Discussion about “aid in dying” (AID) has re-emerged recently with Diane Rehm’s book and documentary on PBS (“When my Time Comes”), and the Katie Engelhart book “Inevitable”.  And, just in time, this week an acquaintance called me to ask about a friend who wants “Death with Dignity.”  The phrase makes me wince (just as much as “physician assisted suicide”, I think).  I liked the more profound discussion of the role of Aid in Dying by Dr. Lonny Shavelson in a recent “lunch conversation” as part of the Completed Life Initiative series. (https://vimeo.com/534607128)  Shavelson is Chair of the Board of Directors of the American Clinicians Academy on Medical Aid in Dying.  In his presentation, he challenges the false dichotomy between a miserable or a merciful death too often implied by proponents of AID, and their “usurping” of the term “dignity”.  As he points out, “dignity” language linked to AID is deceptive and wrong, even if it may be useful to galvanize the public to adopt state laws that allow physicians to write prescriptions for terminally ill patients.  There are many paths to dignity as we die, many ways to maintain self-respect, and to move into our death in ways which accept and gracefully face our ending.  None are perfect and none is clearly “better.”

I personally find the medical community’s overdue attention to professional involvement in patients’ death and dying to be at an uncomfortable stage right now.  Things are moving fast as ideas of how we can and “should” support dying evolve, and providers and people of good faith come down on very different sides of the discussion.  Even if one supports access to AID, there are injustices to our current boundaries – like 6-month trajectories, exclusion of people with progressive dementia, mandated self-ingestion.  And for me it feels like abandonment if a physician writes a prescription and then steps aside for the actual event, as frequently happens in the US.  But perhaps this is the way such a very new conception of “care” feels its way and matures. 

For too long, extending life has been the goal of medicine -- even at the cost of suffering and postponing the inevitable.  Regardless of personal convictions, we are learning to be comfortable with responding to our patients’ curiosity about AID with our own curiosity about their journey.  We need to be open to exploring fears and dispelling myths.   And yes, for some of our patients, the option of AID provides comfort, a measure of control, and a choice if suffering become too difficult.  Even if we decline to write the prescription, we still need to engage and refer. This supports not only our patients’ dignity but our own.