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Is Death With Dignity the Same Thing as Suicide?

Last time on The Alex and Ronni Show, we discussed Oregon's Death with Dignity Act (I prefer the phrase, medical aid in dying or M.A.I.D), and my acquisition of the drugs that will end my life when/if I choose to do so. TGB reader Kate R left this question in the comments:

”I totally understand your whys of controlling when you decide you want to depart. You are fortunate to live in a state that supports this choice. I'm going to throw this in the conversation.

“My husband committed suicide by his own hand after many years of depression etc. I was shocked and not pleasant to witness. How is your choice not considered a form of suicide?”

The short answer is that it is not a “form of suicide”; it IS suicide, condoned and made legal in my case by the state in which I live.

Eight other U.S. states – California, Colorado, Hawaii, Maine, New Jersey, Vermont, Washington state - plus the District of Columbia also have death with dignity laws. In addition, no state law in Montana prohibits a physician from fulfilling a request from a terminally ill, mentally competent patient for medication to end his or her life.

Mostly, states and countries that allow medical aid in dying avoid the word suicide. I have no proof of this but I think they do so (as do I) because certain words are freighted with extra meaning beyond their basic definition, suicide being one of them. So we end up with such phrases as

Death with dignity
Freedom of choice at life's end
Medical aid in dying
Physician assisted dying
Right to die
Self-determined end of suffering

But they all mean suicide – that is, to die by one's own hand. Pains are taken in the words and meaning of the statutes where it is allowed so that the people who acquire the drugs to commit suicide are terminally ill as determined by physicians and are of sound mind.

Additional verbiage in the laws seeks to ensure that no one can be coerced by another person into taking the drugs and my doctor made a point to advise me that in choosing the day to use the medication, I must be physically able to lift the glass to drink from it on my own, without assistance.

A big feature of the medical aid in dying laws in the United States and most other countries is that the patient be terminally ill, usually with fewer than six months to live, according to physicians.

There is a case now in France of a 76-year-old woman who is is not terminally ill campaigning for her right to die just because she wants to.

In 2018, Jacqueline Jencquel, who has been vice president of the pro-assisted suicide organization ADMD (French language site), and a member of the Swiss right-to-die campaign group Exit (French language site), told Vice News:

”What really surprises people is that I'm not dying. In France, to get the right to die, you have to be on your very last legs and screaming in pain.

“We enacted the Léonetti law in 2005. This law was extended in 2016 to allow terminally ill people to be put to sleep with sedatives—to cut short their suffering before death. But it doesn't go far enough. It's a way of not really dealing with the end of life. The idea is to suffer first, then we'll help you bear it until your body just quits.”

Saying that she wanted to see another spring, Ms. Jencquel extended her first self-chosen “exit date” of January 2020 for six more months. Then she extended it again until the end of the year because, she said, she will have a new grandson in November.

“I am not in good health,} she recently told Euronews. “I have osteoporosis, I'm very fragile, and I have a stomach issue. And I know it's not going to get any better”.

“What's this taboo around death? I mean, we're mortal, aren't we? What is an option is the suffering before dying. And I don't really see any purpose and meaning in my life anymore.”

Dr. Vianney Mourman, a palliative care physician at Lariboisière Hospital in Paris, who rejects Jencquel's argument, told Euronews:

“'If she were very sick, and say “I suffer so much and nothing relieves me, by humanity, please help me kill myself.' The speech wouldn't be the same.'

“He insists that only once you've given the way to alleviate the suffering without success you could 'perhaps imagine that assisted suicide could be offered'. But for someone who is not sick and has a future, 'we can't, and we shouldn’t allow it: it's breaking a taboo that puts society at risk,' he reiterates.”

All the above is a wordy response from someone who believes that death with dignity, right to die, physician assisted dying, etc. are just other ways of saying suicide. I don't have trouble with the word but then, I've been reading and thinking about it for many years before I was in a position to consider it for myself.

Now I'm curious to read what you have to say.

If you are looking for more information about assisted suicide, here are three good organizations:

Death With Dignity
Dignitas
Right to Die Europe

Comments

It is ludicrous to have laws against suicide. What will they do to me after I've killed myself? Send me to re-education school?

