Death is complicated, challenging, and frightening to think about and deal with. Everyone would probably agree that they want a “good death” for themselves and their loved ones. But what’s a “good death,” and who decides?
Our health care system continues to find ways to keep people alive longer. In some cases, that’s a miracle. In others, it prolongs life at the expense of quality of life.
Do not resuscitate orders are becoming more common as we consider the complications of living life with a significant disability. And even in those cases, DNRs aren’t always followed, or people change their minds at the last minute, instead requesting medical intervention [nytimes.com/2022/01/03/opinion/advance-directives-death.html].
“Death with dignity” is one of the many subjects that has generated heated debate. But what exactly does that mean?
Different names, similar concepts
According to deathwithdignity.org, it’s an end-of-life option that permits those eligible to legally request and obtain medications that allow them to end their life in a “peaceful, humane, and dignified manner.” Other terms to describe a similar practice include:
- Physician-assisted death
- Physician-assisted dying
- Aid in dying
- Physician aid in dying
- Medical aid in dying
Other terms some consider inappropriate and likely to inflame controversy include:
- Assisted suicide
- Doctor-assisted suicide
- Physician-assisted suicide
Misconceptions about how this works and what it means can distort people’s understanding and influence legislation. Oregon enacted the Death with Dignity Act in 1997 [oregon.gov/oha/ph/providerpartnerresources/evaluationresearch/deathwithdignityact/pages/index.aspx]. To request a prescription for lethal medications, it requires that patients be at least 18 years old, capable of making and communicating health care decisions, and diagnosed with a terminal illness that will lead to death within six months.
To qualify for a prescription for lethal medication from a licensed Oregon physician, these steps must take place:
- The patient must make two oral requests at least 15 days apart; patients whose life expectancy is less than 15 days may skip the waiting period.
- They must also provide a written request signed in the presence of two witnesses
- The prescribing physician and a consulting physician must confirm the diagnosis and prognosis and determine whether the patient is capable of making such a decision.
- If either physician believes the patient’s judgment is impaired, the patient must be referred for a psychological examination.
- The prescribing physician must inform the patient of feasible alternatives, including comfort care, hospice care, and pain control.
- The prescribing physician must request, but may not require, patients to notify their next of kin of the prescription request.
Why such laws are necessary
The main arguments for these laws revolve around patient autonomy and relief of suffering when there’s no hope for recovery. Autonomy, at its core, is the belief that patients determine the medical interventions they want and don’t want. It’s predicated on informed consent, which explains any decision’s risks and benefits. Also, many argue that patients make health care decisions throughout their life and therefore should be afforded that same opportunity as they near death.
In addition, relief of suffering is a foundational principle of health care. Advocates contend that patients suffering from an incurable disease should have the choice to end their suffering through legal means.
They also assert that these laws allow patients the opportunity to die when they choose without fear that they’ll lose their physical or mental capacities. Patients can arrange to say goodbye to loved ones, plan for organ donation, and rest assured they won’t be a burden on their family.
Moreover, even when people have access to high-quality palliative care, they can still have unbearable suffering and distress. Forcing patients to suffer against their wishes is unethical and inhumane, according to those supporting these laws. They also assert that most state’s statutes have strict protocols that prevent abuse and eliminate the possibility that someone will choose other, more dangerous means to die.
Why such laws are abhorrent
These laws appall many, sometimes based on their faith and others based on the role of health care in our society.
Opponents argue that so-called death with dignity laws devalue human life and cause doctors to ignore other means of relieving pain and suffering in dying patients, which could lead to additional unforeseen societal consequences. Moreover, they contend that these laws could lead to circumstances where involuntary euthanasia will eventually be performed or that laws will be further expanded in unethical ways.
For example, there’s the potential for coercion of patients to accept this method of death, in addition to the possibility that some patients lack the capacity to understand their decision. They also contend that safeguards don’t reflect the real-world realities of terminal illness and family conflict, so it’s impossible to know that such decisions are truly voluntary.
These laws also place an undue responsibility on physicians to violate their oath to “first, do no harm” by bringing about death, according to opponents.
They also worry that these laws can alter society’s views of disability and aging by sending a message that death is a viable option that patients in these circumstances should consider. In addition, they argue, legalizing physician-assisted dying hinders the improvement of alternative health care support systems such as palliative care.
The Catholic church opposes these laws, as do many Islamic groups and the Orthodox Church in America. Other religious groups have views on both sides of the issue.
The complicated landscape
As you know if you’ve experienced the death of a loved one, the journey can be stressful, enlightening, and overwhelming all at the same time. Whether you live or practice in a state that legally affirms laws that permit patients to choose to end their life, you can take steps today to advocate for those you care about.
- Advance directives are the cornerstone of decision making at the end of life. Each state has a different template, but the practice of stating what your wishes are and under what circumstances is vital to having your choices honored. Be sure to revisit your advance directives yearly or as your medical conditions change.
- Talk with your loved ones and clients, if appropriate, about what they want. Discuss what quality of life means to them and under what conditions they would want to withdraw life-sustaining interventions.
- Understand what hospice is, how it can provide much-needed support to patients and families at the end of life, and how you can choose a hospice facility that acts in your family’s best interest.
- Accept that your loved one’s or client’s decisions may be incompatible with your religious or other beliefs. Your role is to support and advocate.
There’s no one way to approach death, and we’re all different. Regardless of your opinions, honoring a loved one’s wishes at the end of life, to the extent you can, is your duty and responsibility. Until you face those difficult situations, embrace the time you have with your loved ones because you can’t get it back.