Physician Assisted Dying

It’s not every day you get an e-mail from a family member saying, “In three days I will be dead.” My spouse’s cousin was writing to the family to say goodbye. He was following through on a long talked about, debated and wept over decision to end his life on his terms. He had a chronic disease that was entering its terminal phase. He had said for years when it got to that time, he would choose to end his life. He was sending final correspondence to his family via email.

Most of us have no idea when we will have the last conversation with a loved one. Too often it is at the death bed through tears and the realization there is not enough time to say everything that needs to be said. At some level it is a rare gift to know, and not miss the opportunity to say everything on one’s heart and in one’s mind. If there is one lesson to be learned it is–don’t wait to tell your loved ones what you want them to know. Chances are good you will not know when the last conversation is. There is tremendous power in saying the words, “I love you” aloud. There is tremendous healing in articulating to someone what they mean in your life and how your life is better because of them.

Everyone has a different experience of suffering. The loss of independence, sense of self and the fear of being a burden to family members are just a few components of suffering for some patients. I would venture a guess there are as many types of suffering as there are people who are dying. While there is always a way to manage pain and other sources of suffering, people do on occasion “seek the assistance of a physician to end their life.” (American Academy of Hospice and Palliative Medicine or AAHPM). 

In the area where my spouse’s cousin lived, physician assisted dying is legal. In the United States physician assisted dying is legal in ten states and the District of Columbia. It is hotly debated in other states from time to time.

The AAHPM released a statement in 2016, “Physician Assisted Dying (PAD) is defined as a physician providing at the patient’s request, a prescription for a lethal dose of medication that the patient can self-administer by ingestion, with the explicit intention of ending life. Although PAD has historically not been within the domain of standard medical practice, in recent years it has emerged as both an explicit and covert practice across various legal jurisdictions in the United States. PAD has become a legally sanctioned activity, subject to safeguards.”

According to www.compassionatechoices.org, “Medical aid in dying is not assisted suicide, suicide or euthanasia. Medical aid in dying is a safe and trusted medical practice in which a terminally ill, mentally capable adult with a prognosis of six months or less to live may request from his or her doctor a prescription of medication which they can choose to self-ingest to bring about a peaceful death.”

Language is important. “Leading medical organizations such as AAHPM and the American Public Health association have all adopted policies rejecting the term “physician assisted suicide.” The American Association of Suicidology, a nationally recognized organization that promotes prevention of suicide through research, public awareness, programs, education and training comprised of respected researchers and mental health professionals, asserts medical aid in dying is fundamentally distinct from suicide.” (Compassionate Care)

The alleviation of human suffering and pain should be at the forefront of any discussion on the subject of medical aid in dying. How the patient experiences suffering is the conversation that matters. The moralizing that happens when (perhaps) well intentioned religious and ethical wannabes judge another’s life is itself a source of suffering. 

Three principles can guide our thinking and conversations about end of life, whether physician assisted dying is under consideration or not:

• Listen. Every patient has a unique experience of their own impending death. Alleviating their suffering is the most important task.

• Respect. When we put the needs of the patient first, the goals of treatment and the means of treatment are fundamentally shifted. When comfort is the standard against which all interventions are measured, there is a wide range of options, including physician assisted dying.

• Keep your judgements to yourself. You may or may not agree philosophically, theologically or socially with the concept of physician assisted dying. Luckily for the patient, it’s not about you and what you think. When listening and respect are employed in full measure, with an open heart and open mind, it is much easier to keep our judgements to ourselves, which is exactly where they should be. The conversations about physician assisted dying are not hashed out in the ethereal realms of philosophy, theology or social ethics. They are decided one patient at a time in the reality of their own life.