I agree with you that, whatever anyone calls it, state-sanctioned death by one's own hand is suicide. All states should supply chemical means to people who wish to choose their own time/place of death. Had my younger brother had the option, his widow might have been spared a horrific event. (Although, his clarity of thought may have made the point moot.)

Younger Brother's wife came home from shopping to find him in a glider in their back yard. It isn't pretty to find the results of a well-aimed long gun. He was only 70, but he left a horrific memory in his widow's (age 76) brain.

You, thankfully, are thinking clearly about your own predicament. You are providing us with a wonderful service. Thank you, so much.

There is also, or even mainly, a person's mental suffering to consider, which seems to be what Ms. Jencquel is referring to. And generally, mental suffering is what "suicide" addresses, as Kate R pointed out. "Right to die", "MAID" and similar expressions focus on physical suffering. To me (I know others might argue this), our society is sorely lacking in educating people how to relieve mental suffering or often even much compassion for it, despite much lip service paid, many dollars spent in counseling and a plethora of self-help books published.

For years, doctors have given patients, who are terminal and in pain, more and more drugs until they know it will end their lives. I don't see it as suicide but understand it's just a word. What it is is giving the dying person a choice in how they go and when-- better that way than with a gun, which is brutal for those who come after to see what happened. To let people say last words and go peacefully is easier on the loved ones. It's important to have the right drugs and I hope that Arizona eventually lets it go on the ballot. I've heard religious people claim that dying from the disease gives more time for asking for forgiveness. I think that's fine for them to decide it's what they want for themselves but not for others. Where these laws are carefully set up to avoid coercion, I think it's about mercy to let each decide their time. It's not just for the elderly either as some imply. My mother-in-law had shattered her hip at 95. She opted to have a hip replacement but never fully came back. The idea of death with dignity never came up as she had no time limit it was just wearing out.

In 1994, while Dad was dying of his lung cancer, my oldest brother died by suicide-using a gun owned by his son. He had battled depression for 20 years and never stopped counseling and saw his counselor the day before he died.

Shortly after his funeral, I was sitting with Dad. He said "maybe that euthanasia they started in Holland (where we emmigrated from in 1961), isn't such a bad idea. Dad had realized he would feel like he was drowning-his words. And the cancer had spread to his bone which is immensely painful.

My view on Death with Dignity, for those facing certain death per our current medical criteria, is that it provides a humane and respectful end-of-life in full control of the individual at a time of their choosing. I don't place this in the same bucket with my brother's suicide. That said, I also have a reasonable understanding of depression both as a Registered Nurse and a sister dealing with the long-term family impact. We all wish he hadn't done it. We will never know why-he had a successful business, a long-term marriage, 2 smart children...the outside looked like the idyllic life. Obviously, the inside was in tremendous pain. I have much respect for mental health and believe depression is a true disease.

All that to say, I have a very difficult time with suicide being condoned yet I believe in Death with Dignity.

How's that for an answer to a big conundrum.

The possible distinction between death by dignity and suicide may be more than just semantic. There are some types of life insurance policies that do not pay out when suicide is the cause of death. Perhaps an insurance or legal professional could provide more detail on this issue.

People who have simply "had enough" have long found ways to end life; in many cultures the tacitly accepted way is to simply stop eating, but it's not as rapid, and the person may be pressured to abandon the course.

IMO, MAID criteria should include mental as well as physical suffering, and also, when the trajectory is inevitable, as with some neurological illnesses, not require a 6-month terminal dx before dispensing the meds.

Those interested in the issue might like to read "How Dutch Law Got a Little Too Comfortable with Euthanasia" by Scott Kim, in The Atlantic.

I believe in my 'right' to end my life whenever I want to do so. I believe the 'taboo' mentioned stems mostly from religious thought, which I rejected some years ago.
I don't really see myself choosing that for now, but I KNOW that it will be an option if I am diagnosed with something terminal.

What I have been doing for the last few years, though, is building a community for myself of women who are family now. And women who will see me out when the time comes. So, whatever the disease, I would not use MAID if pain could be managed. To die in the company of (and maybe even in the arms of) folks who love me is a truly lovely and comforting thought. I would love to be awake for that transition.

What we wish for and what we get are often different things, though, so I am grateful that some are waking up to these possibilities of a better death.
My life is my own. If circumstances arise that make being alive untenable, I will stop living regardless of laws. Online research provides answers.

