Why Some People Want To Die: Exploring End-of-Life Options & Issues

Over the past few years, through my interactions with many elderly and ill patients, I have come to understand something that I never understood before: why some people want to die.

There are many people who, due to their advanced age or a severe illness, are ready to die, and they think about dying almost constantly.

They want to die. They want the right to choose an end-of-life option.

This has been a surprise to me, and the tension it creates with healthcare personnel, as well as the struggle it creates for the patients and their loved ones, is an issue of epidemic proportions.

Our healthcare system doesn’t seem to recognize this as an important issue, and our society doesn’t seem willing to hear or accept it.

Our healthcare system seems much more comfortable keeping people alive, even though their quality of life may be very poor, rather than allowing them to die at a time and place, and in a manner, of their choosing.  So the healthcare system is at odds with, and unwilling to support, the wishes of a substantial number of people, and that number is growing dramatically.

Why Some People Want to Die: Exploring End-of-Life Options & Issues

How we deal with this issue, as a society, as individuals, and as medical professionals, says a lot about who we are as a culture. I believe that we will be judged, as a culture, by how we care for our most vulnerable populations–the elderly and the ill.  Right now, we are failing.

This question has long been contemplated and debated: Should a competent person have the right to choose when it’s their time to die?  Should our society support end-of-life decisions?

We have made some progress in providing relief for people with clearly diagnosed terminal illnesses in certain US jurisdictions, but what about those who don’t live in one of these jurisdictions, or are not terminally ill with a prognosis of less than six months to live? What about people who are not comfortable with the concept of Medical Aid in Dying, or can’t afford it? What can we do for them?

While clearly public opinion and political persuasion influence legal decisions on end-of-life options, it is a very personal choice. It’s likely the biggest personal decision a person will ever make. While it may be influenced by many factors, such as personal relationships, religious beliefs, access to adequate medical care, etc.  sometimes it just comes down to a person deciding that they are “done.”  Their mind may be sharp as a tack, but their body is failing them. They are trapped in a body that is providing no comfort or joy, only pain and limitation, and they are all too aware that their circumstances will not improve.

They want to die.

So what can we do to support these people, while staying within the boundary of legal and ethical practice?nbsp;This is a challenge, and it will become a greater challenge over time, as the number of people becoming very old, frail, and ill increases dramatically.

I recognize that there are many people who want to live as long as possible, even when they are dealing with challenging circumstances that others would not find acceptable. And we clearly need to continue supporting them to the best of our ability. But there are many, certainly more than most people would imagine, who want to die as quickly as possible, and if given the freedom to do so, and the necessary means and support, would choose an end-of-life option that is in alignment with their personal values ..

Some of these people are dying from a terminal illness that is progressing rapidly, causing pain, difficulty breathing, profound weakness, loss of control of their bodily functions, and other distressing symptoms. They are fearful of what lies ahead, and of losing the ability to make their own decisions.  For these people, having control over the manner of their death, rather than allowing the disease (and their medical providers) to control and dictate their fate, is the only form of control they have left. Most of these people tell me they’ve had a good life, a meaningful and productive life, and they don’t want a drawn-out, struggle-filled, undignified ending to that life. They believe they deserve better.

Other times, these are people who don’t have a rapidly progressive terminal illness. Sometimes they don’t have a terminal illness at all.  They may be very old, increasingly frail, or suffering from a condition that is causing them “unbearable and hopeless suffering.”  What I hear from these people is that they feel like they’re “done”. That they’ve lived beyond the point they should have. They’ve lived complete lives and believe there is no reason to continue fighting and struggling to get through each day.  Like those with a clearly terminal illness, these people do not suffer from clinical depression and are not “suicidal.” In fact, they don’t really want to die. They just don’t want to live with the circumstances they are in, and they are aware that their circumstances are not going to substantially improve, so they don’t see an acceptable alternative.

I am not suggesting that we, as medical providers, should stop looking for ways to enhance these people’s lives, reduce the burden of their symptoms, identify sources of stress and anxiety, evaluate and treat for depression, etc. I’ve taken care of a number of patients who were told they would be dying soon, but after receiving better medical care and more hands-on therapies, their lives improved and they lived with far more comfort and joy for months or years. My first choice is always to try to provide this type of support.

Why Some People Want To Die: Exploring End-of-Life Options & Issues

Despite these efforts, there are people who are ready to move on, and instead of ignoring their pleas and brushing off their questions, we need to be willing to accept where they are and help them find peace. And if that means helping them understand the end-of-life options available to them for having a peaceful and dignified death, and compassionately guiding them in accomplishing that, so be it. We always need to stay within the bounds of legal and ethical practice, though we need to focus on what is in the best interests of our patients, rather than on what is most comfortable for us as individuals or most acceptable to mainstream medicine.

There are times in our life when we must take a stance—stand up for what we believe is right and just. Sometimes we will be standing alone. Sometimes that stance will cause discomfort.  It may make us vulnerable to attack or derision.

This is one place where I am taking a stance. And while I’m not exactly alone, I am certainly not standing among many of my peers in medicine, who are too uncomfortable with death and too risk-averse to offer this kind of guidance and support to patients and families.

I believe that everyone should contemplate, and talk about death. Our own death and the deaths of our loved ones. Not obsessively, but enough to become relatively comfortable with the concept. Death is the only thing in life that is guaranteed. Being comfortable with it and prepared for it creates a kind of freedom that only those who experience it understand. I’d love to help you experience that kind of freedom.

My patients all tell me that having a discussion about their future, including their death, gives them the freedom and peace of mind to make the right choices for their individual situation.

It often helps to begin this conversation with your loved ones first. If you don’t know how to get that conversation started, let’s have a talk. I can help.

Go ahead and schedule a free phone consultation with me and we can get the conversation started.

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