“Patients may be less likely to try to end their lives early in an illness if they know there are legal options should the pain and suffering become unbearable.”
-Andrea Maikovich-Fong, PhD, ABPP
As a cancer psychologist I believe deeply in the power of candid dialogue, the courageous type that comes from leaning into, not turning away from, what is uncomfortable or difficult to discuss. So let’s start an uncomfortable conversation by stating a difficult truth. The human body has the potential to experience immeasurable and excruciating amounts of pain. Pain that causes people who once ran marathons or corporations to curl into a ball and sob uncontrollably for hours. Pain that can become so severe one must choose between intolerable suffering and being medicated beyond the point of self-recognition. Pain that is so overpowering and difficult to watch that it robs those at the end of their lives from authentic connections with loved ones, and leaves loved ones with horrific images of a once dignified body and mind reduced to primal suffering.
Despite the hundreds of ways human bodies deteriorate, my clinical work has convinced me that the human spirit is unfathomably resilient. We humans want, desperately, to survive whatever ailments befall us. Faced with physical transformations, grim statistics, and five thousand variations of pain, we endure because we want to live. I have witnessed the grace, courage, and tenacity humans can demonstrate amidst the most difficult of human conditions.
Unfortunately, there is sometimes a point at which the human body no longer has the capability to successfully heal, and it is inevitable that death will come soon. At this point, suffering is no longer a sacrifice bravely made toward the end goal of ultimate survival, but for some it becomes simply a painful state that precedes an inevitable, close death.
Through hundreds of conversations with people facing life-threatening illnesses or the end of their lives, I now hold as truth that as human beings we must strive to help each other maintain dignity and self-efficacy throughout life’s challenges. There is no time when this commitment to each other is more important than at the end of life when tremendous suffering is involved.
Another uncomfortable truth is that there simply are more and less peaceful deaths. One of the factors that differentiates between these is the degree to which a person maintains a sense of dignity and a sense of control at the end of life. I believe that when there is suffering without any hope of recovery, and when that suffering becomes intolerable, offering the choice of aid in dying may be the ultimate way to care for each other and honor each other’s dignity and humanity.
In conversation with a cancer and chronic pain patient who is among the bravest, most insightful people I have the honor of knowing, I have also thought about how aid in dying may actually result in the extension of life, and in decreased suicide rates among the terminally ill. Her perspective, which she gave me permission to share, is one of someone who lives with at times paralyzing fear of future increases in pain and of burdening her loved ones. She feels that terminally ill people may be less likely to end their lives through fear-inspired suicide early in a disease process if they know that there are legal options that would be available if they reached a point of impending death and intolerable pain. She feels that this option may also create space for conversations between the dying and their loved ones where loved ones may come to more of an understanding and acceptance of death. She discussed how aid in dying could “take some of the fear out of dying,” and may help people feel more in control and choose to live in as connected and meaningful a way as possible for as long as possible.
Nothing about this topic is comfortable. Nothing about death and suffering is easy to talk about. However, I believe that we fail each other as human beings if the consequence of our discomfort is that we do not acknowledge and recognize how offering the choice of aid in dying supports the basic human right to dignity and self-control at the end of life.
Andrea Maikovich-Fong, PhD, ABPP is a board-certified clinical health psychologist who works with cancer patients. Her words reflect her opinions only, and in no way reflect those of her employer.