(Ron Kokish is chairman of the Roaring Fork Valley Senior Matters Board of Directors, in Carbondale, Colorado. He is a lifetime member of Final Exit Network and a strong advocate for end-of-life freedom of choice. This article was published in The Sopris Sun in Carbondale, Colorado and is used with permission.)
Freedom means having options throughout our lives, including the time during which we are dying. Medical Aid in Dying (MAiD) increases our options. Unfortunately, it was not yet legally available in the 1980s, when my friend Dorothy’s father, Michael, died of cancer. So Michael had no legal option for obtaining prescribed medication to avoid his cancer’s last painful and dependent stage.
Instead, he obtained his lethal medication on the black market. It didn’t come with a warranty. On the appointed day, with support from his adult children, he used it, but it didn’t work as promised. Unconscious, Michael lingered for hours. His waiting children had no one to call for advice, but Michael had left instructions for this eventuality. Sobbing, his son Bill lovingly carried out his father’s wishes using a pillow. The family used what options they had to honor their father’s request.
I’m uncertain about managing my own dying (if I’m lucky enough to have an opportunity to manage it at all), but I’m grateful that my children will not be in Dorothy and Bill’s position. About 20% of Americans now live in places (10 states and Washington, D.C.) where MAiD is legal. Colorado is one of those places.
The basic rules are similar in all of them. Patients must be 18 years or older, of sound mind, and able to ingest the medication. The prescribing doctor (not all doctors are willing to prescribe) must believe their patient will likely die within six months, and a second, consulting physician has to agree. Finally, the patient has to make three requests for lethal medication over a period of two weeks, and at least one request must be in writing.
There are other conditions as well, but those are the basics. Some states make exceptions in some circumstances, but these are limited, and in any event, Colorado is not among them. Pharmacies don’t routinely stock the currently prescribed “cocktail”, and obtaining the medication(s) takes at least two to three days after the prescription is submitted. When everything works as intended, the time from request to receipt can be well under three weeks.
Naturally, such a complicated system doesn’t always work as intended, but by most reports, it’s working fairly well for Coloradans who meet its requirements and can negotiate the bureaucracy.
MAiD laws came from decades of work, and the number of states that have them is growing. Given a terminal diagnosis, I would be comforted to know I could die peacefully at a time and place of my choosing, regardless of whether I choose to exercise that option.
However, the political compromises that established qualifications for MAiD excluded some dying people from the peaceful death they made possible for others. What if my diagnosis is amyotrophic lateral sclerosis and my doctors think I can live well over six months past the time I’m able to swallow? What if my diagnosis is Alzheimer’s disease and I’m likely to live well past the point of recognizing my children or managing my toileting? What if I’m one of those excluded by the political compromises?
Dying has become closely associated with medical care, usually to postpone death, but also to make dying more comfortable. So, it’s understandable that we look to medicine to hasten death as well. But there are also non-medical means for hastening peaceful dying. Two methods are well established and supported by at least two national organizations (Compassion and Choices, and Final Exit Network). Neither method requires cooperation from physicians or bureaucracy, and both are legal in every state.
One method is Voluntarily Stopping Eating and Drinking (VSED). I’m told that hunger is not usually overwhelming. Thirst can be more discomforting but can be managed, especially with medical and social support. Some people who want to die on their own terms prefer VSED, even when lethal medication is available, because it is essentially natural. The dying process itself can take one to three weeks, leaving time for goodbyes and fully experiencing this last stage of living. One can easily begin (and interrupt) the process, and no special technology is needed.
Those who want a faster, peaceful death (more like lethal medication) can turn to breathing inert gas (usually ordinary nitrogen). Reportedly, death usually occurs in under 15 minutes, and without discomfort. The method requires constructing a device consisting of a tank, regulator valve, tubing, and hood. Because doing this for others is legally risky, it’s necessary to obtain materials and construct the apparatus yourself while able. Then, one must initiate the lethal process while able to don the hood and turn the valve.
Further specifics about peacefully hastening death, medically or non-medically, are beyond the scope of this short article, nor am I advocating anything except increased end-of-life options for everyone. I don’t want anyone’s options to be as limited as Michael’s were.
Final Exit Network (FEN) consists of dedicated professionals and caring, trained volunteers
who support mentally competent adults as they navigate their end-of-life journey.
Established in 2004, FEN educates qualified individuals in practical,
peaceful ways to end their lives, offers a compassionate bedside presence, and defends
their right to choose. For more information, go to www.finalexitnetwork.org.
Payments and donations are tax deductible to the full extent allowed by law.
Final Exit Network is a 501(c)3 nonprofit organization.
Thank you for this good summary of what is at stake when facing a deadly disease. My only concern is with the mention of “managing my toileting” if diagnosed with Alzheimer’s. I concur with the writer about not wanting to live far into Alzheimer’s. However, I would not put the emphasis on toileting capacity. Many disabled people need assistance with toileting. They cannot survive without it. Toileting assistance is a regular part of many hospital stays and for some people in nursing homes. While it is not something I would be pleased to need, it may be needed at some point. I have needed urinary catheters several times in recent years and gladly accepted them because they were needed. I don’t plan to decide that it is time to die should I need toileting assistance, but I know that many non-disabled people find it upsetting. I look at it as another adjustment to my life that may be as necessary as using a cane, a walker, or a wheelchair.
It should be our choice, incontinence or not…
Until this becomes everyone’s right, messy suicides and liability of families will be a concern. It should not be this way.
I can’t help believe the reluctance is due to the profit margins of nursing homes and hospitals…and to a lesser degree religion.
It is simply not fair to us who have had a good life, but now are ready to go.
Ron, I greatly appreciate your advocacy for our right to die on our own terms. Along with what you wrote, I want to emphasize to our readers that not only is it “legally risky” to obtain materials for someone else to take their own life, but it is considered assisting in a suicide, which is a crime.
One would hope that the dying person’s physician would provide a prescription for strong tranquilizers or sedatives.