A few questions before you go
As medical advances have extended first-world life spans by decades, dying has become less of an acute event and, more often, a slow, manageable decline. Comfort measures, no matter how grim the phrase can seem, usually treat the clinical symptoms that come with the body’s deterioration. If untreatable suffering – physical, psychological or spiritual – leads a person to wish for a quicker end, that assistance must come from elsewhere. For now, such help looks like it must be delivered by the health care system, by way of legislation.
Some questions are in order.
Are we a society that enforces prolonged suffering? (See: “You wouldn’t let a dog go on like this.”) Are we a society that will treat the natural end of life with a medicated death? (See: “Birth is uncomfortable and messy too.”)
Do we even need a law to sanction what has been happening, one way or the other, for centuries? (If we want to evolve to a point where doctors can provide assistance with dying without risking their licences, then yes.)
Haven’t laws that respect an individual’s choice and safeguard against slippery slopes and death panels been passed in other places? (Yes, but we still have to write a law that is appropriate for our health care system, our legal system and, most importantly, our society.)
What, exactly, would make you want to call it quits? When you need help getting to the shower? The toilet? When you can’t take a deep breath without gasping? Would it be intolerable to have your child offering sips of Sustagen? Or your partner of 32 years attempting to give you a bed bath, and laughing or crying at the soapy mess? Would you accept a pair of nurses leaning over your hospital bed, showing your best friend how to make sure you have dry continence pads? Do you think these will be your limits when the time comes or do you think you’ll accept a long goodbye?
What is quality of life? What is dignity? How important are they to you? How much independence do you expect at the end of your life?
What if your level of need requires you to move to an institution? Would that be it? Could you endure having to ask a stranger to feed you?
If dependence is not the outer limit, what about pain? Is a semi-sedated state acceptable? What if the pain can usually be controlled? How much pain would you accept?
Over what period of time should you need to express a wish for a hastened death before you may be allowed to make it happen? Weeks? Months? Years? What if you die before your case gets through the system?
More specifically, what conditions should qualify you for early dismissal? Progressive metastatic cancer? Motor neurone disease?
What about prognosis? What is an acceptable horizon that you would be willing to skip to avoid further discomfort? Weeks? Months? Years? Did you know that most
specific medical prognoses for terminal illnesses are wrong? What margin of error do you find acceptable for this? Weeks? Months? Years?
Does the disease have to be clearly terminal or merely progressive and debilitating? What about chronic heart failure? Depression? Diabetes? Paralysis? Psychiatric illness? Outliving your friends? (Heads up: Dementia precludes clear consent for assisted dying, so the most often feared disease isn’t likely to make the cut.)
Is having lived a full life reason enough?
Have any of your doctors explicitly discussed with you the fact that you will die? Why not? (Extra credit: Go make an Advanced Care Plan with them and discuss it with your loved ones. This is much more likely to affect your last minutes than a voluntary euthanasia law.)
And who gets to pass judgement on your application to die? Your specialist? Your general practitioner? What if they disagree? How about bringing in a social worker to mediate, and assess for complex family dynamics or financial strain? How about a psychologist, to see if there’s a treatable mood disorder? How about an occupational therapist to explore your potential level of function? How about all of them together? Will you be in the room? Will your partner? Children? Friends? Will they all have to approve your request? (Bonus questions: Have you ever tried to schedule a multidisciplinary meeting with your family? How much time do you have left now?)
How, exactly, should your Nembutal prescriber refigure their understanding of “do no harm”?
In what part of the hospital do you think your death should occur? Do you believe assisted dying is part of palliative care or its opposite? What if some staff don’t support it? Should they be replaced?
Would you prefer a morning or afternoon appointment? Will you take the next available slot?
Or would you prefer for your death to happen at home? Who should write that script? Who should dispense it? Could you store it safely to be certain that no one else finds it before you need it? What if there is leftover medication and your bereaved partner finds it?
Who will be called if something goes wrong? A doctor? A nurse? Who is currently training new clinicians to assist with dying? Would you be OK with them learning on the job?
What if, by the time you gain approval, you can’t take the medication on your own? Who should administer it? Your children? Which one? Would a clinician be preferable? Would you feel more at ease with the assistance of a machine?