To Die with Dignity

by Victoria Stirling
- Canada -

"It's not the fact that one day I will die," Joan said, ” The problem I have is wondering just how it’s going to happen!"

En-masse, the 1978 class of nursing students to which I then belonged, nodded their heads. We all agreed with the concerns our peer had voiced.

I’m aware that this is a highly sensitive subject for a lot of people, but it’s one I feel needs to be talked about openly. It's often been said that taxes and death are two inevitable facts of life; this reality applies equally to every one of us, no matter where we reside. Well, our taxes change, but dying remains the same singular experience it has always been. Each of us has to face that final end of life; no one else can do it for us.

From the late seventies up to the end of the nineties I worked as a staff nurse in an acute care hospital. My primary clinical experience was working on a respiratory, cardio-vascular unit. Sadly during that time I was witness to many patients' demise. Some patients went peacefully to sleep, while others endured rigorous resuscitative measures before finally expiring. A number of them suffered much pain, and often prayed or pleaded for release.

The population of our world is aging, regardless of what country you call home. Most of us recognize that truth. Despite our many valiant efforts to change or delay the effects of time, our bodies do eventually wear out.
I’m well aware of the beliefs of pro-lifers in Canada and elsewhere on euthanasia, but that’s not the issue here. What I, and many other people, want is the assurance that when it’s time to die, we will be allowed to do so with self-respect.

Some states in America have adopted the same as, or something similar to, Oregon’s Death with Dignity Law, which gives a person the right to ask for assistance to die when death is imminent. Naturally, this has created heated debate especially from religious groups, and also from some physicians.

When the Oregon Department of Human Services released the fifth year statistics on the implementation of the state's Death with Dignity (DWD) law in 2003, the statistics documented the safety and soundness of the Oregon law: all 46 DWD patients were mentally competent and terminally ill; all made repeated and voluntary requests for assistance; and all had access to (and the great majority were enrolled in) hospice programs. Since the law's passage in 1998, a total of 292 people have died with legal assistance in Oregon.

These statistics are just a small part of what is now known as the "Oregon experience." As Barbara Coombs Lee, President of Compassion in Dying, has found, far more than those who have exercised this option have benefited from the law. She sees the bigger picture and describes it this way: "For every Oregonian who hastened his death, 10 others began the qualification process, hundreds discussed the option with their doctors, and thousands found comfort just knowing they had a choice."

And, shouldn’t that freedom of choice be allowed all people? Unlike the next patient who suffered terribly before finally dying.

In October of 2006 in ”The Last Word on the Last Breath,” Jan Hoffman of The New York Times described the bitter end of one young man who suffered terribly before finally dying:

The male patient was only 35. He had been in a vegetative state for 15 years, and had developed septic bedsores, and pneumonia. His kidneys were failing, and despite the feeding tube, he was losing weight. Now he was in cardiac arrest. He was dying. But the young staff doctor had no choice. The patient’s relatives, convinced that the man could communicate, had insisted that all revival efforts be made. So the doctor gave the patient a few mouth-to-mouth breaths, climbed on the bed and began vigorous chest compressions, trying cardiopulmonary resuscitation. The patient was intubated; shocked with electric paddles, and injected with epinephrine. Blood spurted as a central line was inserted into the large vein in his groin to administer medicine and fluids. EKG electrodes the hospital room filled with people and shouted orders. After 15 minutes, the doctors finally called the time of death.

“Kneeling on that bed,” said the doctor, Daniel Sulmasy, now a New York internist, medical ethicist, and Franciscan friar, “and doing CPR, felt not only pointless, but was like administering final blows to someone who had already had enough of life.”

Recalling this experience from his internship he said, “Why was I forced to crack this person’s ribs? Why couldn’t we have let the patient die in peace?”

Extreme cases like this one are rare - but believe me they do occur. However, the question of who has final say over whether CPR should be attempted on a gravely ill patient - the doctor, the patient or the patient’s representative - is alive and unsettled in both law and medicine.

Hospitals and governing bodies around the US and various parts of the world have been wrestling for years with a “patients’ right to die with dignity.” The major sticking point, as I see it, is balancing competing values.

For example in the British House of Lords the ”Assisted Dying for the Terminally Ill Bill,” was first introduced in 2003. It was unsuccessful, but was then re-introduced to the House by Lord Joffe in November 2005. The debate continued for several months, but the bill was defeated yet again in May 2006.

Nevertheless, Lord Joffe commented, ”Patients want to exercise choice. It is unjust to force them to continue to suffer when there is an answer that is safe and works well.”

It’s obvious from that remark that he remains hopeful that in due time, the bill will be accepted.

