Death with Dignity Isn't Suicide

Posted by Melissa Barber on April 25, 2011

Ethan Remmel, PhD

Recently, for a blog interview I was asked, "what's the biggest misconception about Death with Dignity?" Hands down, the greatest confusion regarding Death with Dignity Acts stems from terminology. Words shape how we view different subjects, and with a cause like ours which often elicits strong feelings, language is king.

People who oppose Death with Dignity Acts typically say these laws allow "assisted suicide". Using this verbiage is a fear tactic which purposefully confuses people into thinking of criminals like William Francis Melchert-Dinkel but this couldn't be further from the truth. In fact, the word "suicide" simply isn't accurate.

A terminally ill patient making a request under the Oregon or Washington Death with Dignity law is doing so to hasten an already inevitable and imminent death; therefore, the act cannot properly be equated with "suicide". None of the moral, existential, or religious connotations of "suicide" apply when the patient's primary objective is not to end an otherwise open-ended span of life but to find dignity in an already impending exit from this world. Individuals who use the law may be offended by the use of "assisted suicide," because they are participating in an act to shorten the agony of their final hours, not killing themselves. Cancer (or another underlying condition) is killing them.

I came across an eloquent blog on Psychology Today recently written by Ethan Remmel, PhD who's been diagnosed with incurable colon cancer. A developmental psychologist and associate professor of psychology, he's able to approach preparing for his death from an analytical yet personal angle. I heartily recommend that anyone who's interested in end-of-life issues follow his blog.

A couple weeks ago, he decided to request medication to hasten his death under Washington's Death with Dignity Act:

There are many safeguards on the use of the Act, and I respect those who choose not to participate, but I respect even more those who enable terminally ill people, such as me, to maintain some dignity and control at the end of our lives. So I have the medication now. It is safely locked up. I have not decided if or when I will use it, but it gives me great relief to know that I have some control over my dying process. I do not think of using the medication as suicide, and I don't think others should either. It would be part of a dying process that has already begun, not of my choice. It would be done in consultation with my family. It would be done to spare myself and my loved ones unnecessary suffering. I think it is important to talk about this because I think there is still some stigma associated with choosing to end one's life, even under these circumstances. I think open discussion is necessary to overcome this stigma, and avoid the unnecessary suffering that can result.

Traditional medical care treats illness as a battle. Living is winning; dying is losing. But I find this battle metaphor unhelpful in dealing with terminal illness like mine. Living is not winning if the quality of life is low. And I don't accept that dying is necessarily losing. I think it is possible to die well, and that the inevitable end does not have to be considered defeat. I much prefer the hospice care approach, with the focus on quality of life. I am not trying to get better or live longer. Those things would be nice, but they're not my goal. My goal is to feel as good as possible as long as possible.

Not surprisingly, after openly and honestly writing about his decision to make a request under Washington's law he received reactions from people reading his blog, and a couple days later posted this response:

I have received some feedback on my thoughts about the Death with Dignity Act. As I said, I have not decided whether to use this option, but I feel strongly that it should be legally available to mentally competent and terminally ill people such as myself. As I also said, I do not view it as "suicide" (although that is a convenient term), because I would not really be choosing between living and dying. I would be choosing between different ways of dying. If someone wishes to deny me that choice, it sounds to me like they are saying: I am willing to risk that your death will be slow and painful. Well, thanks a lot, that's brave of you.

Couldn't have said it better myself.

Posted on April 25, 2011 in FAQ, Personal Stories

Comments

Posted by Deborah Darby on Monday, April 25 at 12:55 p.m.

I'm active in Compassion & Choices, another group that works with DWD to support the right to death with dignity.

A dear friend asked me recently, "So what's the difference in suicide and what your organization supports?" I'd known this wonderful woman for many years and was surprised I'd never put it into words for her before. So I told her: suicide is an act of desperation, usually taken when you are "out of options", feel depressed and are probably acting in secret; when you are all alone, leaving some kind of unpleasant outcome for your family to encounter (and sometimes VERY unpleasant!) and can create incredible survivor guilt, heavily laden with "If only I had known..." feelings.

Death with dignity is done out in the open, is absolutely the person's choice (one option), with family and friends around if that's what you want, after you've at least discussed your wishes with loved ones and healthcare professionals. It can be quite peaceful, may even have an element of celebration around it! Plus everybody knows the outcome and is more or less prepared for it. There is sadness and grief, but much less survivor guilt and generally no big painful surprise.

