I had an interesting conversation with Dr. Jean Abbott, a retired physician, ethicist and hospice advocate about the concept of “death with dignity.” As a result of that conversation, I invited her to be a guest blogger so she could share her thoughts directly with you. Leave a comment, below, to tell me what you think about the subject.
What does it look like to “die with dignity”? To end our life with dignity sounds like something we would like to embrace. One definition I found interesting is: “the state or quality of being worthy of honor or respect.” But what might dignity look like at the end of life? Is it being able to maintain our identity, being strong in our weakness, or being gracious in care-receiving? Is it having the opportunity, in the words of Ira Byock, to accomplish the four things that he proposes as most important: to be able to say, “Please forgive me,” “I forgive you,” “Thank you,” and “I love you.” Perhaps this is part of the reason we fear dementia so much – the loss of control over how we react and interact at the end of our lives.
Natural death is rare in these days of technological “progress” – which can extend life but can also extend dying. There is a recent movement called “The Completed Life Initiative,” which features seminars and discussions about choices we may want to consider as we try to have some control over the arc of the end of our lives: “Your life, your choice” is their tag line. The idea of life “completion” is an intriguing one – is there a way to be at peace with important tasks I was able to complete, and reconciled to those that aren’t possible?
Which brings me to the sadness I feel because the concept of “death with dignity” has come to be associated with medical assistance in dying (MAID). This movement has created such an important option for life completion for a few who need this choice to achieve a gentle death under some control. But does that mean that other kinds of dying lack dignity? Does it mean that all those deaths where people cannot control the trajectory of their decline are failures? MAID provides an important exit ramp in those unusual times when suffering and pain can’t be managed well by the tools of palliative care and hospice. For Alan Kelly, MAID provided comfort, control and, yes, dignity to what was one of the most difficult medical trajectories a person can face. That is why I believe that the option of medical assistance in dying should be available to all. But there are so many ways do die with dignity – we can’t let the word “dignity” be hijacked to the service of just one way of dying. We each have our own unique paths: the challenges of serious chronic illnesses and the process of dying with them are immense and varied. To approach whatever of these challenges I will face with integrity and some ability to “steer the ship” is something I hope to be lucky enough to do. May each of us find our way to a dignified path with which to end our earthly existence.