Ronni, thank you for this forum, your courage, and your amazing clarity of thought.

I agree with Rain Trueax's comment. When there is cause, for example extreme confusion and agitation or pain, that can't be controlled, there is a treatment known as palliative sedation.

I agree with Cop Car, it’s ludicrous to have laws against it. And as progressive as Oregon & a few other states are in medically assisted dying, it still seems punishing and backward. “You have to be diagnosed with a terminal illness.” “You must have 6 months or less to live.” “You must lift the glass yourself.” Not that I have issue with the term suicide, but given all the legal & medical hoops you have to jump thru, I’d hardly equate it with that word.

I watched both of my parents die from cancer, writhing and delirious and drowning in morphine. In the time after they were diagnosed with terminal cancers and before their bodies finally gave out, we spent that time opening up and sharing our feelings, laughing & reminiscing, etc. They were both raised to believe suicide was the “ultimate sin”, but Mom didn’t see it as suicide at all towards the end and wished for that option greatly. I wished she had it too, I hate that her death was a relief on our parts more than anything when it finally happened.

I understand the basic definition of suicide, but to me the word indicates that a person is probably suffering from intense depression if they are in good health, 'have everything to live for', and decide to take their own life.
The difference to me, of MAID, is that one has decided not to suffer unduly and usually has shared their decision with their loved ones.
Perhaps a fairly insignificant difference, but I don’t think so. Suicide is cruel for those remaining behind.

Technically it is suicide, and technically we're dead after our death. Younger people (some) are coming up with words that don't have eons of negative energy around them, and I like that. At first, I thought, this is just too precious. But after some reflection, I like it. "Transitioning," rather than die.........yup, just moving from one state to another. And "self euthanization" rather than suicide. Softer, gentler, and, maybe, kinder. I could "die," but really? Sort of a boring word for what, it seems, really transpires. I think I'll "move on," "transition," "head out," oh, I can see it's time to think of some more lovely, imaginative words for this.

Anyway, as me mum said,"There's lots worse things than dying."

The Centers for Medicaid and Medicare set a qualification guideline for hospice services of six months to live. A physician referral is necessary for hospice consultation. Language matters. The best way to obtain this is to ask the doctor, "Would it surprise you if this individual passed away in the next six months?"

Good give and take here, thanks, definitions aside, words, the thing is suffering isn't a good thing nor lingering in a state of loss for many years, so I went to Five Wishes Living Will, and wrote out what I thought, and my Geriatric Social Worker reminded me to share the info with my family, she works in a Aging Well practice I just joined, at age 70, and after reading Jane Gross's book Caring for Our Aging parents-and Ourselves, A Bittersweet Season, what is right for me may not be for others. Living in a State which doesn't allow for MAID, her mother in the book decided to stop eating, when the time came. It worked, took two weeks or so. (guess important to check with the lawyer's if you still have a life insurance policy) My Mother in law was in HOSPICE for about five years, with Alzheimer's Disease, and the seven years before that she was combative and not recognizing family, wish she would have written something out, because I know she didn't want to be like that for so long. My Mom at age 92, is in an ALF, all together different story. We each have our own journey. and Ronni, still think if you can wait it out, wait to see who is elected in November.

Janet adds an important view on this topic. “Suicide is cruel for those remaining behind.”

A friend agreed to be at her best friend’s Invitation to be present at the family gathering for her final exit.

Afterwards, my friend felt an unexpected complicity in her best friend’s death. Oregon Compassion and Choices offered no support.

I don't think anyone knows what they will do for sure until we are in the situation. Lots of good thoughts here but every one should do what is right for them. I just watched the movie Clemency ...very good film about capitol punishment. I am against it but think I would do it if myself to the person that hurt or killed the lights of my life.

I attempted suicide in 1964. Obviously, not successful or I REALLY would be famous. I have
lived nearly 60 years more. No children, but three wives. Yep, those years were good and
an experience. Now, in my seventies, I realize that most of life is over. I'm still in pretty good health and enjoying the autumn vacation I've earned. I am, however, realistic enough to know that this "Indian summer" won't go on forever. I would not end this show yet, but I cherish the exit available to me. Only an individual knows the right time, but not when one is young. How would an age be set? Who has that right? Age 70 or later? Age 40 or later? Many contemplate suicide when there are glorious years ahead of them. When I was sixteen and alone, I saw no glory in my future. Due to a fluke in the drugs I took, I lived that future.

