In Me Before You by JoJo Moyes, Will expressed his desire to die rather than suffer the pain and degeneration from his spinal injury. This debate creates a passionate book club discussion. In this post I want to give more information to help your book club discuss this controversial subject.
Will wants to end his life at a location called DIGNITAS in Switzerland. DIGNITAS is a genuine association founded in 1998. According to the organization’s constitution, its main objective is to ensure a life and death with dignity for its members.
Members may ask for help with dying from DIGNITAS. But, not just anyone can choose to end their life. They have strict medical requirements. The first is if you suffer from an illness that will lead to inescapable death. Second, if you suffer from an unbearable disability. Or last, if uncontrollable pain dominates your life.
For legal reasons, only the individual can deliver the life-ending dose of Sodium Pentobarbital. You must be able to swallow a pill, dispense medicine via a gastric tube, or to open the valve of an intravenous access tube. If you are unable to do those actions, then DIGNITAS cannot help.
So, where in the United States is it legal to choose to end your life?
Many U.S. states look to Oregon’s Death with Dignity Act (DWDA) as a guide. In effect since 1997, the law allows patients with terminal illnesses to end their lives. The final act is a self-administered lethal medication prescribed by a physician. The physician does not administer the medicine themselves. Only two other states, Vermont and Washington, have also passed Death with Dignity laws.
In Oregon’s most recent DWDA Annual Report, prescriptions for lethal medications were written for 122 people during 2013 compared to 116 during 2012. And there were 71 known deaths. Since the law passed, 752 patients have died from ingesting medications prescribed under DWDA.
Loss of autonomy (93.0%) was the top concern for ending a life. Next, 88.7% chose the decreasing ability to enjoy life’s activities contributed to their decision. And loss of dignity (73.2%) made up the third reason.
The national right-to-die debate revived again recently. In April 2014, Brittany Maynard was diagnosed with an aggressive and terminal brain cancer. She publicly announced her decision to move to Oregon to take advantage of their laws. By November, Brittany Maynard carried out her decision to end her own life. She left a message to her family and friends on Facebook. “Goodbye world. Spread good energy. Pay it forward!”
The attention Maynard received was not by chance. Behind the scenes is a right-to-die group called Compassion & Choices. After Maynard called their headquarters, they arranged national magazine stories and op-ed pieces. They turned her name and #DeathWithDignity into a successful social media campaign. And they also created this emotional video:
Since the start of their campaign, 26 states are considering Death-with-Dignity laws. Yet, these bills struggle to pass into law.
Why is it so difficult for these laws to pass?
A big barrier is the confusion over terminology. Some terms may mean different things to each individual. Below is a list of terms and definitions:
Euthanasia or mercy killing: A third party administers medication to end a patient’s life. Euthanasia is illegal in every state.
Physician aid-in-dying or physician-assisted death: When a physician prescribes a lethal dose of medication to a patient. The patient must suffer a terminal illness and be mentally-competent. The patient decides whether or when to ingest the lethal medication. And the patient must be the only one to self-administer end-of-life medications.
Suicide: The act of killing oneself on purpose. Here’s where the terminology gets a little ambiguous. Proponents of death with dignity would identify suicide as when a healthy person chooses death over life. While death with dignity patients seek a hastening of an inevitable death.
Assisted Suicide: Suicide of a patient suffering an incurable disease by taking lethal drugs provided by a doctor. The trend is to avoid terms like “assisted suicide” by advocates of end-of-life choices.
Hospice care: Focuses on relieving pain and symptoms (pallative care) of a patient with a serious illness. Attends not only to their physical, but also emotional and spiritual needs.
Palliative sedation: Sedating a terminally ill patient to the point of unconsciousness to relieve untreatable suffering. These patients are usually days or hours from death.
Advance directive: A legal document in which a person specifies what medical actions should be taken if they are no longer able to make the decisions for themselves. These directives usually cover the right to refuse life-saving medical treatments, nutrition, and breathing assistance to hasten their passing.
Strong opponents to death with dignity are within the medical field or religious groups. Large organizations to smaller grassroots organizations have expressed their opposition.
The American Medical Association states that for a physician to aid in the death of a patient would cause more harm than good. The physician’s role should be as healer and the act goes against that role. Physicians need to encourage their patients to discuss their preferences for medical intervention. An advance directive documents their desired course of action in the case of a life-threatening illness or injury.
A national disability rights group, Not Dead Yet, opposes death with dignity legislation. They contend that it legalizes a deadly form of discrimination. Visiting this organization’s website would be particularly interesting for your book club discussion. Will Traynor’s and Not Dead Yet’s opinions clash on living with a disability.
The National Hospice and Palliative Care Organization also does not support physician-assisted death. They believe that effective therapies are available to provide relief from a terminal illness.
I hope this information cultivated enlightened conversations on the topic of end-of-life choices. We have read a few books that deal with suicide and death. Check them out too:
Hirschhorn, Dan. “Terminally Ill Woman Who Planned Assisted Suicide Dies.” Time. November 2, 2014.
Richardson, Valerie. “Assisted Suicide Movement Gaining Traction across U.S.” Washington Times. January 21, 2015.