This debate also continues in Australia. Reporter Natasha Johnson spoke about the US’s Oregon model for persons’ wanting to choose to ‘die with dignity in a broadcast in March 2002. She reminded listeners to think about their own situations. ”The clock is ticking for all of us, but when our time is up, what will our dying be like?” She then says,

As euthanasia supporters continue to campaign for law reform, a Melbourne hospital is piloting a program aimed at enabling more patients to die with dignity. The "Respecting Patient Choices" project is modeled on an acclaimed American program which encourages people, both sick and healthy, to draw up end-of-life plans. Trained staff will counsel patients about appointing an enduring medical power of attorney and documenting ahead of time what sort of medical treatment they want to receive or refuse, should they become terminally ill and unable to communicate their wishes. In an age of extraordinary lifesaving technology, the program aims to give patients more control over the dying process and spare families the agony of deciding when to pull the plug on medical treatment.

Many doctors believe they should be able to exercise their judgment about whether CPR or other extreme measures in a given patient’s case should be used. However, a patient’s representative, who is often a relative, may believe every medical option should be used. Unfortunately, patients’ families, led on by TV medical dramas, often believe these measures are almost always effective - a notion studies have determined is not necessarily accurate.

What I have found interesting is the Japanese attitude on this volatile issue. They do not regard wanting to end one’s life as a disgrace, as some other societies do.

This is discussed in Rihito Kimura’s “Death, Dying, and Advance Directives in Japan” (John Hopkins University Press, 1998):

“The end of human life should be understood by society not only in terms of medical criteria, but also as a cultural phenomenon. A majority of Japanese feel that modern biomedical and medico technological innovations have effected a change in our common understanding of the process of death and dying. Historically, death was a natural event, and the criteria for death - cessation of heartbeat and respiration - was unquestioned. This is no longer the case.

"An individual's death should be a personal and private matter as well as a familial, communal, and social one. It has been so regarded for many thousands of years in Japanese society and culture. Our traditional socio-cultural understanding of human life admits the natural process of death as a positive event marking of the end of life. The ideas expressed in Zen-Buddhist phrases such as "accept death as it is" and "life-death as one phenomenon" have been a key motif totally integrated in our traditional understanding of life.” (Fuji, M. 1991).

It was not only as a nurse that I saw first-hand how some people die miserably. My dear 100-year-old friend, Connie, had broken her arm. But, the doctors at the hospital’s emergency department, afraid that giving her heavy pain medication might kill her, allowed her to suffer terrible agony, causing her to die anyway. What she went through was unnecessary, inhumane and miserable; it’s something I would never wish on anyone.

I also had another friend whose husband, when his wife (my friend) was in the end stage of a terminal condition, couldn’t bring himself to say to the doctors, ”Let her go peacefully.” It was terribly hard to look at her connected to numerous tubes, plus a ventilator - knowing she had requested that this never be done. I know that it’s never easy letting go of a loved, yet isn’t that kinder than watching them needlessly suffer?

As I'm up to my three-score plus ten years (which is past the time we are all supposedly given), this topic is very personal to me. I have some definite ideas about how I want to go through the last portal of life.

Personally, I do not want to lie anywhere in a vegetative state and linger for months on end. Neither do I want any extreme measures used to keep me alive; for me death would be much better.

I have set all this down in my legal documents. Each member of my family is aware of my feelings, and I feel confident they’ll honor these last requests of mine.

In Canada, like some other western countries, we’re lucky - we already have many inalienable ‘rights’. But, in addition to those, I believe we now need a person’s right to choose how they will go through that final portal. Death is, after all, a normal process of earthly existence, and something that no one, anywhere, should have to face with fear.

But around the world the debate continues over who will make this final decision; it raises fundamental challenges to medical integrity and social ethics since determining who gets to make the final decision also infringes on patients’ individual rights. This delicate arrangement can and does rub feelings raw for many.

Still, I remain hopeful that in the not too distant future all of these arguments will be settled amicably. I, for one, hope an agreement will be reached that will allow people everywhere the right to “die with dignity.“

For more information, further debate and helpful resources, visit PBS' On Our Own Terms page. - Ed.

About the Author

Victoria Stirling is a retired nurse, published freelance writer and the author of the book, “From the Other Side of the Bed.” She is also a lay-preacher for the United Church of Canada.

Born in Newbury, England, Victoria immigrated to Canada in 1966 with her husband Harvey and their two children. She enjoys spending time with her grandson and lives in London, Ontario.