Dear Ronnie and Friends, i can't help but to suspect that more states will allow people to take their own lives & and eventually for less critical reasons (inoperable cancers and such). Suspect that where this will end up is: things like M.A.I.D. pills no longer being a person's choice (unless you're wealthy) but a legal/medical requirement for people 70 and above to get off the planet - for rather minor health problems.

I agree that dying by your own action is suicide, and that that word that is freighted with traditional and religious connotations. I respect and support everyone's opportunity to navigate their lives according to religious beliefs, but I don't support (or even understand, really) their insistence on forcing their religion on others. Why should anyone think that they get to decide how close I must be to dead before I can take my exit? I am a member of a family where there was a suicide in the usual sense of the word (i.e., not a late-life death with dignity). Although it is a tragedy in my eyes, and although we suffered as a consequence, I would not call it cruel. Calling it cruel frames her death in terms of its effect on others, which is an important aspect of death but not its essential nature. Her death was quintessentially personal -- could anything be more personal?

I DO believe that suicide is terrible for the family left behind. And I am not for it, because it is said in the Bible that only God gives life and only God takes it away.

I think this is one of those conversations that becomes much more interesting as it becomes less abstract, less "what-if" and more "when". Of course, causing one's own death is suicide but so what when death is inevitably upon us.
Birth and death are arguably the two most personal events in anyone's life and death is the only one even remotely under our control. Give us that choice and hope that it is carefully considered.
Leaving one's remains to be unexpectedly discovered by a partner seems deliberately punitive but I'm no master at managing relationships.

Many insightful and provocative comments here. This post and thread prompted me to look up Carolyn Heilbrun again today, leading me to a magazine article from 2003, written a few weeks after her death, which I had never read before. Some of the things it said, I was aware of and some I was not. Heilbrun took her own life, at 77, by a method much harder than what she would be able to do today in many places. She had planned to end it at 70, but apparently kept finding that she had not reached her shelf-life before then. Her story is fascinating. She was a successful woman, in apparently every way of measuring that, with a prosperous and seemingly satisfying life, but she is reported as having said that she had become "sad about the universe."

Each day, more and more, I understand how someone may feel that way, to the point of wanting out, but I'm intrigued by how most people go on through the same events and culture -- or worse -- and without many of the privileges and benefits of others, and just keep rolling along regardless of how they feel about life.

As often happens, most of what I would say has already been well-articulated by TGB readers. After 57 years of defying my night-owl nature to get to work on time, in retirement I'm no longer an early riser. Sometimes I don't read TGB until late morning or even early afternoon.

I've been a supporter of what started out as the death with dignity movement for over 40 years. I'm appreciative of the progress that has been made and that M.A.I.D. is available in my state. However, I had hoped that by the time I reached my 80s--I'm now 83--there would be fewer restrictions and hoops to jump through. I had hoped that mentally competent older adults nearing the end of life would be able to decide for themselves and that the means would be reasonably available.

Unfortunately, thanks to the overhyped "opioid crisis" (which has pretty much disappeared from the news since COVID-19 and never involved the vast majority of elders anyway), it has become extremely difficult to stockpile the appropriate medication. A firearm would be my absolute last resort. I'm not there yet but am refreshing my education on potential alternative routes should I need one down the line.

A fascinating conversation.

I'm thinking of the government's ability to control a person's life. Even with Roe v. Wade which essentially removed the government control over a woman's body, the fight continues to this date.

To me whether the choice is to bear a child or to end one's life, it is a completely personal decision, and there should be zero government involvement.

Whether ending a life is due to physical illness or mental illness makes no difference, and judging someone who makes that choice is what is cruel.

I'm glad that California allows me to make choices, but I fear that if Trump retains power, that may disappear as well.

American author, feminist, and literature professor at Columbia University Carolyn Heilbrun had decided to end her life at 70. But still enjoying life, she stayed on until 78--and then ended her life. She touched on her reasons in her poignant book The Last Gift of Time.

I'm happy for Irma if, in her state, "Even with Roe v. Wade which essentially removed the government control over a woman's body...." is true. In too many states it is not, really.

