Like other posters, my views on dying are influenced by my experiences. Eldercare (for family in the US) has been my primary focus for the last decade; I've had endless discussions with physicians, nursing staff, social workers - and with the bureaucrats who control a large part of access to services.
Having first hand navigated the bureaucracy, I do worry about that end of life options are being defined by cost pressure.
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Suicide is not the only way to avoid dying in pain and suffering. Palliative care is the 'third choice'. With palliative care one can be kept comfortable, supported both physically and emotionally, and die naturally.
There is a lot wrong with the US health care system, no doubt. But one thing US public health care (currently) gets right is funding hospice care.
Once a doctor determines that a patient has less than six months to live the patient is eligible for a hospice program, the expenses of the program are paid by Medicare. I am so grateful that this program exists as it means that money does not have to be a factor in the comfort of one's final days.
Hospice is palliative care - this is not prolonging life, but rather allowing the dying process to happen while mitigating pain and suffering. A hospice patient has access to whatever pain meds are necessary, there are no restrictions. But it's far more than medicating - it's all about care. It's about valuing the person until the end.
In the hospice programs my father and MIL used the patient has his own care team - a coordinating social worker, nurses and aids trained to work with the dying, and a raft of services designed to keep the patient comfortable and emotionally supported to the end. One may stick with one's own doctor - who presumably has known the patient for years - if one wishes to.
Via hospice, my father and MIL had access not only to physical comfort but also to emotional support such as counseling, massage therapy, music therapy, visiting pets therapy. Whatever it took to make the brighten the patient's day, to ease their fears.
Hospice also provides support, both practical and emotional, for the family - and most importantly helps us help our loved ones through the dying process.
My father was an Alzheimer's patient; the hospice staff were able to reach him at a level that where other medical professionals couldn't. MIL found it difficult to come to terms with the inevitable, thanks to support from hospice she found emotional and spiritual comfort. Both died at peace.
Had we not had access to this outstanding program both dad and MIL would have faced a very different end.
(From what I've read, not many people in Switzerland even know that palliative care is available here, as the assisted suicide debate has overshadowed discussion of this option.)
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But hospice is expensive.
As healthcare costs rise, what will happen to these services that help the dying? As suicide becomes the acceptible choice, will resources be taken away from palliative care? And what frightens me most: will there come a time when the choice is no longer mine to make?
IMO, based on what I see daily in eldercare, I worry that the pendulum has swung too far. Society already devalues the elderly, begrudges resources spent on them.
As that excellent BBC article linked by Island Monkey discusses, when one is young and healthy one perceives quality of life very differently than when one is elderly, ill, or disabled. When my time comes I certainly do not want a 30 year old doctor judging my quality of life or making a call to end it - because we do not use the same scale of measurement.
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Given the current state of US finances, I have no fear of being hooked up to machines and kept alive against my will. Rather I fear the opposite:
As suicide becomes more common, how long before some policy wonk decided that a lot of money could be saved by no longer funding hospice programs?
How long before a doctor - or worse, a bureaucrat - decides that a patient's value to society is not worth the cost of caring for him? How long before a patient is not even informed of his options?
I only know of the Liverpool Care Pathway from what I read in the Daily Wail. (i.e., allegations of financial incentives paid to trusts based on the number of patients put on the LCP) But DM hype aside, if in the UK decisions are already being made unilaterally, without the patient's consent - that makes my blood run cold.
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I would never choose EXIT for myself, but I am a proponent of self-determination. Emphasis on the 'self' part. Since the abortion comparison has already been made, I'll turn to Bill Clinton's quote: Like abortion, assisted suicide should be safe, legal... and rare .
But given that the pendulum has swung so far - how do we safeguard the vulnerable?