Words matter: discussing death with dignity
By Trish Laub | September 11, 2020
When both of my parents went into medical crisis within a short period of time around the age of 90, I realized that the end of their lives was in the foreseeable future. I never imagined what the end-of-life process would be like, but I knew I wouldn’t let them suffer and I would protect their dignity. One of my biggest concerns was whether or not I could fulfill their wishes for a peaceful and dignified death.
I had heard about it to die with dignity, but honestly I didn’t know what it was. I had only heard what others were saying: that he was offering a suicide pill, that it was risky to allow people to kill themselves, that there would be no regulations and that it would become too easy. access. I quickly realized that the words chosen were, at a minimum, emotional and at times very loaded.
Curious, I attended a presentation a friend gave to local geriatric students. I was stunned by what I learned about the medical assistance in dying (MA) program she was running. The program was none of the things I had heard. The guidelines were strict, the monitoring even tighter and the eligibility criteria very precise, and required proof of the patient’s mental capacity.
Most surprising to me was the fact that about 30 percent of patients never take the drug. Either they die of natural causes before the drug was dispensed or before the scheduled administration date, or they change their mind because they did not experience the expected decline in quality of life and chose to die. naturally. Essentially, the program gave the patient control over their own end-of-life experience.
Then recently I listened Deborah Kan interviews Kelly Bone, who was diagnosed with early-stage Alzheimer’s disease and hopes to use the services provided by Death With Dignity, which are currently not available in the United States for people with dementia. The interview shed light on the misunderstandings and inaccurate terms surrounding the topic of death with dignity: euthanasia, assisted suicide and medical assistance in dying.
Euthanasia is performed, and medications administered, by a trained professional with express consent and is illegal in most countries, including the United States. Assisted suicide is a process in which the patient contemplates taking medication. Die with dignity, also called medical assistance in dying, allows terminally ill adults to request and, after being found to be qualified and mentally capable, to receive a prescription for drugs they may choose to take to bring about peaceful death.
Dr Grube, National Medical Director of Compassion and Choices, wrote in a column titled, Ten facts about physician-assisted dying, âLanguage matters: physician-assisted dying should not be called ‘suicide’ or ‘assisted suicide’. He continued, “Legally, in all jurisdictions where physician-assisted dying is permitted, ‘this is not about suicide, manslaughter, euthanasia or compassionate murder’.”
While those who oppose the service tend to define it in terms of who administers the life-ending drug, the medical community defines it as characteristics of the people taking these measurements.
In the Ten facts article, David Pollack MD, psychiatrist at Oregon Health & Science University School of Medicine in Portland, OR, said that a “growing body of evidence clearly distinguishes the characteristics of people (who died by suicide) resulting from patients who seek medical assistance in dying.
âThese differences include the type and severity of psychological symptoms, the degree of hopelessness, the reasons for wanting to end your life, the ability to communicate regarding your wishes and fears, the degree of personal isolation, the openness to the wish and method of ending their life, and the impact on the person’s family or support system after the person’s death.
I wondered about the difference between suicide, intentional suicide usually as a result of mental illness and often with a feeling of hopelessness, and the conscious choice to end your life once certain criteria are met, like limitations in order to preserve dignity during the end-of-life process. Medical assistance in dying does not involve suicidal tendencies or a desire not to live. It cannot be performed spontaneously, but instead requires due diligence on the part of several doctors, under strict legal control, and the legal prescription of drugs prepared by a licensed pharmacist.
One is an event involving isolation, hopelessness, and trauma, resulting in physical death. The other can be inclusive, allowing the patient to be surrounded by family and love, and aims to create a peaceful transition at the end of life. The decision to commit suicide is final, while the decision to continue physician-assisted dying is an option and not a warrant. Even after receiving life-ending medication, the patient may change their mind if their personal criteria are not met, such as deterioration in physical or intellectual health which the patient believes would result in loss of dignity.
Because Bone does not qualify for death with dignity in the United States, she was asked if she considers suicide as an alternative. She said, âFor me, it’s not dying with dignity. Going to do it somewhere in my house while in hiding, not being able to say goodbye to my husband and leave him with all this guilt, make him find his body and things like that, that for me is not a good way to be continued. It’s not fair to my family members.
For Bone, âworthyâ consciously makes the decision and discusses it with family members and doctors. On a personal call with Bone, she added, “I don’t want to kill myself – I love my life!”
Ultimately, the option of physician-assisted dying is a matter of dignity. Dignity is the state of being worthy of honor or respect. Offering dignity is a kind of grace, kindness or mercy. When we want to die with dignity, isn’t it really the grace and mercy that it offers that we are looking for?
I was not interested in understanding the language surrounding death with dignity until I had walked the end of life path with several loved ones, fearing that I would not be able to offer them death with dignity. they wanted. Understanding the words doesn’t mean I have to like or hate the option, only that I now have the clarity to make informed decisions that match my beliefs. It gives me the compassion to accept the reasons why someone else might want to make this choice. I understand that all Kelly wants is to have the possibility of a peaceful end of life if the progression of her disease does not allow it.
I think everyone wants a peaceful end of life. I don’t know what decisions I will make about the end of my life, but I do know that the end of life deserves the dignity, as well as the grace and mercy, that our culture so willingly denies it.