Assisted Dying, the 'Dying Role,' and the Pursuit of a Good Life to the End

Key Insight

The debate surrounding assisted dying, often termed 'death with dignity,' highlights the tension between preserving life and alleviating suffering. While societies recognize the right to refuse treatments, medications, or even to turn off pacemakers, expanding this to actively assisting in hastening death raises complex ethical questions. Advocates propose allowing terminally ill adults with unbearable suffering, after repeated requests and certifications of mental soundness, to obtain lethal prescriptions, a practice allowed in places like the Netherlands, Belgium, Switzerland, Oregon, Washington, and Vermont.

However, concerns exist regarding potential societal dependence and the displacement of palliative care. For instance, in the Netherlands, by 2012, one in 35 people sought assisted suicide, which is seen by some as a measure of failure if it suggests that improving life through other means is not feasible. The ultimate goal should be a 'good life to the very end,' not just a 'good death,' requiring robust efforts in assisted living and comprehensive palliative care to enable a fulfilling conclusion.

A critical aspect of a meaningful end-of-life is fulfilling the 'dying role,' which involves sharing memories, passing on wisdom and keepsakes, settling relationships, establishing legacies, and making peace. The case of Peg Bachelder, a piano teacher with recurrent cancer, exemplifies how hospice care can facilitate this role. Despite severe illness, hospice enabled her to manage pain effectively with medications (e.g., morphine, gabapentin, oxycodone) and continue teaching her students for four of her final six weeks, saying goodbyes and giving parting advice. Similarly, the physician's father, in his final days, expressed a desire not to prolong the process of dying, seeking peace and the ability to maintain dignity in his last moments at home.