help refer patients to prescribing physicians.)

It was the hospice chaplain, Marc said, who took him aside and told him to look up Dr. Lonny Shavelson. When Marc searched Lonny’s name, he saw that the doctor ran something called Bay Area End of Life Options. The medical practice was the first of its kind in California, if not the whole country: a one-stop shop that specialized in assisted death. There were articles on the Internet that praised Lonny as a medical pioneer. Unlike other doctors, who prescribed lethal medications for patients to take on their own, Lonny or his nurse was present at every single death; it was part of their standard package, which went beyond the requirements of the law. Other articles, though, were less kind. Some criticized Lonny for running a boutique death clinic. He charged $3,000 and didn’t take insurance, and he didn’t offer refunds if people changed their minds. “Less than you pay for a funeral,” Lonny told me when I asked about his rate.

Marc did some research and found that neither Medicare nor the Department of Veterans Affairs would pay for Bradshaw’s assisted death. Under the 1997 Assisted Suicide Funding Restriction Act, Congress had, with bipartisan support, banned the use of federal funds “for the purpose of causing or assisting in the suicide, euthanasia, or mercy killing of any individual,” a move supported by then president Bill Clinton, who had pledged during his first campaign to oppose death with dignity legislation across the country. Marc didn’t care about the politics. He could pay. He sent an email to the address listed on Lonny’s website: “We would like to enlist your services in this regard.”

Bradshaw formally requested to die on January 9, 2019, starting the clock on California’s mandated fifteen-day waiting period. Afterward, Lonny’s nurse sent over the paperwork. Bradshaw had to sign a state of California form titled “Request for an Aid-in-Dying Drug to End My Life in a Humane and Dignified Manner,” pledging that he was “an adult of sound mind” who was making his request “without reservation, and without being coerced.” Bradshaw told Marc that he wanted to sign his name perfectly—every letter in its proper place—but midway through, his handwriting gave way and looped upward into a wispy scrawl.

It seemed to Lonny that if Bradshaw let the cancer take its course, it would probably kill him in a few weeks’ time. It was hard to say exactly what the death would look like, though it’s possible that he would feel some pain in the end and that hospice nurses would offer him heavy painkillers, probably morphine. On the way out, he might pass through a period of what doctors call “terminal restlessness” or “terminal agitation,” which can induce confusion, disorientation, insomnia, angry outbursts, paranoia, and hallucinations. Some dying people dream that they are underwater and trying hard to swim to the surface to tell you something, but they can’t get there. Many dream of travel. Planes, trains, buses. The metaphors that fill a dying man’s dreamscape can be callow and obvious. For others, delirium is more pleasant; they see angels on the ceilings and the walls. Benzodiazepines could help with the unrest and anxiety. Antipsychotics could ease the visions. Drugged or not, Bradshaw would likely fall into a coma. Maybe he would stay that way or maybe he would dip in and out of consciousness for a while. After a few days or weeks, he would die. The cause of death would technically be dehydration and kidney failure, but the death certificate would recognize his cancer as the underlying killer. Perhaps his children would be at his bedside, but perhaps they would have gone home for the night to get some sleep when Bradshaw took his final breath. Death isn’t always poetic. People die while nurses are adjusting their bodies in bed, to ease pressure off their bedsores. They die when they get up to pee. One hospice nurse told me that men often let go after their wives leave the room for a bite to eat.

The nursing home was painted pale yellow and it looked like a life-size dollhouse, tucked into a street of suburban bungalows in a city called Citrus Heights. The parking lot outside was full, so Lonny pulled into a space next door, which belonged to the Christ Fellowship Church. “We’ll tell them we’re just going to kill someone,” he said brightly as he changed his shoes. Marc was waiting outside, a middle-aged man with a broad frame and black rectangular glasses. He squinted at us, uneasy.

Inside Bradshaw’s room, someone had hung framed photographs on the wall: collages of children and grandchildren, close friends and their grandchildren. There was a certificate thanking Bradshaw for his military service. On the countertop were half-eaten bags of Halloween candy and half-used bottles of hand sanitizer and a plastic cowboy hat—maybe left over from some nursing home theme night. I imagined it sitting atop a nimbler, more alert Bradshaw. “Hi, sweetie,” Cheryl said, sitting at the edge of her father’s bed. She was as slender as her brother was robust, in a peach-colored sweater. “Everyone is here.” Cheryl had flown in from Maryland and Sean had come from Washington State. Marc and Stephanie had driven from nearby and had brought their son. They had all scheduled time off work for the death.

