(The author is a retired journalist, editor of this blog, and produces FEN’s quarterly magazine. He helped his own cancer-riddled father to a peaceful exit and has been committed to the RTD movement ever since. – Jay Niver)
The right-to-die (RTD) movement has passed many milestones, in the US and around the world, since 1995 when Bob Dent became the first person to benefit from legal aid in dying.
Will the next landmark be to support elders who have had a “completed life” and are ready to end theirs – even if they’re healthy?
Dent died in Darwin, Australia, after aid in dying had been legalized in the Northern Territory. An outraged national parliament overturned the territorial law, but now five Australian states have passed legislation to permit “voluntary assisted dying.”
One in five Americans now has access to medical aid in dying (MAiD), in the 11 jurisdictions where it is available. Elsewhere, full-blown euthanasia – where a healthcare provider is empowered to administer lethal drugs – is legal in Belgium, Canada, Colombia, Luxembourg, and the Netherlands.
Nowhere in America is euthanasia allowed: Every patient approved for a terminal prescription must be able to take the drugs without assistance. That requirement discriminates against thousands who are physically unable to do so, due to debilitating disease (like ALS or Parkinson’s) that renders them unable to use their hands or swallow.
- There is another, even more restrictive (and arbitrary) bar to access: To be eligible for MAiD, one must have a six-month maximum terminal prognosis. If it’s seven or eight months, you’re out of luck.
- Worse yet, if you face years of intractable pain or suffering, and diminishing quality of life, no US law can help you. (We’re not that compassionate.)
- Finally, if you suffer from dementia, you are also ineligible for MAiD, because every requesting patient must be mentally competent.
Hurdles Cleared Away
Our northern neighbor has one of the world’s most progressive, inclusive MAiD laws.
- Canada has no requirement to be terminally ill (with any timeline). One must simply have “a grievous and irremediable condition” – a serious disease, illness or disability; an irreversible, advanced state of decline; or unbearable physical or mental suffering.
- Starting March 17, 2023, mental illness will also be considered for eligibility.
- A physician or nurse practitioner can directly administer a substance to cause death. Patients may do it themselves, but virtually every Canadian MAiD recipient chooses the first option.
- People who may develop dementia can use something called a “waiver of final consent.” That is, a person who has requested assisted dying, been assessed and already found eligible can make a written arrangement with their medical professional for MAiD to be provided on a specified future date. The procedure can then be provided on or before that date if they lose decision-making capacity.
- This allows some with dementia to live longer, because they don’t have to proceed prematurely with MAiD to avoid losing access to it entirely. Still, people who lose decision-making capacity before their suffering becomes intolerable are not helped by the waiver provision.
The Next Step?
In two other countries with liberal RTD views, debate has emerged over what may be the ultimate progression of assisted dying. The Netherlands and Belgium are pondering MAiD for older adults who view their lives as “completed” and not worth living; their desire to exit need not have any medical foundation. Instead of ceaseless, unbearable suffering, the person simply feels like they’ve lived long enough.
In this country, any such talk is hushed and/or private, though a parallel concept of “rational suicide” is coming up in an academic way. Dr. Dena Davis, 72, a bioethics professor at Lehigh University, defends the controversial idea that suicide can be a reasoned, rational decision for some seniors; not a result of mental health problems. That runs counter to most social and religious convictions that any suicide is worth preventing. (She talked earlier with FEN about Advance Directives.)
Final Exit Network, unlike every US MAiD law, does not require applicants for its exit guide services to be terminally ill. FEN believes that competent adults “who suffer from intractable physical pain, chronic or progressive physical disabilities, or who face loss of autonomy and selfhood through dementia have a basic human right to choose to end their lives when they judge their quality of life to be unacceptable.”
FEN’s criteria are more forgiving, compassionate, and realistic.
But no one who says only, “My life is complete, I’m ready to call it quits,” would come close to passing muster in either their first FEN interview or with the Medical Evaluation Committee.
One Personal Plea
The topic of a “completed life” or “rational suicide” came up recently when FEN received a letter from an Arizona woman unafraid to give her full name and where she lived. She said she failed once at an inept suicide attempt and wished she could have legal, sufficient assistance. She wrote, in part:
“I am turning 86 years old next month (March) and I am well/healthy. No illnesses. I have lived a full and productive life, but there is no longer any joy in it. I am blasted with negative news, dying friends, no family nearby, and I am just sick of it all … Why can’t I be allowed to Die with Dignity …
“I AM suffering, daily. I live alone and have no financial problems, I am comfortable, but I am desperately unhappy with life and all the surrounding things in life … My life is COMPLETE, why not “Let me go, peacefully?”
It got some of us to thinking. My first thought was that most aging, ill, or suffering people would gladly trade places with her. My second thought was that there’s nothing stopping her from arranging her own self-deliverance: Suicide is not illegal. If she had done it right the first time, she wouldn’t be in her current, depressed situation. After all, Derek Humphry, in his bestselling do-it-yourself guide Final Exit, provides all the clear instruction anyone needs.
Maybe soon, in Belgium or the Netherlands, someone like the writer could find legal help for what she couldn’t do on her own. For now, however – in America and every other country with any degree of assisted dying – the idea of a “completed life” as a reason for death is a step too far from legal and political arenas. MAiD faces too many other, immediate hurdles and ways to improve without clamoring for government to get involved in helping people die just because they are tired of living.