I believe this is the most interesting group of comments on a very complicated topic that I have ever read. Would someone get this blog entry published abroad for the whole world to read?

I appreciate the efforts toward deep thought which must have been expended while composing these words. Ronni, you have accumulated a great multitude of very intelligent individuals that hold nothing back when their goal is honest and real contributions that will stir up the thoughts of others reading this.

One thought I had which shoe-horned its' way into my brain concerned a question generated by one other contributor. How much hate must one hold in their heart for another human being to make such statements about our sitting President, attributing responsibility for some evil act he MIGHT commit in the future? Who is the evil one? You know who you are.

Will delaying your "transition" in order to learn who wins the upcoming election actually make your journey easier? How much might you needlessly suffer to do it? (You are not going to allow my comment to be published, are you Ronni?)

Even if you don't allow it, I would rather that you don't go into that dark night any sooner than necessary. I've been watching you work tirelessly for US for a long time now. It will be a great loss.

For much of my life I have wondered why the word "suicide" is so fraught with condemnation and aversion. He or she "COMMITTED suicide!" (or rape, or murder, or incest!). I'm sure as other comments have suggested, it is tied to religion. A sin. Not coming from a religious family, free to make my own decisions, and living in Oregon, I was by my husband's side when he chose the right to die.
I would like to suggest that the act itself has much in common with abortion, another policy I endorse and, as in suicide, it depends upon the circumstances. I like to believe that most thinking people can imagine what those circumstances might be and can honor the decision. Each of these are the ultimate personal act that comes from within the heart of the human most effected by the outcome.

I’m in a Southern state, so we will never have assisted suicide in any form.

So the choice is to move to another state while you still can or take up shooting lessons, get street drugs like fentanyl or rent an apartment at least 6 floors up with a patio or travel to the Grand Canyon.

It’s terrible that the entire country does not offer this choice to alleviate such worry and despair for our right to chose when. It should be our choice...our freedom to choose.

Religious people should not have the right to tell the rest of us what to do and how to live.

I believe people who blatantly state that, "only God gives life and only God takes it away" are hypocritical unless they have refused medical intervention throughout their entire life. Would they have refused resuscitation of their drowning child or rejected antibiotics prescribed to cure a virulent infection? I doubt it!

I agree with the PP, macmsue, about the hypocrisy of religious views. If God gives you the "gift" of cancer or COPD or diabetes or heart failure and "calls you home," you would be wrong to not accept it, using that philosophy. Why would you fight "God's will." That being said, in my country, Canada, we actually have no abortion laws at all for 30 years and the sky hasn't fallen. Nobody tells their neighbour what to do with her body. It's considered NOYB. We've had MAiD for only 4 years and in some parts of the country, such as Vancouver Island, the capital of British Columbia, it's now approaching 7% which is the highest uptake in the world. We even let you choose it for the early stages of Alzheimer's, if you're proactive enough to want to know you have the illness and skip "living" with it.

We pretty much have country-wide laws and don't allow individual provinces to do what they like to restrict personal freedoms so we don't have issues like you would have in the southern states.

Dear macmsue, your fangs are showing.

If they put it on the ballot, I think so many people would vote for it that it would soon become acceptable and legal.

Maybe I should add that I'm now 96 and in the last year have considered suicide. Not because of health reasons and in many ways I still enjoy life, but it just seems pointless.


i'm now 96 and in the last year I've considered suicide

I don’t much care what word anyone uses for ending their lives. It’s a personal choice.

In the US we’re very misguided in so many ways. Don’t believe in abortion, fine, don’t have one. But Prevent abortion and don’t support moms who can’t work Or feed their families, don’t have an education etc... You’re a hypocrite.

If you believe in god then follow gods rules. If you don’t believe in god then make a considered decision.

I believe god is the collective love and good of humanity. These past 4 yrs have shown us there is also true evil in the world and it is running the our government.

As we age and begin our dying process is it OUR choice in how that should unfold. The fact that humans can’t tolerate the idea of dying has caused innumerable problems for life on the planet we’re desecrating.

However it happens, whenever it happens I wish you, Ronni, a good Journey. I wish it for myself. And for all others as well.