My friend said, "Oh now I get it..." Wish everybody did.
Posted by Bill Pieper on Sunday, May 01 at 08:58 p.m.

It seems, then, that the second most prevalent misconception is this idea of a "slippery slope," as though Oregon or Washington would suddenly start dragooning unwilling people, such as those who are disabled in some way, and compelling their suicide. That's such a crock, but you hear it all the time. Yes, the Nazis did it, but nothing ever contemplated by the death with dignity movement points in that direction or ever will. How can we effectively rebut this nonsense?
Posted by Maria Louisa on Monday, May 02 at 01:00 p.m.

Just because you say it is not suicide does not therefore make it so. These are life/death issues that are not decided simply through one's opinion.

One can make the decision to no longer extend life through medical means. One can even go off one's feed, as animals do in nature. These are not suicides. But to take a drug deliberately with the knowledge and full intent of death is indeed a suicide, just the same as if a person had administered a bullet to the skull.

And about the slippery slope - it already exists in Oregon. A woman wanted to be approved for a new experimental cancer treatment, but she did not qualify. Out of "compassion" she was sent an unsigned letter from the state telling her that they could instead point her in the direction of doctor assisted suicide. This was done in the misguided spirit of "helpfulness."
Posted by Melissa Barber on Monday, May 02 at 03:47 p.m.

Good to hear from you again, Bill, and thank you, Maria, for contributing to the conversation. Independent studies have found no evidence of a slippery slope for vulnerable populations with regards to Oregon's law. Here's one such published study: http://jme.bmj.com/content/33/10/591.abstract

The case Maria is referring to really has nothing to do with a slippery slope and is a scare tactic used by opponents to mislead people about Death with Dignity Acts. Oregon's governor, John Kitzhaber, wrote an insightful op-ed piece during the Washington state I-1000 campaign about how this case has been distorted for political gains. I invite everyone to read it: http://www.seattlepi.com/default/article/I-1000-Base-the-debate-on-facts-1289684.php

Lastly, Maria, in my post I'm simply discussing conventional definitions of suicide which are generally understood to stem from a mental illness and don't adequately describe a terminally ill patient's mentally competent decision to hasten his or her death.

In the words of Dr. Ethan Remmel, a psychologist, "[Taking the medication] would be part of a dying process that has already begun."

And further explains, "I would not really be choosing between living and dying. I would be choosing between different ways of dying."

Best,
Melissa
------------
Melissa Barber
Electronic Communications Specialist
Death with Dignity National Center
Posted by trudy gamble on Thursday, May 05 at 10:52 a.m.

my husband died at 83 ,Iwas his proxy and with the help of a very kind doctor he died without pain and very peacefully.
I hope my children will help me to also have a death with dignity,Trudy
Posted by Frank Wells on Thursday, May 05 at 10:44 p.m.

When I decide I no longer want to live, I will kill myself. It's my life, and thus my decision. I'm not interested in having my hand held compassionately, and dignity (whatever that may mean) is the least of my concerns. I voted for the Oregon law, twice, so that at least a few people could exit in a tidy, sanitary manner without having to make a mess.

Why do you people keep trying to turn self-killing into something it isn't? Please stop the goofy rationalizations and the silly word games.
Posted by E. James Lieberman on Monday, May 09 at 07:35 p.m.

From the psychiatric/medical standpoint Death with Dignity Act (DWDA) patients and the typical suicide are diametrically different:
• The DWDA patient is terminally ill and wants to live; the suicidal patient has no terminal illness but wants to die.
• DWDA deaths are peaceful and supported by loved ones; suicide brings shock and tragedy to families and friends.
• Death in DWDA is openly planned; it changes timing in a minor way, but adds control in a major, socially approved way; suicide is secretly planned, and/or impulsive and violent and wastes years of potentially good life.
• DWDA empowers vulnerable patients and their loved ones; suicide expresses despair and futility.
Posted by Angela on Tuesday, May 24 at 05:18 p.m.

Read your dictionary!

Suicide "the intentional taking of one's own life. "

Hello? Don't candy coat it for what it is. A person is INTENTIONALLY ENDING THEIR OWN LIFE! Therefore, it is suicide!
Posted by Taylor on Wednesday, May 25 at 09:50 p.m.

