Why do we Fear the End of Life and Words Like: Assisted Dying, Assisted Suicide, and Euthanasia??

My purpose in writing this article is to raise awareness, get discussions flowing, and make the topic less fearful.

The current debate about voluntary assisted dying provides an opportunity for action to address inequities in the current healthcare system, to help dispel the fear of death, and to better support the health workforce in delivering high-quality care for those facing the end of their lives.[1]

The terms "assisted dying, assisted suicide and euthanasia" will either be positive or negative to you depending on which ‘side of the fence’ you sit. What are my views in all this? I am a pro-choice individual and believe people who are of sound mind should be able to make end-of-life decisions themselves with the proper support, medical guidance, and community support, as long as there is legislation in place.

I find it interesting that most people who have pets or who love animals would never allow an animal to suffer. Imagine a beloved pet who is chronically ill, losing weight, not eating, lethargic, and has difficulty with going up and down stairs, getting into and out of their pet bed. Would you want to continue to watch the pet struggle? Do you want to watch them suffer? Be in pain? Get worse and worse? Be diagnosed with yet another disease like cancer, diabetes or neurological illness? Probably not, and it is not illegal to take this beloved pet to the vet and ask that they be ‘put down’ because of their condition. Most vets will agree, and some will even suggest, the animal/pet be "put out of its misery.” You might even be told it is the "most humane" choice.

So, I find it curious that on a worldwide level there are many who have a very different reaction when it comes to humans. Again, imagine the above scenario of increasing decrepitude, except it is not your pet, but your mom, dad, sister, brother, child, spouse, partner, grandchild, best friend. They are diagnosed with a progressive, chronic, debilitating disease which will worsen and worsen. They are of sound mind. They cannot sleep well, are in constant pain that no medication can alleviate, barely eat or drink; and they tell you, “I have had enough. I do not want to live in this horrible pain any more. I have no quality of life.”

What is your reaction? Does your country, state, or province allow assisted dying? If yes, what are the rules and criteria? Is it physician assisted? Will the patient be prescribed a medication that they take themselves? Will it happen in hospital or at home? Will family and friends be present along with medical staff, a death doula, or death midwife so the person is not alone? Will there be music playing, soft lighting, the sun streaming into the room? Will a minister, priest, rabbi or other religious figure be present? How does the individual's religion regard assisted dying?

What if this scenario described you? What if you were suffering and dying?

None of us knows what we would choose until we are put in that situation. We can guess. We might have strong feelings or reactions one way or the other, but watching a loved one in such a state, or ourselves being in such a condition, changes everything.

As of the writing of this chapter, I will list the most up-to-date information regarding countries, states, and provinces that have legislation in place and those that are debating and voting on legislation.

Quebec has put forth legislation regarding assisted dying and it has been utilized by quite a few already. The rest of Canada made assisted dying legal on June 13th, 2016, but with strict criteria. The new law “limits the option to the incurably ill, requires medical approval, and mandates a 15-day waiting period.”

Dr. Catherine Ferrier, President of the Physician's Alliance Against Euthanasia, tells us what dignity means to her: being in charge of one’s own death at a time of one’s own choosing.[2] Dignity is an issue of autonomy, the ability to make a choice. Most dying persons, if they had the choice, would choose to die surrounded by their loved ones in their own homes. This choice is not afforded to many.

Several organizations provide information on the topics of death with dignity, physician-assisted suicide, and euthanasia, including but not limited to:

●       Dying with Dignity Canada

●       Death with Dignity

●       Compassion & Choices

●       Patients Rights Council

●       DIGNITAS

●       Ethics, Euthanasia, and Canadian Law

Belgium, Canada, Colombia, Switzerland, the Netherlands, and Luxembourg have laws that legalize physician-assisted suicide under certain defined circumstances; each one has its own sets of conditions and parameters. The most progressive countries with progressive ideas and regulations about euthanasia and assisted suicide are Switzerland, allowing euthanasia since 1941; Colombia, since 1997; Belgium, since 2002; and the Netherlands, since 2002. According to the Dying with Dignity Canada website, Switzerland is the only country that offers non-resident assisted suicide.

In the United States, the states of California, Oregon, Colorado, Vermont, and the District of Columbia (Washington DC) have laws to allow assisted suicide. Many other states have legislation pending or they are open to discussion for “right to die” legislation: Alaska, Arizona, Connecticut, Delaware, Hawaii, Indiana, Iowa, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah, Wisconsin, and Wyoming. 

Victoria became the first state in Australia, beginning in 2019, to have voluntary assisted dying.[3]

There are different terms used depending on the country, state, or province; and while the end result is the same, the route to get there is a bit different.

Physician-assisted suicide is defined by Merriam-Webster.com as “suicide by a patient facilitated by means or information, as a drug prescription or indication of the lethal dosage, provided by a physician who is aware of how the patient intends to use such means or information.”

Dying with Dignity Canada defines assisted suicide as when “medication [is] prescribed by a physician, but [the] patient administers the dose.”

Merriam-Webster.com defines assisted suicide as “suicide with help from another person [such as a doctor] to end suffering from severe physical illness.”

