Right to Die - What You Need to Know Before You Make Your Choice

Explore the Major Considerations About Choosing to End Your Life

Patient lying in bed next to oxygen mask in intensive care unit
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If you are weighing the ultimate step of exercising your right to die - also known as self-determination - there are many considerations that should factor into your decision. These include your health prognosis and mental state, legislation around the issue and who you'll inform. We'll review what you need to know before you make your choice.

A Brief History of Right to Die

In 1990, Dr. Jack Kevorkian, a physician who called himself a death counselor, made public his first attempt at helping someone die.

Over the next 10 years, he claimed to have helped 130 people before he was arrested, then convicted of second-degree murder in 1999.

It was during this time that Americans became far more aware of the fact that the medical system often goes to great lengths to make dying a difficult, painful and expensive process.

Too many older people who have lived full lives, who suffer from difficult symptoms and pain are who are debilitated by diseases and conditions that are difficult to manage are kept alive far longer than they wish. This sometimes occurs even when they have planned meticulously, and have prepared all the necessary paperwork to keep it from happening. These people may suffer a negative quality of life because they cannot choose death.

Some of these patients, on facing the total lack of quality left in their lives, want to learn more about the possibilities and options for determining when their own deaths will take place, by their own hand, in order to end their pain and suffering.

Each of us has our own reasons for exploring possibilities at the end of life. If determining the time and place of your own death is something you are interested in exploring, there is advice available for helping you decide how to move forward.

What to Do Before You Consider Your Right to Die

Explore every other avenue first.

 A person should choose to self-determine their own death only if they feel they have no more quality of life. Before you choose death, you must be sure that there is no way for you to recover or develop quality of life. Consider all of the following:

  • Get second opinions about your condition, treatment options, and prognosis.

  • Explore the opportunities for palliative care and hospice care and know the differences between the two. Hospice care is intended to oversee your final six months of life, while palliative (comfort) care can last for years and may be a good choice for you.

  • See a psychiatrist or psychologist to determine if you are depressed.

  • Get involved in support groups or groups at your church, synagogue, temple, mosque or other place of worship.

What to Know About Your Right to Die

If you have decided to begin an exploration of your right to die, there are several big picture concepts you should fully understand.

There are many pros and cons. Become knowledgeable about the arguments for and against the right to die - both for individuals and for society - before you make any decisions.

Religious and spiritual beliefs about choosing death are a factor for many people. Faith may take on a larger role in many patients’ minds as they think about whether they will hasten their deaths.

Many patients examine their belief systems more closely than they have previously in their lifetimes. Their examination of their beliefs has a big influence on whether they will, ultimately, choose to die by their own hands.

Your views may change over time. Our acceptance or rejection of the idea of self-determination sometimes changes, so how you feel about it today may differ from how you used to feel about it - or how you would feel about it in the future. People who have spent a lifetime believing that they could or would never make the choice to die may find themselves in a situation later in life when the concept begins to make sense to them.

It works the other way, too: People who have always assumed that they would be ready to determine when it was time to die sometimes find that when the “right’ time comes along, they just can’t or won’t make that choice. Remember that you can change your mind at any time as long as you haven’t taken the final steps to die. This is a reason you won’t want to discuss your decision outside your closest circle of family and friends. At no time should you ever have to worry about someone else's expectations. Your own expectations are the only ones that are important.

You can simply refuse treatment. Most Americans have the right to refuse treatment, even when refusal may hasten their death. In the case of terminal disease, if they choose to refuse treatment, they are choosing death. While that isn’t quite the same as self-determination, it may speed up the process.

Doctors help patients die every day. There isn’t much literature on this, but it is accepted in “aid in dying” conversations. If 89-year-old Mrs. Jones is in horrible pain and suffering great debilitation, and she asks her long-time physician for a “little extra” of whatever drug she’s taking in a dosage that might hasten her death, that doctor may well oblige. He or she will make sure there is no paper trail. All records will be clean. But Mrs. Jones will meet her Maker sooner, not later.

There are legal ways to choose death.This is called “self-determination.” These legal routes take place in those states where Right to Die legislation or judicial rulings have taken place. “Legal” means that state-licensed physicians, given a certain set of procedures and criteria, may write prescriptions for legal doses of the “right” drugs to patients who follow those procedures and meet those criteria. Gain a good understanding of the legal aspects of your decision, whether or not you live in a right-to-die state.

You cannot legally ask someone to actually make your death happen. In no place in the world is it legal or acceptable to ask someone else to administer the medications that will cause your death. In all assistive roles, the patient is given the support and tools but must take the actual steps him or herself to die. The patient will be strongly encouraged to create legal proof that he or she was acting of his or her own accord. They may be asked to produce a “sound of mind” video. And the task may be carried out in secret so that their family and other loved ones aren’t there and therefore cannot be thought to have played a role. Be sure that if you decide to follow through you make very secure arrangements - no one should ever be accused of direct assistance that could cause them to be charged with a crime.

There are organizations that will help you. There are places in the world where patients can travel to get support for self-determination. They usually work undercover, but with good track records.

This is not the time to call attention to yourself. Deciding to die is a personal decision and should remain personal, shared only with your closest loved ones and family. Making it public and calling attention to yourself comes across more as a cry for help and less as a solution for the loss of your quality of life.

Making a Decision and Moving Forward

When it comes time for you to make a decision about self-determining the end of your life - if you ever find yourself in that position - there will be no right answer or wrong answer. There will be YOUR answer. Again, your choice is the only one that is important.

Once have read and learned all you can, asked all the right questions and taken care of your will and other necessary legal paperwork, you will have a far clearer idea of the right path forward for yourself. If you feel in your heart and mind that you have made the right choice for yourself, you will begin to find some peace of mind.

Here is a master list of resources about your right to choose death with dignity.