By Kelduyn R Garland, PhD, DD, of the Silver City End of Life Options Coalition
Since the work of Elisabeth Kübler-Ross, MD, brought death & dying out of the ‘closet’ and back into life’s process, people have progressively begun to claim their birthright as to how they want this end time in their life to be. No longer is it the ‘doctor’s decision’ about treatment and care as people make this decision… it is their own. Kübler-Ross’s work, as well as the rise of Hospice Services and films such as the 1980’s “Whose Life Is It Anyway?,” the TV biographic movie “Last Wish,” and Bill Moyers’ four-part documentary for PBS in 2000 entitled “On Our Own Terms,” have contributed to providing the impetus for changes in the medical protocols and delivery of end-of-life care.
A controversial issue that continues to be a part of this arena is the question of what makes End of Life Options (also referred to as Death with Dignity) different from Suicide -- which is a big “no-no” in our society, as well as it being illegal in most states for someone to assist or support in any way or manner another person in taking their own life.
Let’s take a look at the characteristic dynamics and modes involved in both of these concepts, which demonstrate the clear difference between Death with Dignity and Suicide.
The modes of implementation used in Suicide have a dominant characteristic of violence (e.g., drug overdosing, hanging, gun shot, plunging to death [fall], auto accident, and CO2 poisoning), congruent with the characteristic dynamics underlying someone deciding to commit suicide.
People who intend to commit suicide are secretive about their decision and not communicating their plan to anyone, thereby causing them to be isolated and alone. Feelings of powerlessness and helplessness are dominant in addressing their circumstances and issues. These individuals experience depression / despair and/or rage / anger, and this decision to end their life is a ‘knee jerk’ reaction to circumstances in their life for which there are other options and solutions. In the mental / behavioral field, suicide is seen as a ‘reaction formation’ response, and is defined as a ‘long-term / permanent solution to a short-term problem” that has other options for resolution.
In contrast, the modes, dynamics and characteristics are very different when End of Life options include Death with Dignity. The major difference is that the person is in a terminal end stage of disease for which there is no ‘cure’ and therefore no options or solutions for changing the outcome, with quality of life continuing to diminish. The individual is mentally competent to understand and make this choice, and the person makes their own choice about their life-ending process.
Unlike suicide, this choice is made out of empowerment, with the individuals being clear, confident, and at peace with it. They communicate this to family and friends, and involve their support, making this an inclusive, nurturing and supported process.
Modes that can be used in this process include Medical Aid in Dying (physician providing Rx for the terminally ill person to self-administer in states where it is legal), voluntary stopping eating or drinking (the US Supreme Court has affirmed the right of a competent individual to refuse medical therapies, and this includes food and fluids), palliative care to control pain and provide comfort, and a ‘walk in the woods’ as the Native Americans did. All of the decisions and actions employed are at the choice and direction of the person, and no one else.
Comfortingly, options exist for individuals with terminal conditions to exert control over their end-of-life experience. As noted on the website for Death with Dignity (deathwithdignity.org): “The greatest human freedom is to live and die according to our own desires and beliefs.”
In the 2013 Morris v. New Mexico case, the State’s statute on suicide was challenged, claiming that physician aid in dying did not constitute contributing to suicide because of the individual right to self-determination concerning one’s dying process. New Mexico’s Second District Court Judge Nan Nash issued a landmark decision on January 13, 2014, that terminally ill, mentally competent patients have a fundamental right to aid in dying under the substantive due process clause of the New Mexico State Constitution. In her ruling she stated:
“This Court cannot envision a right more fundamental, more private or more integral to the liberty, safety and happiness of a New Mexican than the right of a competent, terminally ill patient to choose aid in dying. If decisions made in the shadow of one’s imminent death regarding how they and their loved ones will face that death are not fundamental and at the core of these constitutional guarantees, than [sic] what decisions are? The Court therefore declares that the liberty, safety and happiness interest of a competent, terminally ill patient to choose aid in dying is a fundamental right under our New Mexico Constitution.”
NOTE: Judge Nash’s ruling was appealed all the way to the New Mexico State Supreme Court where the judges unanimously decided that the decision needed to be made by the legislature. End of Life Options legislation was introduced during the 2017 session and did not make it all the way through the two chambers. Plans are to bring the legislation back before the New Mexico State Legislature during the 2019 session.
For more information on end of life options see the following resources:
To contact the Silver City End of Life Options Coalition or leave comments: firstname.lastname@example.org