Euthanasia is defined by Merriam-Webster.com as “the act or practice of killing or permitting the death of hopelessly sick or injured individuals, as persons or domestic animals, in a relatively painless way for reasons of mercy.”

While these are the more common terms, another less common one is consensual physician-assisted suicide, when the “physician prescribes and administers the dose to the patient.”

Other terms used by advocacy organizations and on social media are:

●       Death with dignity

●       Assisted dying

●       Dying with dignity

●       Death with choice

●       Right to die 

Mr. Philippe Couillard, MD, the current Premier of Quebec, was a neurosurgeon before entering politics. Couillard stated that his encounters with dying patients convinced him people do not want to die, but they do want to end their suffering. Couillard describes the procedure used for making the request for medical aid in dying as one supervised by the individual’s attending physician with consultation and approval of the hospital’s medical team. At any time in the process, a patient may withdraw the signed request. After four years of hard “heart-wrenching” consideration and debate, Quebec voted to approve the availability of this procedure.[4]

Nearly one in four senior Americans report they or a family member experienced excessive or unwanted medical treatment, according to the Gerontological Society of America’s 2014 Public Policy & Aging Report. [1] Americans strongly support holding physicians accountable when patient’s end-of-life health care preferences are not honored.

This topic will come up more and more and be seen in articles, blog posts, discussion questions and topics, which will include information and the necessity for advance care directives, mandates, living wills, and powers of attorney.

The “Quebec protocol” calls for a three-step process that starts with sedation, followed by putting the patient into an artificial coma, then administering a powerful muscle relaxant that causes breathing and the heart to stop. Under the protocol, the dispensing pharmacist is required to prepare two identical sealed kits—in case there’s an issue with the first one.

 The law, both the one in Quebec and the rest of Canada, does not mandate that all (Quebec) physicians must participate in assisted suicide or euthanasia, only that facilities such as hospitals must offer the service of medical aid in dying to individuals.

Quebec’s health minister, Gaetan Barret, maintains the law is one that Quebecers have been awaiting a long time. “People in this province have had the debate,” he said. “People are waiting for that law. I don’t think there are people waiting to have access to medical aid in dying, but the principle of having the choice is something people want to have.”

According to a recent poll, at least two-thirds of Quebec doctors have indicated they want no part of euthanasia. [2] I find it interesting that the general population in principle agrees with the new law while many physicians do not. Why is that?

Further Resources on Death with Dignity, Physician-Assisted Suicide, and Euthanasia

1. “Should Euthanasia or Physician-Assisted Suicide Be Legal?” ProCon.org explores the points raised by proponents and opponents of these practices.

2. Olson, Samantha. “First Child Dies by Euthanasia with Parent’s Approval,” MSN Canada: Health: Wellness. Sep. 18, 2016.

3. “Watch: Desmond Tutu Speaks About Medical Aid in Dying.” Compassion and Choices. In this recorded message, Archbishop Emeritus Desmond Tutu speaks to the question of death with dignity.

4. Gorman, Anna. “Hoping to Live, These Doctors Want a Choice in How They Die.” Kaiser Health News. Mar. 30, 2015.

5. Sanburn, Josh. “How Canada’s Right-to-Die Ruling Could Boost Movement in U.S.” TIME. Feb. 6, 2015.

6. Karnes, Barbara, RN. “Thoughts on Assisted Suicide.” BKBooks Blog. Apr. 26, 2015.

7. “What Are Christian Perspectives on Euthanasia and Physician-Assisted Suicide?” published by the Euthanasia Pro Con feature of Pro-Con.org, shares an informative list of the following Christian perspectives: Anglican, Baptist, Christian Science, Eastern Orthodox, Episcopal, Evangelicals, Jehovah’s Witness, Methodist, Mormon, Presbyterian Church in America, Unitarian Universalist, United Church of Christ, Mainline and Liberal Christian denominations.

8. Anderssen, Erin. “The Difficulty in Defining Death.” The Globe and Mail: Health and Fitness: Health. Jan. 19, 2014.

*This article is an excerpt from book 2 of Journey's End: Cultural, Ethnic, and Religious Perspectives on Death and Dying which is currently being written with Julie Saeger Nierenberg. We are almost 1 year into it and know we have at least another 6-8 months to go. But as book 1 took 2.5 years, we are patient as we want the book to be well written and well edited.

** Book 1 as we call it: Journey's End: Death, Dying, and the End of Life (Xlibris, July 2017)

[1] https://www.theguardian.com/commentisfree/2017/nov/03/we-have-to-get-better-at-supporting-patients-right-to-the-end-of-life

 [2] Ibid.

[3] https://www.theguardian.com/society/2017/nov/29/victoria-becomes-first-state-to-legalise-assisted-dying-as-parliament-passes-bill?lipi=urn%3Ali%3Apage%3Ad_flagship3_feed%3BVZqW1oZaTr6oQ5z0XRuEPw%3D%3D

[4] https://www.theguardian.com/commentisfree/2017/nov/03/we-have-to-get-better-at-supporting-patients-right-to-the-end-of-life