Last november a member of my family commited suicide, leaving his 2 teenage sons fatherless. I also have a friend, sweetest girl in the world, who suffers from genetic depression, and was hospitalized for suicidal thoughts last january.
I am now writing a paper on the morality of euthanisia, and its forcing me to think a bit.
Every one says the big difference is that terminally ill patients are already dying, and this provides a way for them to control the way they die. Yes?
But (it may just be my religious background) wouldn't that be the same thing as suicide? I mean the intentions be hind the actions, not the actions themself. The point is control, and how are we to say that those two months dying that we cut are any less valuable than the twenty years living with depression? What if on that last day of your life (call it fate) you were ment to change someone's life?
Don't get all defensive, cause i'm totally for DWDA. I'm just over curious, and i explore all points of veiw. So if you have an explanation... i'm REALLY interested!!!
Posted by Sherri Hickox on Friday, May 27 at 06:38 a.m.

I watched the show on HBO lastnight 052611. I have breast cancer-I watched my mother die a very painful death due to the same illness, breast cancer. I only wish that mom had that choice. My four brothers and sisters and I had to watch her die and it was horrible. I see my doctor next week for my 6month exam and fear that it is back (cancer, a new lump). Wishing my family and I had the choice to die with dignity .....
Posted by Melissa Barber on Friday, May 27 at 05:35 p.m.

Taylor, I appreciate your genuine curiosity, and Angela, thanks for joining the discussion.

I've looked at several definitions of suicide and I think we'll just have to disagree on this one, Angela. Like Dr. Remmel and E. James Lieberman, after a significant amount of research and reflection, I and many others others have come to the conclusion there is a vast difference between a person who commits suicide to end an otherwise open-ended span of life and one who hastens an inevitable and impending death due to terminal illness.

In the words of Cody Curtis in "How to Die in Oregon", "If I had the option, I'd prefer not to die, thank you very much." But that wasn't one of the options for Cody as she faced terminal liver cancer.

Like Sherri said (thanks for your comments, Sherri), this is a possible option, and one which should be available to everyone when faced with a terminal illness.

Sherri, my thoughts are with you when you go in for your six month exam.

Best,
Melissa
--------
Melissa Barber
Electronic Communications Specialist
Death with Dignity National Center
Posted by anthony jackson on Monday, May 30 at 08:26 a.m.

It's very weird to me how people hate to see a animal hurt and would hate to see it suffer. So now my question would be what's is the difference between a person and a animal. People are fine with a animal not suffering but not a person what is the world coming to. I saw the movie for the first time and was very touched by it. I wish there was a way I could help get the law passed in Texas.
Posted by Nicol on Wednesday, June 01 at 12:08 p.m.

I watched the documentary the other night, and it was very moving. So much so, that I could not sleep last night. All I could think about was my Grandmother. Who died after a long battle with Ovarian Cancer when I was 11. We were with her, in her final hours and they were not pretty, and she was in alot of pain, that the doctors could do nothing about. I knew if she had the option of DWDA, she would have taken it, as Im sure so many family members out there who have watched their loved ones die in front of them, would agree. Ultimately, whether some call it suicide or physician assisted death, it boils down to the fact that we as humans, have the right of choice. And I believe 'this choice' should be given to everyone. If you do not agree, that is fine with me, it's your choice not to.
Posted by Christian on Thursday, June 02 at 01:14 a.m.

I am a Pastor and know the Bible very well. I have have studied it since I was a child and teach its principles and virtues for a living and as a calling. I was by my father's side three years ago when he suffered greatly for many days before dying of renal cancer. I am convinced by my understanding of scripture, my relationship with God, and through my own experience that there is no moral, decent, kind, humane, or godliness in allowing a person who is imminently approaching death to endure prolonged suffering, greatly and needlessly without hope of relief. To not allow or assist in easing or ending the suffering of a mentally competent adult is to "do harm". My father begged for assistance that we nor the doctor's were allowed to give. The godly thing, the humane thing, the right thing was available and present but with-held. I pray that one day people will look past their clouded judgments and misguided fears and that our nation which has so faithfully fought for freedom on all fronts will fulfill that devine calling to the freedom of death with dignity which should be as unalienable a right of man as those on which our nation was founded.
Posted by Nicol on Thursday, June 02 at 03:49 p.m.

I agree with you Christian. And for all those people who do not agree, they can not say what they would do until they watch their loved ones die, such a sad, painful slow death, or until they themselves are in that situation. I bet when that day came, they would change their minds.
Posted by Andy on Tuesday, June 14 at 11:58 a.m.

