Family of Woman Who Chose Medical Aid in Dying Share Photos, Final Moments (Exclusive)

Days after Roseana Spangler-Sims ended her life through California’s Medical Aid in Dying law, her family is remembering their last moments with her.

“We love her and we wanted to help her to feel the best she possibly could and the most positive she could before she was faced with her life ending,” says her daughter-in-law Cindy, who, together with her husband, Roseana’s son, Shawn Cisneros, and her sister Sandi Hunter were with Roseana, 72, when she died. “She’s not in pain any more.”

Two weeks earlier, Shawn, Cindy and Sandi had traveled from their homes in Florida to meet Roseana, who had been diagnosed with stage 4 pancreatic cancer in 2024, at a VRBO house in the mountains north of her Vista, Calif., apartment. The rental was chosen by Shawn because it was located in one of Roseana’s favorite hiking spots, and because the owner supported their mission.

On Sunday evening, Aug. 31, Roseana took the fatal dose of medication that ended her life. But in the hours leading up to that moment, the family shared unexpected laughter.

Roseana surprised her family with a request: “It’d be nice if we can play poker.”

Shawn says he knew his mom loved to collect pennies — “she’d pick up every single penny she found and she’d save it in a jar”— and they even brought her penny jar to the rental. “But I’ve never played poker with my mom before,” Shawn says. “I didn’t realize my mom really loved it.”

It turns out, Sandi says with a laugh: “She’s a card shark.”

In her honor, the family left her penny jar in the VRBO, along with a deck of cards and a note: “May the luck of Roseana be with you when you’re playing.”

Those moments of joy were welcome, but difficult to reconcile with what was to come.

“We’re talking and laughing, but hours later, we know that this is it,” Shawn says. “Going from one high with her to a whole different level, it was very hard. I’m always going to have this thought in my head, ‘Maybe we could have had another day, maybe we could have done this for another week.’ ”

But, he says, he knew the reality of his mom’s situation.

After she was diagnosed in April 2024, she lived in constant pain. And when chemo and radiation couldn’t help her heal, Roseana chose her own ending. Shawn says she was unwavering at the end: “Ultimately she said, ‘I am ready. I want to go.’ ”

In the weeks leading up to her death, Roseana decided she wanted to share her story publicly with PEOPLE in hopes of raising awareness for MAID as an end-of-life option. (MAID is currently legal in 11 states and in Washington D.C. — other states are considering legislation).

And she made plans for her final day with her death doula, Melissa McClave, who was also on hand with the family at the end. “It was a last act of love for her to share her experience so that other people can understand that it’s not as scary, it’s not foreign as people think,” McClave says. “We’re able to normalize the conversation around it.”

In her last months, Roseana had also worked with the San Diego-based hospice organization Hospice By The Sea, but opted to have just her family and McClave there at the end. Her medication was prescribed by her physician, end-of-life specialist Dr. Donald Moore, weeks earlier, but per the stipulation of the California End of Life Option Act, the medicine needs to be self-administered, not given by a doctor.

Roseana, an avid hiker before she got sick, also decided she wanted to do a psilocybin ritual on her last day, using magic mushrooms to give her “the feeling of being one with nature” she said, and to help alleviate her pain in the hours before her death.

Psilocybin facilitator Eva Navarrete performed a smudging ceremony, burning sage and blessing Roseana, before Roseana self-administered a microdose of the mushrooms.

Although Shawn says he himself is “anti-drugs,” he says he was grateful for the ceremony.

“What that facilitator did for mom was incredible,” Shawn says, “My mom commented that this was the first time in the last 18 months that she has not felt any pain. That’s not something sustainable, day in and day out, but I can’t tell you how happy I was that she had some time with us without experiencing that pain.”

The family had set a hospital bed outside on the deck overlooking the Palomar mountains beyond. Roseana lay there after she took the psilocybin and the family sat with her.

In their hours together, Cindy and Sandi painted rocks to honor Roseana. Cindy’s featured stars, a nod to Roseana’s love of Star Trek, and Sandi’s showed a sunset over mountains, the scene that would be Roseana’s last.

Roseana signed the rocks, and left messages on chips of balsa wood to give to loved ones.

Cindy, Sandi and Shawn experienced a very different kind of ending 17 years ago when Cindy and Sandi’s mother died of pancreatic cancer. She had withered away, in pain for a long time, they said. “We saw both sides of what this disease can do,” Shawn says.

Being with Roseana at the end “was really hard to go through, but it was what she wanted and I’m happy that she is not in pain anymore,” says Sandi, who considered Roseana a second mom (her four boys called her Grandma Roseana). “She didn’t have to do the great suffering that we had to watch our mom go through.”

Cindy says she’s grateful for the time they were given with Roseana — and for the fact that she was able to leave them on her own terms.

“We got to spend time doing things she loved, and we had a lot of fun together,” she says. “She was able to tell us how she felt about us. And then we were also able to tell her more personally how we felt about her. She was an awesome person, just very selfless and thoughtful of others. Even until the moment she died, that’s exactly how she was.”