Understanding death with dignity

How does physician-assisted dying work?

• Nine states and the District of Columbia allow a terminal patient who will die within 6 months to choose a death with dignity, as long as certain conditions are met.

• Though laws vary by state, the person must be of sound mind, choose to do so freely, and be able to administer the medication to themselves.

• They need to request the medication in writing, in front of witnesses, and two doctors must certify that they meet the requirements.

• Many people find a lot of relief and comfort knowing that they have the option to end their pain on their own terms, and it is important to embrace that choice for your loved one.

If your loved one has been diagnosed with a terminal illness, you likely face questions of mortality on a daily basis. And one of the most difficult can be the issue of whether to consider a “death with dignity.“ As you provide the person you love with the support they need, be it physical, emotional, or financial, you may also find yourself called upon to help them explore the possibility of choosing the time and manner of their own passing.

Death with dignity, also known as physician-assisted dying, is an end-of-life option that may be available to someone who is expected to die of debilitating conditions within half a year. In general, this is an option pursued by those whose quality of life has fallen dramatically; that is, people whose illnesses have deprived them of the ability to take part in the activities that give their lives meaning and have stripped them of their autonomy. 

A terminally ill person who is at least 18 years old and meets specific criteria as verified by two doctors may ask one of them to prescribe medication to hasten death, allowing the patient a peaceful and dignified exit on their own terms. They must make this profound request on their own, and it must be entirely voluntary. Furthermore, they must be able to ingest the medication by themselves. 

Though it may seem ironic, choosing death with dignity is often said to be liberating. The decision can give your loved one longed-for peace of mind in knowing that there is an endpoint to their pain. In many cases, this knowledge frees them up to enjoy and make the most of their last days. 

You may experience your own profound sense of relief if a loved one pursues this possibility. If they are suffering less, you, as both part of their support system and a witness to their pain, may then feel at liberty to relish what time you have left together and to worry less about their deterioration. 

Is death with dignity legal in every US state?

Death with dignity is not an option everywhere in the US. In 1997, Oregon became the first state to pass a law permitting it. Since then, eight states plus the District of Columbia have codified rules permitting legal residents to exercise it as an option: California, Colorado, Hawaii, Maine, New Jersey, New Mexico, Vermont and Washington. As each state’s laws about death with dignity differ, make sure you consult with individual state departments of health to be certain of the nuances of the laws where your loved one lives.

If your loved one is considering moving to another state in order to take advantage of its laws, be sure they are clear on the rules regarding legal residency in their intended new home. These vary from state to state, and may require proof of local voter registration, a state driver’s license, proof of ownership of property, and more. You can help your loved one by doing such legwork for them, while at the same time making sure they keep in mind how stressful moving itself is even in the best of circumstances.

If your loved one pursues death with dignity, be sure they know to take the medication their doctor prescribes in the state where this is legal, and not, for example, at a serene location beyond its borders. Tempting though it may be, going out of state breaks the law and may well result in their death being ruled a suicide, which can affect things like insurance claims and the settling of the estate.

How does physician-assisted dying work?

Though rules vary by state, the general process of death with dignity is similar in most of them. Your loved one will need to make a request for the medication in writing, in the presence of two witnesses. Neither of the witnesses can be their spouse or blood relative, or otherwise be a potential beneficiary of their estate. 

Then your loved one will need to find a physician who participates in death with dignity procedures. Not all doctors do, nor does any law compel them to. It doesn’t matter what the doctor’s specialty is; any licensed physician can prescribe the medication.

The doctor can provide your loved one with a referral to a second physician; laws mandate that two doctors must certify that your loved one meets the criteria for death with dignity protocols, though only one will write the prescription.

There are no laws about what kind of medication a doctor should prescribe or when or how your loved one should go about taking them, should they choose to see the process through. Indeed, be aware that your loved one might begin this process and find relief in simply having the option to take life-ending medication without actually doing so. Data show that a third of all people in death with dignity states who get prescriptions for life-ending medications ultimately opt not to take them.

Where do you fit in?

It may be difficult to get your mind around the choice your loved one is making—choosing to say goodbye to you and everyone in their orbit. Take comfort in the fact that they are making this choice themselves in order to lessen their own suffering, and perhaps yours, and allow yourself to embrace them and the decision they have made.

Ultimately, death with dignity is an extremely personal and individual choice. Nobody can tell someone whose condition is terminal what is right for them, their pain, and their emotional state, and your job is to support them and bring them what happiness and relief you can. If choosing death with dignity is what will offer them comfort and joy in these final days and weeks, take this opportunity to show them how much you love and trust them and stand with them as they go out on their own terms.

You may be eligible for free bereavement support. Empathy can help with everything from funeral planning to estate administration, with step-by-step guidance and real-time expert support. Many people get free premium access to Empathy as a benefit with their life insurance claim. We partner with New York Life, Guardian Life Insurance Company, Bestow, Lemonade, and other leading carriers. When you make your life insurance claim, talk to your representative about whether Empathy is a benefit they offer.