(Trish Rux is an end-of-life doula, educator, and registered nurse with inpatient hospice experience. She has a background rich in the study of death and dying, and practical knowledge from being at the bedside of hundreds of dying people. Trish sees working with the dying as a sacred calling and is associated with https://www.ccld.community/story. End-of-Life Doulas help navigate end-of-life issues and can advise the seriously ill or dying person and their family members on what matters most to them. There are many organizations that have doula directories, including: nedalliance.org, inelda.org, deathdoulas.com, and consciousdyingcollective.com. This article is used with permission and was first published on Conscious Dying Collective.
Editors’ note: Final Exit Network also provides a list of trusted VSED doulas.)
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People find me – people who are tired of suffering, people who look ahead and only see more suffering. It’s not only physical aches and pains, though there are plenty of them. The suffering is also aching hearts, minds, and spirits. They are exhausted. When I mention the double effect of not wanting to die, but of being unable to live with the way they feel, heads nod, tears often well up, and people feel understood.
As an end-of life (EOL) doula, I listen. My job is listening, holding space, being present – and it’s also educating and advocating. They ask me about options. Some have heard there are legal means to hasten death and ask directly about them. Some feel there has to be a way out of suffering without the violence, secrecy, and loved ones’ grief at a death by suicide.
So, we talk. I first talk about palliative care, to make sure that all the ways to relieve suffering have been explored. Physical and emotional pain must be addressed and alleviated as much as possible, by healthcare and mental-health professionals. Spiritual pain must be considered by chaplains, ministers, and other spiritual counselors, teachers, and guides.
Then I ask about their support network – how family and friends might feel about a decision to hasten death. Whether or not their closest people could and would be supportive. Whether any of their closest people would interfere in their choice.
And then we talk some more. We talk about their lives, their journey with illness, and their hopes and fears about the end of their life. Not one has taken this lightly. Not one has had absolutely no deep feelings about a choice to hasten death.
I answer their questions.
My job is listening, holding space, being present, and it’s also educating and advocating.
I share the experiences of clients who have chosen to voluntarily stop eating and drinking (VSED).
Most have an affinity for that method. They understand they have the right not to eat and drink, and they want to know more. They begin to feel some control over their life and death. They see an end to suffering along with the bittersweet knowledge of leaving what they know and love about this life. They make a plan, gather the support needed, set a date, and say their goodbyes. Within about two weeks, it brings death on their terms.
Those who don’t resonate with VSED ask about other methods. We discuss their diagnosis and whether it is considered terminal or not.
I live in North Carolina, where Medical Aid in Dying (MAiD) is not legal. If the client’s illness is terminal, we talk about the MAiD process and the need to establish residency in another state where it is allowed – or traveling to Vermont or Oregon, which have eliminated residency requirements. Some decide to pursue the process and undertake the necessary travel and expense. Others may not have the energy or resources, or don’t have an affinity for that method.
Next, I tell them about traveling to countries where MAiD doesn’t require a terminal diagnosis. I outline that there are requirements and a process to complete before acceptance to Swiss programs such as Dignitas, Pegasos, and Athanasios. I know one person, most of the way through the process, who feels in control and is waiting to intuit when the time is right to set a date and make the trip abroad. The family is now supportive, but wishing and hoping for a long time together.
Those who do not have the financial means, or the time or energy for the acceptance process, ask, “What else?” I then tell them about the process of death by inert gas and refer them to Final Exit Network.
These methods are all legal. They all allow for a thoughtful, intentional end to suffering. There is no impulsivity, secrecy, or violence. People exploring these methods experience agency and control – and, in the end, many choose to allow a natural death.
I am an End-of-Life Doula. I listen, I educate, and I support the decisions of my clients.
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Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s 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.
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Trish – Thank you for this message. It is extremely well-written and provides a perfectly sequenced set of steps for consideration by those suffering at the end-of-life. I want your readers to know that you have a short, recently-published book, Dying Matters, that will guide them through the conversations they need to have before they find themselves suffering at the end-of-life.