By Amy Albright (Clinical Geropsychology Doctoral Student, University of Alabama)
We spend a lot of time talking about quality of life, but, increasingly, people around the world are talking about quality of death. Facing the end of life is hard for everyone involved, and many worry about the pain and loss of dignity associated with dying.1 In some areas of the world, individuals may choose legalized medical aid in dying, allowing them to control the time and place of their own death. This assistance allows patients to peacefully and painlessly end their lives through prescribed medication, which is often referred to as “assisted dying” or “death with dignity.” The majority of patients who choose these options are receiving hospice care,2 and many choose to die peacefully at home.3
Within the United States, residents of California, Colorado, Montana, Oregon, Vermont, Washington, and Washington D.C. may seek assisted dying.4 Currently, all U.S. states that allow assisted dying require that the patient is at least 18 years old, has a terminal illness, and has the legal capacity to make medical decisions.5 Psychologists don’t take a stand on this issue one way or the other; instead, they work with individuals to identify their own values and make their own decisions during this difficult time.6 There is a great deal of controversy surrounding assisted dying, as the idea of ending one’s own life may be uncomfortable within certain cultures and religions.7 This is a choice that must be made at an individual level, and many who explore this option do not choose to hasten their own death. As of 2015, approximately 64% of medications prescribed under Oregon’s Death with Dignity Act were used.3
There is a great deal of variation in assisted dying laws,5 which may be due to how these laws develop. Brittany Maynard, a resident of California, was 29 when she was diagnosed with terminal cancer.8 While she wanted to choose death with dignity, this was not an option in California at the time, and she and her husband moved to Oregon so she could choose a peaceful death on her own terms. Ms. Maynard and her family advocated for California to pass a death with dignity law, and the California End of Life Option Act took effect in June of 2016.9 Due in large part to Ms. Maynard’s efforts, the idea of choosing assisted dying at the end of life is something that many Americans are now aware of. While hastening death is not something that most people will choose, having these tough conversations helps patients and their families become more aware of the services and options available to them at the end of life, allowing them to make the best decision possible.10
Choosing to pursue assisted dying is an incredibly difficult decision for all involved, and judging quality of death is very personal.11 While losing a loved one is never easy, family members of those who seek assisted dying have noted that their relative appeared prepared for death, allowing goodbyes to be said.1 Death is an inevitable part of life, and death with assisted dying laws allow patients and their families some measure of control over the time and manner of death. Simply having the option to influence quality of death may be enough for some patients, and not all who consider assisted dying laws will choose to hasten death. Ultimately, there are no universal standards about the decision to pursue assisted dying, and this should always remain a matter of personal choice.6
Smith, K. A., Goy, E. R., Harvath, T. A., & Ganzini, L. (2011). Quality of death and dying in patients who request physician-assisted death. Journal of Palliative Medicine, 14(4), 445-450.
Campbell, C. S., & Black, M. A. (2014). Dignity, death, and dilemmas: A study of Washington hospices and physician-assisted death. Journal of Pain and Symptom Management, 47(1), 137-153.
Oregon Public Health Division. (2016). Oregon Death with Dignity Act: 2015 Data Summary. Retrieved from http://www.worldrtd.net/sites/default/files/newsfiles/Oregon%20report%202015.pdf.
Death with Dignity National Center. (2017). Death with Dignity Legislation. Retrieved from https://www.deathwithdignity.org/faqs/#laws.
Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., & Cohen, J. (2016). Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. JAMA, 316(1), 79-90.
American Psychological Association. (2017). Resolution on Assisted Dying and Justification. Retrieved from http://www.apa.org/about/policy/assisted-dying-resolution.aspx.
Hendry, M., Pasterfield, D., Lewis, R., Carter, B., Hodgson, D., & Wilkinson, C. (2013). Why do we want the right to die? A systematic review of the international literature on the views of patients, carers, and the public on assisted dying. Palliative Medicine, 27(1), 13-26.
Maynard, B. (2014, November 2). My right to death with dignity at 29. CNN. Retrieved from http://www.cnn.com/2014/10/07/opinion/maynard-assisted-suicide-cancer-dignity/index.html.
Coalition for Compassionate Care in California. (2017). End of Life Option Act. Retrieved from http://coalitionccc.org/tools-resources/end-of-life-option-act/.
Balaban, R. B (2000). A physician’s guide to talking about end-of-life care. Journal of General Internal Medicine, 15(3), 195-200.
Meier, E. A., Gallegos, J. V., Thomas, L. P., Depp, C. A., Irwin, S. A., & Jeste, D. V. (2016). Defining a good death (successful dying): Literature review and a call for research and public dialogue. The American Journal of Geriatric Psychiatry, 24(4), 261-271.
Amy Albright is a doctoral student in the Clinical Geropsychology program at the University of Alabama. Her research focuses on health literacy and the end of life, and she has a particular interest in factors that influence seeking medical assistance in dying. This includes both patient and provider attitudes towards physician-assisted death, as well as health and palliative care literacy.