Life is precious … so when we get ill, we fight.  We try hard to stay healthy as long as we can.  When we get ill, we take advantage of the miracles of modern medicine.  And we often find we can tolerate lots of pain and suffering … more than we thought we could when we were healthy.  But eventually, death becomes inevitable, and for most of us, our goal shifts from avoiding dying, to having a good death.  An easy death.  A death in which our pain and suffering are minimized.

The concept of having a good death is not new — it goes back thousands of years. And mostly, it’s not controversial. The hospice movement is one outgrowth of this. Tenets of the hospice movement include: Minimize the dying patient’s pain and suffering. Take advantage of all possible options for palliative care. Don’t spare the pain medications. Forgo further medical treatments and procedures if they are likely to be futile and cause only further suffering. Have your loved ones with you. If possible and appropriate, die at home.

But palliative care can only do so much. Depending on what we’re suffering from and our particular situation, often the dying process can be torturous. For many of us who have been caregivers for dying loved ones, we know all about this. Dying of cancer, stroke, heart disease, and neurological diseases like Parkinson’s and ALS can often entail immense, intolerable agonies. Often, it’s not easy getting out of this world!

As a mentally competent adult, we can choose not to suffer through those agonies. To have a peaceful death. To cut our suffering short. To make a “final exit”. Fortunately, we live in a time where a peaceful death is possible. Our doctors can make sure our dying is easy, if they are allowed to.  So there’s the logic. When death is inevitable anyway… why live through the final and so unpleasant stages of your bodily disintegration?

This is the most personal of choices. Every person is different and every situation is different. Not every dying process entails such great pain and suffering, and at that final stage, every one of us will have a different perspective. Making a final exit and cutting your suffering short is never an obligation. It’s a choice that should be available to all of us, and that some of us will make.

Sometimes pain and suffering become intolerable, even if one is not “terminal” — in other words, even if death is likely more than six months away. Parkinson’s, ALS and other neurological diseases often fit this profile.  We believe that your right as a mentally competent adult to make a final exit, should depend only on your own judgment of how intolerable your physical suffering is.

Dementia:  Alzheimer’s and other forms of dementia are exactly what we are talking about, when we say that sometimes pain and suffering become intolerable, even if one is not “terminal.” These diseases will eventually kill you, but typically after years of horrible suffering. You don’t know who you are, who your loved ones are, where you are. You lose the ability to speak, to eat. If you’ve cared for someone with Alzheimer’s, you know all about this. For someone in the very early stages of dementia, it can be a very rational choice to say, “I want to cut my suffering short. I want to die now.” And if you’re still mentally competent, you should have that right.

It’s not suicide.

Legally, taking advantage of an aid-in-dying law is not suicide. If you do, your death certificate will list your underlying illness(es) as the cause of death. Morally and ethically, there’s a vast difference between choosing to spare yourself final agonies, versus suicide as it is commonly understood: the irrational act of a depressed or mentally ill person. That’s not what death with dignity is all about. Sparing yourself from suffering through final agonies is a fully rational, humane and wise choice.

Loved ones and physicians are protected if they assist.

Assistance is not always necessary, but it must always be available. The essence of aid-in-dying laws is that loved ones and physicians are protected if they do assist. And we typically do need assistance. We are helpless when we come into the world, and helpless when we leave it. In any event, for all of these reasons: the proper terms are aid-in-dying, medical aid in dying, assisted dying, or death with dignity. Don’t call it “suicide” or “physician-assisted suicide”.

It’s what doctors should do.

It’s fully consistent with the two highest duties of a physician: to cure, and to relieve suffering. When cure is no longer possible, relief of suffering is the only thing that counts. There’s no incompatibility with the hippocratic oath and indeed with any part of the moral calling of physicians. Aid in dying is for everybody, religious and non-religious. Suffering is NOT part of God’s plan.

There is no ‘slippery slope’.

Years of experience in the US (where the Oregon law was first passed in 1994) and in European countries with death-with-dignity laws, prove that no one is being pressured to end their lives. Aid in dying laws include stringent protections for the vulnerable. The “slippery slope” is not a real concern. You can’t be coerced. With an aid-in-dying law, if you’re a mentally competent adult, it’s always your choice to hasten your death, or not to. It’s never your mandate or obligation.

It’s fully consistent with doctors’ roles and responsibilities.

A doctor’s duty is two-fold. First, to heal, and second, to relieve suffering. And when death is imminent and/or suffering is intolerable, we should be able to call on our doctors for assistance. Many compassionate and humane doctors and nurses have always done this … but it’s been under the table, hidden and not acknowledged. It should be legal, out front and open. (In fact, only by making it open can we ensure that safeguards are adhered to.)