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Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus
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Death with dignity is a term you may already be familiar with, or you might be more accustomed to the phrase physician-assisted dying or even euthanasia. There’s a good chance that you live in a state where assisted dying is not legal , since only eight states and Washington D.C. allow physician-assisted dying.
But the broader meaning of the term “death with dignity” encompasses the compassionate care afforded to people with terminal illnesses. In states where physician-assisted dying isn’t legal, families still decide every day to withdraw life-sustaining treatment and interventions to allow death to happen naturally.
The decision to end another person’s life is never easy. Ultimately, families want to alleviate the suffering of a loved one, and sometimes withdrawing treatment or administering life-ending medications feels like the best option.
Here, we’ll discuss the pros and cons of death with dignity so you can make an informed decision, whatever that decision may be.
As medical advances and technology allow people to live longer, “longer” doesn’t always translate to “better.” The basic question of quality of life in the face of suffering and pain is at the heart of the issue. Death with dignity is the legal term for when terminally ill individuals request and receive medication from a physician that will hasten death.
The criteria for receiving death with dignity is strict. In states where death with dignity is written into the law, you must meet the following requirements to qualify:
Physicians must inform patients of all the available alternatives, and patients must notify their next of kin of their request. A second physician must confirm the patient’s prognosis of fewer than six months to live and their capacity to make an informed decision. Once the individual makes the request, they must wait 15 days before making a required second request.
After meeting those conditions, a physician writes the prescription. Still, the individual must wait 48 hours to pick it up, which must be witnessed by two other individuals that can’t be a healthcare provider or relative. Administration of the medication must be completed by the patient and not by another individual. The patient can rescind the request at any time or choose not to take the life-ending medicine.
Ending suffering, although it’s the most common reason people choose death with dignity, is not the only reason. Families and their loved ones may benefit in other ways from choosing death with dignity.
Suffering takes many forms and is caused by a variety of illnesses or disabilities. Cancer, paralysis, multiple sclerosis, ALS, and Alzheimer’s disease are just a few of the conditions that can cause significant pain and suffering. Medications can control pain, but many cause extreme sleepiness or side effects such as nausea and dizziness.
Patients also report the loss of independence, hopelessness, inability to enjoy life, and loss of purpose. All of these symptoms have a profound impact on the person taking care of them, friends, and other family members, too. Death with dignity ends suffering and gives the patient some control when they have lost control over the rest of their life. It also allows the person to die at their chosen place, which is usually at home.
By opting for death with dignity, an individual can avoid a worse and more painful death in the end. Neurological conditions are typically progressive and worsen over time, bringing increased pain and suffering as time goes by.
The reality is that caring for someone with a terminal condition is stressful, overwhelming, and expensive. Families suffer right along with the patient, and their suffering can be long-lasting and painful—both emotionally and financially.
Some medical conditions can lead to the loss of mental capacities. Death with dignity is a way to avoid this decline. When someone loses their ability to make safe decisions or use good judgment, their safety is at risk, and their condition puts family members under tremendous stress. The patient retains their dignity by choosing to end their life before they worsen.
If you have planned in advance for organ donation, you can make those arrangements in a timely fashion once you have opted for physician-assisted death. Time is of the essence with organ donation, so death with dignity allows for the procurement of organs for people who are waiting for them.
It isn’t always possible to predict when someone will die. With death with dignity, you can arrange to see friends and family, say your goodbyes, and communicate your love for them. Planning the time of death allows people who want to say goodby to travel to where you are.
In states where death with dignity is legal, residents are often better versed and more knowledgeable about end-of-life care such as palliative and hospice care. Physicians offer and are more willing to provide these services to patients with terminal conditions.
Oregon leads the nation in hospice and palliative care. But death with dignity laws have opened the conversation about compassionate end-of-life care, even in places where it’s not yet legal.
Death with dignity isn’t embraced by everyone. The idea of someone taking their own life under any circumstances can be disturbing to some, and it arouses strong feelings for healthcare providers, families, and clergy.
For some, taking a life, even if it’s your own, is morally and ethically wrong and goes against religious doctrine. Even for the person considering death with dignity, close family members may strongly object to the idea, creating conflict and discord.
The Hippocratic Oath is a set of ethical standards that physicians commit to in their practice. Part of the oath states, “First do no harm.” In the eyes of some, death with dignity is an affront to and disregard of the oath to “do no harm.” For a physician to comply with the Hippocratic Oath, they cannot aid in their patient’s death.
Under unusual circumstances, it is possible that someone could be convinced to sign an agreement to death with dignity, not understanding what they are signing. The supposition is that a family could do this to inherit money.
A person who has a terminal illness could feel pressured to choose death with dignity to relieve their burden on the family. The individual wishes to ease the burden on the family more than they wish to alleviate their own pain and suffering.
Some in the disability rights community oppose death with dignity because they feel there are other ample alternatives.
The premise of this argument is that people may use death with dignity not to alleviate pain and suffering but instead to relieve the humiliation of dependence on others to function—and that death with dignity disproportionately affects the poor and minorities who are not in a position to have good health care and access to reasonable alternatives.
The concern is that with legal aid in assisted death that other non-assisted suicides also rise. There is some data to support this idea.
We know that disability and illness cause higher rates of depression than the rates found in the unaffected population. And we know that people who are not adequately screened and treated for depression could inappropriately consider death with dignity.
As you consider end-of-life care for a loved one, there’s much to think about regarding compassionate care. Seeing a loved one suffer is heartbreaking, but you should know that you now have more choices than ever to alleviate suffering.
Ask your loved one’s physician about palliative or hospice care so that you understand your options. If you live in a state where death with dignity is legal and your loved one is considering it, explore the pros and cons to make the best decision.
