This study surveys the differences of relatively healthy proponents of end-of-life choices and people with irremediable health conditions having already made the decision to hasten their deaths on what each group considers important in influencing a desire to hasten death. Psychosocial factors were more important than physical ones for both groups; but those contemplating what might influence them to hasten their deaths in the future thought pain and feeling ill would be much bigger factors than they turned out to be for those deciding to do so. Those having decided to hasten their deaths cited the lack of any further viable medical treatments and having to live in a nursing home as bigger factors. Identifying these psychosocial factors influencing a desire for a hastened death suggests that caregivers and medical providers may want to review what compassionate understanding and support looks like for people wanting to hasten their death.Keywords end of life decisions, desire to hasten death, assisted suicide, elder suicide, terminally ill
Since Derek Humphry’s best-selling book in 1991, Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide, public opinion on terminally ill patients seeking a hastened death has moved from wildly controversial to enormous public support, including now the majority of physicians (Humphry, 1991; Kane, 2020). After initial concerns about potential harmful consequences for vulnerable populations proved unfounded (Lindsay, 2009; Albaladejo, 2019), more and more countries and states are passing legislation to support the public’s interest in being able to have control over the manner and timing of their own death when faced with irremediable health conditions. Final Exit Network (FEN) is one of the organizations in the United States, alongside ten (and growing) state approved medical-aid-in-dying options, and other domestic and international groups and countries, that support end of life options. Examples of these organizations include Compassion and Choices, Death with Dignity, Dignitas, Exit International, and the World Federation of Right to Die Societies. These programs continue to grow in number and provide resources for those seeking information about how to achieve a peaceful death rather than a drawn-out process of increasing frailty, violent gun options, or loss of quality of life and autonomy due to health conditions over which they otherwise have little or no control (Bellamy, 2017). Seniors ages 85 and older had the second-highest suicide rate in the United States in 2018, and firearms were used in 70.0% of them among seniors aged 65 and older (America’sHealthRankings, 2021; Mertens & Sorenson, 2012). State-sponsored physician-aid-in-dying programs and informational organizations like the ones we have mentioned above aim to offer elders and others with intractable health conditions peaceful options when it comes to controlling their deaths.
There have been multiple studies seeking information from doctors, families, and patients assessing why people who use state sanctioned physician-aid-in-dying programs have chosen to hasten their deaths as well as studies of people’s emotions who are dying of terminal illnesses without such choices (Ganzini et al., 2008b; Hendry et al., 2013; Hudson et al., 2006; Singer et al., 1999). Central to these investigations has been the value of a person’s autonomy over both their life and death decisions, complicated sometimes by mismatches between provider and patient knowledge, lack of effective communication, familial, financial, demographic and social factors, or outside constraints on patients’ real options (Meier & Morrison, 2002; Winzelberg et al., 2005). There have been efforts to identify cognitive, emotional, relational, and values-based needs that go into autonomous decision making at the end of life, and our current study further adds to that identification process (Callahan, 2002). Our current study further delineates the factors that go into what previous studies have generally concluded are the main reasons people wish they could hasten their deaths in the face of progressive illness or frailty. These factors included not only the sense of loss of self and dignity associated with autonomy, but also an inability to participate in activities that make life enjoyable and a generalized global feeling of intolerable or unbearable suffering (Chochinov et al., 2005; Dees et al., 2011; Ganzini et al., 2009; Rodríguez-Prat et al., 2017).
Our current study compares the view of relatively healthy people who are professed supporters of end-of-life options with irremediably ill people who have already decided to hasten their deaths. We wanted to know whether those who are actually suffering from intractable health conditions and faced with end-of-life decision making may differ in their views from relatively healthy people who are thinking about the questions hypothetically. We sought to understand what factors were most important to each of these groups by asking each group to rate the importance of several physical, cognitive, social, and emotional factors in influencing their current thoughts on why they would hasten their deaths.