The experience in Oregon, USA
For over 20 years Oregon, has had a law permitting assisted death in the very restricted circumstances of terminal illness with a prognosis of less than six months to live. In 2017 a very detailed report was produced of the experience of operating the law. I want to focus on the reasons people gave for seeking VAD. Over 90% cited concerns about losing their autonomy (power over their own lives and decisions). About 75% cited loss of dignity (presumably because of the prospect of intolerable pain). Less than half of the applicants cited the fear of being a burden as a reason for seeking VAD.
I should point out that none of these reasons is a reason for granting VAD in Oregon. The only criterion is terminal illness with less than six months to live.
Of those granted permission for VAD, about 35% did not use their prescription. For those individuals, having permission for VAD is a kind of ‘emotional insurance’. They know that if their illness becomes unbearable, they can end their suffering.
Fear of a ‘bad death’
This fits in with international experience and personal testimony from Ireland and elsewhere that when citizens have the choice to end their intolerable suffering, the ‘fear of a bad death’ is removed. Reassurance about the end of life by qualification for VAD provides relief of stress and enables individuals to enjoy the time that remains to them without the extreme fear of pain and indignity and the fear of being the cause of anguish to their loved ones.
We are social creatures with friends and family who care about us. A ’bad death’ affects them too. It is hard to watch someone you love dying in extreme pain with loss of the dignity that makes them who they are. There is evidence, too, that a ‘bad death’, as well as giving a traumatic experience and horrible memories, can actually interfere with the grieving process of those left behind.
Making available the choice of VAD for those who want it is an act of compassion. Suffering will be reduced in our society, not only for the dying, but also for the grieving.
The Irish Hospice Foundation offers a range of support services for those who are bereaved and grieving.
Alan Tuffery is a member of End of Life Ireland. We are a voluntary group advocating for legislation to allow Voluntary Assisted Dying in Ireland. This is the third in a series of fourteen short articles on issues about voluntary assisted dying (VAD). The first article can be found here, the next article in the series can be found here.