Those that follow this thread might want to know that has Ethan died in the way he wanted surrounded by his family and completely at peace. Read and appreciate Ethan's life and death here: http://ethanremmel.blogspot.com/
Posted by Melissa Barber on Thursday, June 16 at 03:44 p.m.

Thank you so much, Andy, for your comment and for the link to Ethan's personal blog. Even with the very brief conversation I had with him via email when I asked if I could share his story on our blog, I was struck by his generosity and openness. As a long-time advocate of Death with Dignity, I am eternally thankful for people like Ethan and his interest in making the world a better place for all of us.

Best,
Melissa
--------
Melissa Barber
Electronic Communications Specialist
Death with Dignity National Center
Posted by Steve Ward on Thursday, July 07 at 02:52 p.m.

First I am for death with dignity. I want to play devil's advocate for this post. Aren't we all dying? From the day we are conceived we begin the dying process. So shouldn't everyone have access to medications to end their lives if their quality of life is not good? Again we are all terminal. Life is not open-ended. We just don't know the date it will end unless we have control over when we choose to end life. Mental illness can be just as painful as physical illness. If life is just too painful to endure, that is not living.It is just existence. I know chronic pain is another issue but it speaks to our reluctance to relieve others suffering. The DEA is on a witch hunt for doctor's who relieve their patients suffering. I believe that everyone has a right to have their suffering eased if not completely relieved by medication or whatever works. I am the only one in my family that has not had cancer. I watched my father die from prostate cancer that had spread to his bones and bladder. Very painful death. I believe people need to witness a painful death to obtain some empathy for the dying person. What I think is the real issue here is to relieve suffering. Steve
Posted by Melissa on Monday, September 12 at 04:31 p.m.

I have been living with chronic pain due to NTOS (Neuro Thoracic Outlet Syndrome) for over six years. After two surgeries, therapy and medication, I am still sufferring from chronic pain 24/7. I attempted suicide over a year ago but failed on the amount of medication taken. I was admitted to the hospital and then another in-take hospital for attempted suicide. There is no cure and the pain medication partially masks the pain I experience. I looked into Death with Dignity, curious to know if people who have endured chronic pain with no curative treatment could qualify. I graduated college Magna Cum Laude and was always very active and I believe in God. I'm now not able to work, uncomfortable in bed or on the couch, clinically depressed and pushing my husband away. Have these kinds of conditions been considered?
Posted by Melissa Barber on Thursday, September 15 at 12:53 p.m.

Melissa, I'm so sorry you're suffering.

In order to qualify under the Oregon or Washington Death with Dignity Acts, among other requirements, an individual must be:

1. a resident of Oregon or Washington,
2. capable of making and communicating health care decisions for him/herself, and
3. diagnosed with a terminal illness that will lead to death within six months.

For more information, please check out our page about accessing Death with Dignity Acts: http://www.deathwithdignity.org/access-acts/

Best,
Melissa
-------------
Melissa Barber
Electronic Communications Specialist
Death with Dignity National Center
Posted by Susan on Wednesday, April 04 at 10:48 a.m.

This is just so wrong. There is no dignity in ending one's own life, no matter what the reasons. Anyone who claims to be a Christian and approves of this must not really believe that Jesus Christ suffered and died on a cross. They must not believe he meant it when he said, "pick up your cross and follow me." Jesus, WHO IS GOD, brought himself down to our lowest point. People don't realize that when he suffered from the Garden of Gesthemane to his final breath, he actually experienced every single moment of pain and suffering that every single person has and will ever endure. Where we are suffering, there Jesus is.

What a loving and merciful God to give us this wonderful gift of making our suffering mean something and to take it on himself. When united with Christ on the cross, no suffering is ever wasted. I have seen people who believe this suffer and die with the greatest dignity. To have joy while experiencing pain is truly a gift from God and can only be given if it is asked for and if a person is obedient to God's will. I see no obedience to God in any of this "death with dignity" stuff. I see only a misguided trust in one's own will.

As Jesus pleaded with his disciples, "My heart is nearly broken with sorrow. Remain here and stay awake with me...Be on guard, and pray that you may not undergo the test. The spirit is willing but nature is weak." Mt. 26:38-42 He is asking us to be with him in his suffering and not to run away from our own and be tempted to believe there is an easier way out.

I pray for all people who have done this, are considering this, or have assisted in this that they may see through the Lie and experience the Truth and that God have mercy on their souls. Like Jesus said from the cross, "forgive them Father, for they know not what they do."