“Dying is a facet of every life. An anticipated death, in the presence of loved ones, a death chosen after reflection about predictable, unavoidable pain, should not be proscribed by society’s laws or condemned by its mores.”
– George Will, columnist
IT’S NOT OFTEN THAT I CAN SAY, “I agree wholeheartedly with George Will.” But, hey, if you want to die, shouldn’t that be your decision?
Most Americans would agree with George and me. In a 2018 Gallup poll, 72 percent of Americans believe that doctors should be able to help terminally ill patients die.
However, less than a dozen states (California, Colorado, Hawaii, Maine, Montana, New Hampshire, New Jersey, New Mexico, Oregon, Vermont, Washington plus Washington, D.C.) permit medical aid in dying as an option to end “unbearable suffering.” (Advocates reject “pejorative” terms like “assisted suicide” and “euthanasia.”) Laws differ but, essentially, the terms of disengagement require a terminal illness (less than six months to live), residency requirement (except in Oregon and Vermont), age requirement (usually 18 years old) and a protracted waiting period. If that isn’t enough, two physicians must confirm in writing that you are mentally sound and physically capable of self-administering the medication if you are sick and tired of being sick and dying.
The United States is not alone in this aversion to aid in dying. Only a few other countries have legalized it. Medical aid in dying is legal in Belgium, Canada, Colombia, Germany, Luxembourg, the Netherlands, New Zealand, Portugal, Spain, Switzerland (which has permitted it since 1942) and several Australian states. In some of these countries, medical aid in dying is legal for a patient whose death is not foreseeable. But typical for Europe are Denmark and Sweden, where it’s okay to halt life-prolonging treatment if you’re terminally ill but it’s not okay to end your own life or have someone help you.
Aid in dying is a controversial and transformative issue. Laws change. Requirements change. Attitudes change. However, all over the world, the numbers are underwhelming. Although the populations of these countries are in the millions, annual applications are usually in the hundreds and, typically, less than half are carried out. Reasons differ – for example, you die while your request is being processed, or you change your mind, or the government rejects your request. Why can’t this process be easier?
That is what I ask Kimberly Callinan, the president and CEO of Compassion & Choices, the largest right-to-die organization in the country. She says, “It stems from the Constitution, and the talk about life, liberty and the pursuit of happiness. It comes from societal norms, from cultural values. Here in the United States, we have a strong culture of supporting citizens, making sure they are getting treatment that’s available. If someone’s not terminal, the prevailing interest of the government is to support them and keep them alive.”
Callinan also points a finger at the leadership of the Catholic Church – “the hierarchy from the Pope to the bishops focuses on the redemptive quality of suffering, that good things happen to those who suffer” – and another finger at Republican legislators who are influenced by donations from the Church. But, she says, things are changing.
“We’re seeing an increasing number of Republican lawmakers accepting medical aid in dying,” she tells me. “There was a Republican legislator in Delaware who opposed such aid several times but then he visited his dying mother in California and saw her use the state’s End of Life Option Act; it had a profound impact on him and so he voted in favor of the Delaware bill in April [2024].”
Laws often change this way: People who are anti-gay discover someone they know is gay and realize, oh, huh, gay is okay; people who are anti-marijuana see someone who smokes who doesn’t become a criminal or a heroin junkie and realize, oh, pot is okay.
Leaderships are out of sync with constituents. Seventy percent of Catholics support medical aid in dying as do a similar percentage of Republican voters.
Yet only ten states and Washington D.C. have legalized medical aid in dying and, even then, it’s exclusively for the terminally ill. In the other forty states, an assisting doctor or family member can be charged with a crime. In Pennsylvania, nurse Barbara Mancini was prosecuted for giving her terminally-ill 93-year-old father a bottle of morphine at his request. She beat the rap, in part from financial and legal help from Compassion & Choices, but Pennsylvania’s restrictive law remains.
“People who are able to embrace the finiteness of their lives and accept their mortality actually feel more powerful,” says Callinan. “The moment they get their terminal diagnosis, they become unstoppable because they are very clear as to what matters to them. I see the ability to embrace mortality as a gift. At the end of life, it’s important to get closure and peace. Those people who accept their mortality and have conversations with the people around them, say what’s on their mind and make amends and say goodbye, they can die in peace. The ability to accept death is important not just for the dying but for the ones they have left behind.
“Where medical aid in dying is legal, fewer than one percent will use the law. But it has a profound effect: It brings families together and impacts the way end-of-life care is delivered. It results in better hospice care, better palliative care, better conversations between doctors and patients,” concludes Callinan. Aid in dying doesn’t tear families apart. “It brings families together.”
Next week: Necessary documents
Yeah, good question, Stephen. Suicides like Robin Williams and Hunter Thompson come to mind -- they had health problems but not deathly problems. I sure wish we could speak to the dead....
thank you Michael. This raises the question for me of "is the very high number or people who take their own lives by suicide an indicator (to some extent) of the larger number of folks who can't go through the legal process to end their lives and instead take another path to the same end?"