6-STEPS Living Will
What are the differences between extending life vs. natural death, vs. hastened death?
Some people regard extreme suffering at the end of their lives as a sign of valor and/or an opportunity. It can be an act of heroism and part of the legacy for which they wish to be remembered. Or it can be an opportunity to experience agonies similar to those endured by Jesus on the cross so one can move closer to God. It can also be a way to absorb the pain of others and offer profound acts of charity and in order to pay for one's own sins and those of others. To do this they will opt to use full aggressive treatment that relies on mechanical and pharmacologic means to prolong their lives as long as possible at all costs.
Many others fear the pain of dying much more than they fear death itself. For them, heroism as a different meaning; it is the willingness to accept death on its own terms and to die naturally. Dr Rodney Syme noted that many patients would like to "die at the end of the day, as the sun is setting, rather than in the dark of night". This means rejecting any pharmacologic or mechanical means to artificially prolong a life that would have ended without such intervention. They choose to have a natural death.
As it becomes legally permissible to do so, a growing number of people choose to hasten their deaths, a process often described as "self-deliverance". This cannot be an impulsive decision like jumping off a bridge after being jilted by a lover. Instead, it requires considerable thought and planning. You can consider doing this if you:
have a terminal illness with less than six months to live;
are in extreme distress with a quality of life far below that which you consider acceptable;
are fully capable of making your own decisions; and,
it is consistent with your religious/spiritual beliefs.
Should you meet these conditions you may wish to consider hastening your death using either a passive or active methods.
Passive hastening involves Voluntary Cessation of Eating and Drinking (VSED). This process brings death more slowly than physician assisted death but reliably puts dying under your control. If you do this, you will stop drinking and eating. Your lips and mouth will be dry but drops of water and gels can relieve this distress. After fasting for 1.5-2 days, hunger usually stops and is replaced with a kind of euphoria. A relatively comfortable trajectory death normally takes 5-15 depending on the level of your frailty. Because you do not need a physician's approval to start the process, it is chosen by those who believe that they are beginning to experience severe, irreversible dementia but know that they do not meet the requirements of Death with Dignity statutes. Although the process can be started without a physician, it is very helpful to have a palliative care provider involved to prescribe drugs and procedures that can keep you comfortable. This is not something that you can do alone: you must have family or friends to assist. Because of this level of social support, people who choose VSED can end their lives at home surrounded by the people who are most important to them. For more information: www.caringadvocates.org,
Active hastening can take varied forms. For many years, doctors have slowly increased the medication for intractable pain to the point at which the patient loses consciousness and dies. Other methods involve the use of drugs, helium, or ligatures. Each method results in a relatively rapid death. If your state has enacted a Death with Dignity statute, you must ask two physicians for lethal drugs twice, at a 15-day interval. You must be able to self-administer the drugs in a setting that permits you to do so.
For information about how to end your life with drugs in those states in which physician aided dying is permitted,\, contact: compassionandchoices.org. You can also request valuable information about how to end your life through other means and receive compassionate support from www.finalexitnetwork.org.