I’ve made plans to NOT hang around to suffer because of archaic laws and doctors who are unable to accept that death is, indeed, a normal part of the human condition.

I’ve worked in healthcare my entire life. I’ve trained in hospice, have studied death and dying (and yes, have Heilbruns and several others books) since I was a kid. I see death as an old friend. I don’t find it depressing. I like the word transitioning... When it’s time, Exhale.


To me, forcing someone suffering intolerably, physically or emotionally, without end or remedy, to stay alive is state-dictated torture. Yet everyone who knew her still struggles a quarter-century later to reconcile the death by meds of a friend who to all appearances had it all, but as one treatment after another failed to relieve her depression, kept threatening to take her life. At 30 she succeeded. Hard to justify but, as John Belushi reportedly raged when told I know how you feel, You have NO idea what it feeIs like to be me. The most considerate suicide I ever knew, a (physically uninjured) Vietnam war casualty, husband, and father, drove with a gun to a funeral home parking lot. ... So many painful memories. So I hoped when I read above, "I have been [...] building a community for myself of women who are family now. And women who will see me out when the time comes," that in the sig I'd find a man's name. Sorry, Kate. With your each new posting, Ronni, my admiration and gratitude grow. Think of you so often, here, a couple of blocks up Bedford from your old digs. —df
————

If a person attempts suicide but is not successful, are they prosecuted?

When my mother had dementia, I wished there was something like MAID for her. She seemingly sensed when it was “time,” and stopped eating. After checking for medical reasons such as infection (there were none,) we opted to forgo tube feeding. She died 10 days later, relatively peacefully.

Dear Ronnie and Friends, what if the Bible is absolutely accurate? What if the Lord is real, and that death is the beginning of conscious eternity to be experienced in one of only two places?

Dear Sue -- I know what you're getting at, but everything revelatory that I've experienced in life -- whether from a supreme being, or nature or other people or animals -- is that what's important is not how we die, but how we live, especially how we treat others and share the love that has been shared with us, and that I believe is the force that drives everything. Regardless of our theology, if we live in accordance with the message that Jesus shared in the Beatitudes, we should have no reason to fear the darker of the two places, even if those do turn out to be the only options (which I very much doubt is the case).

So well said, Cathy J.

Thanks.

Oh Vera D and macmsue....I love you. You speak exactly how I feel. So many fine intelligent rational people on Ronni's site. I will miss Ronni and all of you when the time comes for her.

And Susan L😊

Ronni, my first thought is you take us with you wherever you are and prompt us to explore what we think about complicated issues.

As a retired clinical social worker, I want to make a distinction between suicide as a result of terminal illness and suicide from depression. As someone commented above, he's glad his attempt was not successful as a teen. Depression is generally a treatable illness and people can get better and feel better. This is not true for terminal cancer. I would be concerned if some of the guardrails were removed and suicide means became more easily available to people with depression or other mental health issues. For some, suicide can be an impulsive reaction to a situational trigger. In an emergency setting with suicide ideation, the person is always asked about access to weapons or pills (means) to determine risk because we know the desire will often pass. So, while both are suicide, one is a reasonable response and the other is almost always tragic.

Sadly, the word suicide is loaded in our culture. The term "committed suicide" is the term we use, as if suicide were a crime! We "commit" murder, "commit" grand theft, "commit" rape. Suicide is NOT considered a crime by anyone who carries an ounce of compassionate in their bones. Having lived through it, I am especially careful to use more appropriate and compassionate languaging, such as "took his own life' or "suicided" rather than label a person who was suffering so immensely that they couldn't bear to remain in their body any longer.
With regard to Medical Aid in Dying being suicide, it was explained to me at a Compassion and Choices conference that suicide is a choice between living and dying. Since in order to access MAiD one has to already be dying, the choice is between dying this way or another way. Were the people who lept from the burning towers on 9-11 committing suicide? No, they where choosing to die by jumping rather than by being burned to death. People who access MAiD do not WANT to die rather than live. They want to be able to avoid the anticipated suffering due to their particular illness trajectory, and find solace in having some control over their ending. There is nothing redemptive about end-of-life suffering. And if you have ever sat at the bedside of someone in intractable pain, you would most certainly wish for them to be able to end it.

Absolutely, Susan! Very clear elucidation of the difference between MAiD and "suicide".

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