Lonny could see that Bradshaw was a more diminished man than he had been just a few days earlier. When California’s aid-in-dying law passed, opponents imagined that plucky cancer patients would soon be marching into their oncologists’ offices to demand lethal drugs, but that wasn’t what Lonny was seeing. Most of his patients were almost dead by the time they ended their lives; they were weak and a little hazy. Sometimes, this was because their primary doctors had dragged their heels—delaying the process for weeks or months. About a third of people didn’t make it through the state’s required fifteen-day waiting period because they died naturally or lost consciousness, or because they grew too weak to lift a glass of medication to their lips. Or because, when the day arrived, they were too disoriented and confused to fully consent to their own deaths. Bradshaw was teetering on the edge.

Lonny had warned the family that confusion could set in at the end. “Let’s put it this way,” he said, “almost everybody, when they get really close to dying, is demented.” Even so, he had to be convinced that Bradshaw knew what was going on. He didn’t need to know the month of the year or the name of the president, but he had to remember what he was sick with and what he had asked for—and he still had to want it. On a few occasions, Lonny said, he had made it all the way to the bedside and then called off the death because the patient was too out of it to agree to anything at all.

“What are you dying from?” Lonny asked. Then he said it again, louder.

“I’d like to know myself,” Bradshaw said.

“Dad, you have to be serious,” said Marc, and the room fell silent. Cheryl rubbed the back of Bradshaw’s sunken hand, like she was willing his mind to cohere.

I pressed my back into the small partition separating the two sections of the apartment and tried to breathe quietly. From where I stood, I could see into the closet, where a few T-shirts were hanging over a pile of plastic adult diaper packages. I could also see that Bradshaw’s hands were bent inward and that his feet looked swollen and pale, like they were waterlogged. Behind me, his grandson looked down at his phone. Bradshaw said nothing for a while and then recalled that there was something wrong with his prostate.

“OK,” Lonny said, smiling. “We have a bit of paperwork to do.”

Bradshaw groaned. “Oh my God.”

“As you can imagine, the state of California doesn’t let you die easily.” Lonny held up a document. “This little paper here is called the ‘Final Attestation.’ The state of California wants you to sign, to say that you are taking a medication that will make you die.” Bradshaw closed his eyes.

“Dad,” Marc urged. “Dad, you have to stay awake for a few minutes. . . . Daddy, you need to sign, right?”

“Dad,” said Cheryl. “Sign your name.”

Bradshaw opened his eyes and signed the form and Lonny said they were ready to begin. He warned everyone that he didn’t know how long it would take. Some patients died in twenty minutes. Others took twelve hours. He said that he had recently been tweaking his standard drug protocol, adjusting doses and delivery schedules, and that he had managed to lower the average patient dying time to just two hours. Bradshaw would start with an initial medication mixed into apple juice. Then half an hour later he would drink a cocktail of respiratory and cardiac drugs and some fentanyl. The drugs would work to kill Bradshaw in different ways. The respiratory suppressants would likely kick in first, to stop his breathing, but if they didn’t, then the high-dose cardiac medications would eventually stop his heart. Either way, it would feel the same to Bradshaw, who would fall unconscious just a few minutes after taking the final dose. New patients were always asking for “the pill,” Lonny said, but there was no magic death pill. In fact, it was surprisingly hard to kill people quickly and painlessly; the drugs weren’t designed for it and nobody taught you how to do it in medical school.

At the sink, Lonny opened a small lockbox that was filled with $700 worth of medication. I stood beside him and watched him unpack it. He pointed to a green glass bottle. “That’s the fentanyl,” he whispered. Fentanyl, a synthetic opioid, wasn’t part of the usual drug protocol, but Lonny had added it to the mix to see if it would speed up his patients’ deaths. He had got the idea from a New York Times article about an opioid addict who overdosed after sucking the fentanyl out of some prescription pain patches and letting the solution dissolve in his cheek. “Wow, why can’t we do that?” he had wondered.

Lonny mixed the first powdered drug into a plastic bottle of juice and passed it to Bradshaw, who drank it quickly. Marc exhaled. “You did good,” said Lonny, who noted that the time was noon.

At the bedside, everyone was teasing Bradshaw about the women he was going to kiss in heaven. “I hope he gives all the girls a kiss,” said Sean.

“Well, that’s a given,” said Marc’s wife, Stephanie, who couldn’t stop crying.

Bradshaw’s flirting had always been a source of family embarrassment. Even in his final years, he was forever hitting on his nurses and v...