That said, what do YOU think, readers?
Society rarely moves in any direction by asking for tiny, tiny steps. You ask for the moon, and negotiate down to smaller steps. Each time, you have to ask for the moon. Yes, MAiD must include a way for people who are just tired of living to get out. The government must allow access for everyone. Not just the wealthy. Not just those who can afford to go to Europe, or spend their final six months in Canada. I would like to continue living in my home until I no longer want to live in my home. Then I just want a quiet, peaceful way out. No muss. No fuss. And no goddamned government intervention.
I am exactly of your mind, Jay. We don’t jail people for destroying their own lives and families for compulsive gambling or other addictions, for example. Why should we imprison people who are locked in the inevitable decline of old age and increasing dependency with or without illness, who feel they have completed their lives.
Each person should be allowed to do whatever he or she wants to do.
Suicide is not illegal. Just don’t make the medical and nursing professions have to provide it. All suicides are tragic. No wo(man) or man is an island. All suicides affect someone, maybe even many “someones”.
And a compassionate society never tells anyone her/his life is no longer worth living, especially someone in reasonably good health in his or her 80s or 90s. There is a lot this woman could do to make her life meaningful once again. She can volunteer somewhere, even virtually.
Way to go Jay
I rather think of it as a “useful life.” Have I contributed in any way by my presence on earth? Have I been an active member of my community? Have I helped others? Have I loved? Have I been a good friend? I don’t want to die with all the negative feelings expressed by the woman you quote, Jay. As one with a terminal illness (although too slow for my taste), depression comes and goes as I see my life shrinking bit by bit, but I don’t want depression to be what motivates me to take my own life, rather that my symptoms are becoming harder to bear, my freedoms too limited, and a sense of “it’s time.” I live in a place where there’s no medical assistance in dying, so I’m out here on my own. I just want to make sure I’m clear-headed when I choose to go (Aye, there’s the rub!).
Excellent article Jay! I believe we should have complete autonomy over all of life’s decisions–including self-deliverance–when and where we choose. Further, I believe that my hard earned tax dollars should be used to assist us to do that.
I feel like the lady from Arizona when I ready even though I am healthy. I want a way
I agree also, that a person ought to be free to do what they want with their body. We can purchase things considered not so good for our health, such as alcohol and tobacco and sugar, but it is nearly impossible to easily purchase something that might reliably end one’s life. I am not comfortable with with MAID model, where one has to beg and prove worthy to a practitioner of the medical church to receive assistance. Feeling that one has lived a complete life and is now ready to move on seems like a perfectly good reason to die.
Great article, Jay. Although many are working hard to turn the ship, MAID is not legal in my state, Arizona, and probably never will be. I often ask myself what I would do if I were diagnosed with a horrific disease where I knew my time on earth was limited and that time would be wrought with pain and suffering. As much as I’d like to move to Canada and just be done with it, I think my family would rather have me stay here. FEN offers the best alternative to Canada or a MAID state if one wants to stay in their own home surrounded by loved ones. The ability to choose a time and place for my passing from this life into the next is comforting, and I am grateful for all the wonderful people at FEN who work to make it possible.
The comment that if the woman who wants to die had “done it right the first time” sounds somewhat harsh and judgmental. Not that FEN is obligated to help her. As a non-tax supported organization, FEN can set its own criteria for helping people self deliver. But your statement makes it sound like this woman deserves what she’s got.
FEN was not aware of, or in any way involved with, the author’s failed suicide attempt; nor would FEN accept anyone for Exit Guide services if their sole wish to die was for having lived “a completed life.” FEN never “(helps) people self deliver” – they must do that themselves.
Failed suicides are a tragic, horrific reason why legal, compassionate end-of-life options should be available. – Jay Niver, blog editor
Recently rewatching “Harold and Maude, I was surprised to realize that Hal Ashby’s 1971 black comedy is as much about the concept of a completed life as about the intergenerational relationship between a death-obsessed 19-year-old and a life-affirming Auschwitz survivor old enough to be his grandmother. When we first meet Maude, she says, “…I’ll be eighty next week. A good time to move on, don’t you think?…I mean, seventy-five is too early, but at eighty-five, well, you’re just marking time and you may as well look over the horizon.” By the film’s end she has taken pills and dies on her eightieth birthday.
I recently had a similar experience in my role as a FEN regional coordinator. “Judy” had a few very minor medical complaints, but wanted to give herself a 90th birthday present: a peaceful, painless exit. I supported the youthful-sounding octogenarian’s application by suggesting that the Medical Evaluation Committee consider this as a rational old-age suicide. And they did. When I called “Judy” to relay the “good news” (on Christmas Day!), she was over the moon with gratitude. So, despite the well-intentioned gate keeping referred to in Jay’s article, it is sometimes possible to assume a modicum of control over one’s end-of-life wishes.
Isn’t VSED legal in 50 states?
Nowhere is VSED illegal. The challenge is that, unless you are at home in control of all your circumstances, you may be with a caregiver/institutional setting that does not readily accommodate your wish to exit without food and hydration.