Dead & Buried

If you're young and brimming with health the idea that one day you may not be might seem far away.

It's easy to think that we can live these glamorous lives, and when we're ready to go, we would just die calmly in our sleep, or die with a flaming arrow through our hearts.

But for those that are terminally ill, the prospect of being alive can actually be more daunting than the act of dying.

So today let's talk about the right to die.

Join me as we explore what it means to pursue a medically assisted death.

The concept of assisted dying might make you think of Jack Kevorkian, the Michigan Doctor who helped 130 patients end their lives in the 1990s.

And this stops the heart as soon as it reaches it.

But Kevorkian AKA Dr. Death was a total renegade who operated far outside the law.

He ended up serving 8 years in prison for his actions.

In the US current medical aid in dying laws couldn't be further from what Kevorkian was doing, but first, let's get our terminology straight.

Medical Aid in Dying, also known as assisted dying, offers a legal way for a terminally ill, mentally competent patient to end their life by taking a lethal dose of medication prescribed by a clinician.

Euthanasia, the act of a physician ending a patient's life with the lethal injection, isn't legal anywhere in the US.

As of right now in 2023 patients must be able to ingest the life ending medication themselves.

To date 10 states, and Washington DC, have authorized assisted dying, which means that 22% of Americans now have access to a medically assisted death.

How do you qualify for an assisted death?

Though the laws differ a little from state to state the basic requirements are the same.

To qualify a patient must have a terminal prognosis of 6 months or less, be at least 18 years old, have two clinicians certify their prognosis, be able to self-administer the lethal medication, and, be of sound mind.

Patients with serious cognitive impairment, such as advanced dementia, are excluded from assisted dying laws in the U.S. even if they have a terminal prognosis.

That's a lot, in fact the U.S. has the strictest assisted dying laws in the world.

What I really want to know is, what might motivate someone to hasten the end of their life?

To learn more, I spoke with Peg Sandeen, CEO of the Death With Dignity National Center, a nonprofit end of life advocacy and educational organization.

Peg's involvement with the right to die movement dates back to the 1990s.

If you think about what happens when we're dying everything peels away from us.

For example we can't work anymore.

Like if we love to hike we can't hike anymore.

Our Lives become smaller and smaller right, they become all about medicine.

Like this doctor's appointment and that doctor's appointment, and so everything about our lives changes and we lose dignity and we lose autonomy.

In your experience, why might someone choose to hasten the end of their life?

There's several reasons you know why people choose Death with Dignity, um, but they all cluster around certain themes.

One of them has to do with peace of mind.

So if you have a diagnosis, or a prognosis, that's really devastating and a condition that you're dying from that has really horrible symptoms associated with it.

If you choose the death with dignity option, then you know that if those symptoms get really bad, if your suffering becomes so great that you have an opportunity to take control, and to say nope I can't deal with these symptoms anymore, I'm going to choose the timing and manner of my death.

And so it just gives people great peace of mind.

In the United States, legal efforts to find a way to ease the suffering of terminally ill patients go way back.

In 1906, Iowa and Ohio legislators introduced the so-called chloroform bills.

Which envisioned the use of chloroform form on fatally ill or injured patients to induce their death.

Their terms were so flawed though, that they never really materialized.

For the remainder of the century, no other legalization efforts bore fruit.

None that is until the 1994 Oregon Death With Dignity Act, which was enacted in 1997.

For the first time in American history, some terminally ill patients had a legal way to end their own lives.

Who uses assisted dying laws today?

Available statistics show that it is mainly older patients who access medical assistance in dying.

For instance, in California, 92% of those who completed an assisted death in 2022 were 60 or older.

And the vast majority about 2/3 had cancer.

That year assisted dying accounted for just .3% of all deaths in California.

Most people don't realize that there are many logistical barriers to pursuing an assisted death.

Which can lead to disparities in how accessible these laws are.

It takes some social and financial capital to access an assisted death.

Starting from finding a physician willing to see you to finding a suitable place to die.

By the time most patients start this process their health is fast declining, and most need help navigating all the steps.

In many states there are volunteer organizations that accompany patients and families on their path to an assisted death.

They provide crucial non-medical support during a time that can be tender and confusing.

Including on their chosen departure day.

I spoke with Jamie thrower, a volunteer from End of Life Choices Oregon about what it's like to support someone on this journey.

Can you describe what it feels like to attend something so intimate in a person's final hours?

It is such a beautiful reminder of the shared humanity.

Being able to be an outside person witnessing someone who's going through something that I've experienced, and being able to be with people at their most vulnerable is just, uh, it's truly an honor.

What types of rituals or ceremonies have you witnessed on someone's chosen day?

I have seen everything from parties to where I've opened the door and I've been been handed a glass of champagne and there's appetizers and lots of people around, and the person just wanted to take their medication and fall asleep to the sound of everyone laughing and talking and sharing memories.

To other things like post death, being able to do ritual washing of the body as a way to say goodbye in a different way.

I see people using technology now to have someone zooming in from across the world to be able to say goodbye, and watch their person drink the medication.

For me my job is just to listen and to help people make that happen if it's if it's doable.

So if you want a a harp player to play while you're drinking the medication I will find a way to make that happen.

You want to do this out in your garden, okay great, let's do that.

We have so many tools, we have so many ways that we can make this a unique experience for people that feel really special to them and become these really unique rituals of how to say goodbye to somebody.

It is such an intimate beautiful thing to be able to witness someone's like crossing over, what else can an assisted death be?

You know we see things in a lot of binary ways.

We see death as sad and hard, and grief is crying, but we don't really allow ourselves to you know kind of see the nuance and and all the other things that death can be.

And so a lot of times families feel really connected afterwards saying you know I thought I was going to really have a much harder time with this, but I feel relief, I feel grateful, I feel so happy that my person was able to go out in this way.

That they got to do it on their terms.

And so I think that yes, the sadness is there, the heartbreak, the grief is huge, but there's also a really strong feeling of love.

A medically assisted death is not right for everyone.

Some people are opposed to it on religious grounds saying that God alone has the power to end human life.

Some argue that assisted dying carries an implicit judgment on what kinds of lives are ultimately deemed livable.

And some clinicians say that assisted dying undermines their mission to save lives, but there are people who feel that their life belongs to them alone and who want the right to choose the course and timing of their own death without having their decisions impact anybody else's choices.

That doesn't mean they see life as expendable.

Wherever you come down on this topic, the right to die is a pressing social issue that will continue to affect more Americans.

According to a 2020 Gallup poll, 74% of U.S. adults believe that physicians should be able to help terminally ill patients die.

As the population ages many more people will be facing diseases that are difficult to cure, or manage, prompting some to want to retain a say and how they die.

To quote cultural Anthropologist and death educator, Anita Hannig, who helped create this episode, "An assisted death is much larger than swallowing a lethal dose of medication, it changes how we live how we die and how we envision our future."