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7 comments on “To Die with Dignity
  1. Renzo Pieraccini says:

    Science and medicine have deeply changed the life during the latest years, it is possible to cute a lot of diseases and we can live longer in good health but at the same time it happens that old and/or sick people can live for a long time suffering a lot of pains and also heavy humiliations, unacceptable for a person. I think therefore that any person should have the right to consciously chose to die with dignity, and it should be possible to decide before, when we are still able to consciously decide.

  2. Nancy Van Ness says:

    It seems to me that many Americans at least, and apparently Canadians as well, do not see the line between euthanasia and allowing someone to refuse extreme medical measures. I understand euthanasia to mean hastening the death of someone who appears to be dying or wants to die by administering drugs or by other means; soldiers on the battlefield have been known to shoot severely wounded comrades in intense pain when there seemed no chance for their survival, for instance. I do not think that is the same as refusing extreme measures of resuscitation or procedures not likely to result in extended life. I especially support the use of medical technology to make patients as comfortable as possible if they choose not to receive extreme treatment.
    I hear Americans equate refusing to force feed someone who is incapable of eating by themselves or refusing to use the electric paddles on a person who shows no signs of heart activity with administering drugs in lethal doses. It looks to me as though these are very different things, but clearly others don’t see it. When we combine a requirement for extreme measures of resuscitation with a prohibition of palliative care and pain management, the result can be torture of the dying person.
    Margaret Edson’s moving play WIT dealt with the issue of medical professionals who want to use their technology no matter what. It was a nurse in that play who had to fight with the doctor for him to honor the “do not resuscitate” order of the patient. The medical profession is certainly clouding the issues, either wittingly or not. The fact is, doctors get paid for doing procedures. They do not get paid as much for keeping people in life threatening situations as comfortable as possible. Even if doctors and other medical professionals are not acting from self interest, even subconsciously, they can be so interested in what they can do, that they fail to make good decisions about what is best to do for the patient.
    This article pushes lots of buttons for me, so I am especially grateful to Victoria and the editors of the WIP for it. I found it hard to read, but I think we need to be thinking about these matters. Respect for human life is at stake.

  3. Sylvia says:

    I strongly believe that we should all have the right to decide to die with dignity…Keeping someone alive and suffering for no reason other than to keep them alive makes absolutely no sense to me…Thank you to the WIP for another interesting article…Sylvia

  4. Anonymous says:

    I’m not a medical professional in any way but Ms Stirling’s article has me wondering about the term “to die with dignity”. I think it means to be honored as human beings and respected for our choices. I believe this is as we should live as well.
    I wonder if we may more positively effect the system of medical care that will be assisting us through our dying process if we take our health care decisions into our own hands and make truly educated choices along the way.
    In addition, and as important,learning to trust our intuitions is key. After all, as we get older we will have lived with our selves longer than anyone else has lived with us. We can’t really depend on anybody else to give us all the facts about our wellness; doctors, like the rest of us, are only human. They make mistakes too.
    So many things are out of our control, and there comes a time when we surrender, but so many things are not. Years of taking prescribed medications, years of medical procedures, poor lifestyle decisions all take their toll on the human body and psyche.
    To consciously live with dignity now opens the way to respect and honor as a way of living and as a way of dying.

  5. This is a contentious one…but i felt very touched by Hoffmann’s testimony on the 35 year old young man who had been ill for 15 years. I really dont know…i have mixed feelings about this. i believe that where there is life there is always hope and as long as one is still alive, everything necessary to keep them alive should be done. i think its unnatural to ask God for death no matter how much pain one is going through but at least doctors should just try and make sure that a person doesnt suffer too much by administering strong pain killers until the time God calls them to eternally rest in peace.

  6. LPR says:

    This is a very good article. We all wonder how and when we will die but I cannot imagine that any of us really want to die suffering and in terrible pain. I feel we should be allowed to die with dignity. It is our right to choose how and when it is time to go. I believe we all truly want to go in peace.
    Thank you for a very interesting article.

  7. David says:

    When I was eight years old, our pet cat, Sammy (around 10 years old herself), was diagnosed with cancer. My parents decided to spend the money to keep her alive, with various treatments. Sammy stayed alive, but was clearly not herself — her energy and playfulness were gone, and she was likely in a fair amount of pain.
    One day, Sammy (who, like the rest of our cats, was an indoor/outdoor cat) just left. We expect she went of to be by herself to die. In our minds, she knew that the treatments she was receiving were sustaining her life — she also knew that it was her time to go. Hence, her decision to take us out of the equation, removing us from any future decision making regarding her life.
    Most people can probably relate to this story, either because they’ve had pets in this situation, or because they can accept that animals sometimes just know when it’s their time.
    Now, if we are willing to concede that a cat can know when its time is up, and can make a conscious choice to die, why can’t we do the same when the animal involved is human?

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