End of Life Planning Physician-Assisted Death: Is It Your Choice? 3/23/2023 | By Terri L. Jones Not long before my mother’s death, she told my sister that she wanted to die. Her long battle with chronic obstructive pulmonary disease (COPD) had taken a horrible toll on both her physical and mental well-being, and her love for us and ours for her just wasn’t enough to sustain her anymore. After reading the book “In Love: A Memoir of Love and Loss”, about a man with Alzheimer’s disease who ended his life with the assistance of a physician in Zurich, Mom asked her hospice doctor about it. She was informed that physician-assisted death wasn’t legal in Virginia where she lived. Thankfully, Mom passed away naturally just a little over a week later. Toward the end, it was easy to understand why my mother did not want to go on living, but I had no idea just how long she had been contemplating this exit route. Going through her things after her death, I found a magazine article titled “A Good Death,” neatly folded in a box of keepsakes. In her handwriting, the article was dated “2018,” a full four years before she passed away. After discovering how my mother had tiptoed around the edges of dying with dignity for years, I felt compelled to look into this option and bring the facts of physician-assisted dying out of the shadows and into the light. Death with dignity or physician-assisted death Death with dignity is defined as “an end-of-life option that allows certain eligible individuals to legally request and obtain medications from their physician to end their life in a peaceful, humane and dignified manner.” Other accepted terms for this practice are “physician-assisted death,” “physician-assisted dying” and “medical aid in dying.” It is not, however, the brand of physician-assisted death practiced by Dr. Kevorkian, where the medication is injected or administered by someone other than the patient. That is euthanasia, which is illegal in the U.S. With physician-assisted death, which is legal in 10 U.S. states (Maine, New Jersey, Vermont, New Mexico, Montana, Colorado, Oregon, Washington, California, and Hawaii) and Washington, D.C., the physician consults with the patient and prescribes the medication; however, the terminally ill person must take the medication on their own. But although death is at the person’s own hand, it is also not considered suicide by proponents of the practice. “People who seek medical aid in dying want to live but are stricken with life-ending illnesses,” explains the nonprofit Compassion & Choices, which seeks to empower people to chart their own end-of-life journey, on their website. “They feel deeply offended when the medical practice is referred to as suicide or assisted suicide.” While some have objections to this practice for moral, religious, or medical reasons, a 2018 Gallup poll found that a sizable majority of Americans (70%) was in support of physician-assisted death for terminally ill patients. Herb Myers, whose wife had COPD, like my mother, and ended her life in Colorado, explained: “Anything else we did would have just prolonged her life and her suffering. I think it was the right thing to do. I think everybody should have the right to go the way they want.” Eligibility In the U.S., physician-assisted dying is strictly regulated. For a physician to legally prescribe an end-of-life medication, their patient must fulfill a list of requirements: Must be 18 years or older. Must reside in a state in which the practice is legal. Must have six months or less to live. At least two physicians are required to confirm this terminal diagnosis as well as overall eligibility for physician-assisted dying. Must be mentally competent and able to make their own healthcare decisions as well as communicate these decisions. For that reason, those with advanced dementia are not eligible. Must make multiple requests for a drug to end their life – twice verbally (with a period of time separating the two requests, based on the state) and in writing. To ensure that the request is being made independently, the patient’s primary physician must have at least one conversation with their patient without anyone else present. Must be able to take the medication on their own. If the patient is unable to administer their own medication or to swallow that medication, they are not eligible for medical aid in dying. Other countries’ laws for physician-assisted death vary, including the legality of euthanasia in some areas of the world. The details Unfortunately, there are no lists of healthcare providers who participate in physician-assisted death. To find a physician who participates in this practice, the person must make an appointment and discuss their wishes with the doctor. Any physician licensed to practice in a state where death with dignity is legal – from dermatologists to hospice doctors – can prescribe the medication and facilitate the process. Conversely, all physicians have the right to refuse to be involved. Once the first doctor is engaged, typically that doctor can refer the patient to a colleague who will certify all criteria of the law have been met. Most physician-assisted deaths take place at home or in a care facility. The person first takes an anti-nausea drug followed by the lethal medication. At any point – right up to receiving the medication –a patient can change their mind. According to Death with Dignity, a leader in end-of-life advocacy and policy reform, about 30 percent of people who fill these prescriptions never take the drug. It acts as more of an insurance policy, should they need it. Related: Aid-in-dying from the physicians’ point of view Sharing the experience My mother did not feel comfortable discussing her wishes with us until the end, and even then, she chose to talk only to my sister about them. If you are contemplating medical aid in dying, it’s important to be open with your loved ones so that they can not only be at your side at your death (if you both choose), but also have some sense of closure when you are gone. In “The Day I Die, The Untold Story of Assisted Dying in America,” the son of a man who chose a physician-assisted death explained that he had grown nervous about his father dying unexpectedly and not being able to say goodbye to him. “I got to say everything that needed saying,” the son said. “I told him that I loved him and that I cared for him. And that I appreciated all the things he had done raising me.” That’s the kind of end that we all hope for. Read More Terri L. Jones Terri L. Jones has been writing educational and informative topics for the senior industry for over 10 years, and is a frequent and longtime contributor to Seniors Guide.