Assisted Suicide: How Patients and Families Really Feel
Aug 21, 2019
Assisted Suicide is an important societal debate that may resonate particularly with individuals who suffer from serious illnesses. Should active euthanasia be allowed? What about assisted suicide or indirect euthanasia? How should the law regulate these practices? We asked Carenity members in the United States, France, the United Kingdom, Germany, Italy, and Spain: more than 3,000 members responded to our survey!
Assisted dying* is not unconstitutional in the United-States
* Assisted dying is a synonym for assisted suicide, but without the negative connation often affiliated with suicide.
Reminders of the legislation in force in the USA
1997: The Supreme Court in the case of Washington v. Glucksberg left the matter of constitutionality of the right of an individual to have a physician assist in facilitating his/hers death to the states, and therefore, ruled that state laws banning physician-assisted suicide do not violate the Constitution.
1997: Oregon's Death with Dignity Act becomes law and becomes the first state to legalize physician-assisted suicide.
2009: The Washington Death with Dignity Act goes into effect and it becomes the second state to legalize physician-assisted suicide.
Today, Vermont, the District of Columbia, Oregon, Washington, Hawaii, Colorado, California, Montana, New Jersey and Maine have legalized physician-assisted suicide (New Jersey's law is currently facing a legal challenge and is now under a temporary restraining order. Physicians may not prescribe medications under the law.).
The different forms of assisted dying
Allowing end-of-life assistance can take many forms that do not have the same legal implications. Not all of them are allowed, even in countries that have legalized one of these practices.
Active euthanasia: The deliberate administration of lethal substances with the intention of causing death, at the request of the patient who wishes to die, or without their consent, upon the decision of a relative or medical professional
Passive euthanasia: Refusal or cessation of life-sustaining treatment
Indirect euthanasia: The administration of treatment, generally to reduce pain, that has the consequence of facilitating the patient's death sooner
Assisted suicide: The patient ends their own life, guided by a third party who has previously provided them with the information and/or means necessary to commit suicide
The law does not go far enough according to our members
Carenity members in the United States are the most satisfied with the law in force in their country, but it should be taken into account that there is no single law in the United States: 9 out of 50 states and the District of Columbia allow assisted suicide. Yet, only 29% think that the law is fine as it is; 69% think that the law does not go far enough.
In comparison, only 10% of the British respondents to our survey consider that the law is fine as it is: 88% think that the law does not allow assisted dying easily enough. (Assisted suicide is currently illegal under British law)
Carenity members in the United States are still largely in favor of all forms of assisted dying, whether indirect euthanasia (72%), passive euthanasia (70%), active euthanasia (62%) or assisted suicide (61%). After Spain, this is the highest rate of approval for assisted suicide. Active and indirect euthanasia rates are below the global Carenity average.
Members support the right to assisted dying
Many justifications for assisted dying
Having an incurable disease, knowing that the end of life is near and certain, being in full possession of intellectual faculties at the time of the request... These are all situations that would justify access to assisted dying according to the respondents to the survey. Two situations particularly moved patients and their relatives in the United States:
- The patient is suffering intolerably (89%);
- The patient has written advance directives specifying the desire for an assisted end of life (84%).
Even 19% of members that participated in the survey felt that assisted dying should be considered under any condition.
Only 33% of members have already thought about assisted dying
33% of our American survey respondents have already considered an assisted end of life due to their illness. This is less than in the United Kingdom, where 43% of patients have thought about it (and far less than in Spain where more than half of the respondents have considered it). Yet, the members of both the UK and the US share the same anguish: suffering in an intolerable way.
Ending physical suffering is the main reason why members said they would consider an assisted end of life, with the second reason being that members do not want to become a burden on their loved ones. Additionally, many members said they would consider an assisted end of life if they knew for sure that their condition could not improve.
Only a few respondents know about advance directives
What are advance directives?
Advance directives are your written instructions about the treatments or medical procedures you want or do not want if one day, after a serious accident or as the result of a serious illness, you can no longer communicate. Advance directives concern the conditions at the end of your life, i.e. to continue, limit, stop or refuse medical treatments or procedures.
Health professionals, generally, must respect the wishes expressed in advance directives. Please note that some states combine a living will and a durable power of attorney together as an Advance Directive.
Only 16% of US members from the survey have already written their advance directives, while 31% were not aware that they existed! This lack of knowledge of available options may explain why 57% of respondents would like to make advance directives mandatory. This would ensure that all individuals are informed. On the other hand, in Germany, 53% of members have already written their advance directives and 75% of German respondents would also like to make them mandatory.
Members tackle the issue with their loved ones
71% of our respondents have already talked to their loved ones about the end of life care and death they want. 36% have even chosen a trusted person.
Any adult may appoint a trusted person through a power of attorney. A power of attorney is a legal document that gives someone you appoint the power to act in your place. A durable power of attorney ensures that power remains in effect even if you become incapacitated. It can be used for medical care and finances. With a valid executed durable power of attorney, if you ever become incapacitated, that appointed person named as the durable power of attorney will be legally permitted to take care of important matters for you, such as paying bills, managing investments, or directing your medical care.
Yet, making that step may be emotionally and psychologically difficult, as 38% of members who have not yet appointed a power of attorney or created advance directives said they would rather not think about their end of life.
What about members opposed to assisted dying?
Although a minority, some of our respondents did express opposition to an assisted end-of-life. Moral and religious beliefs dominate their responses:
“It's unnatural, it's similar to abortion. Only God can decide.”
"It’s not for us to choose when our life should end that’s God's.”
“It should be their choice but patients need to understand what is going on in their body before making any decision.”
"It just sounds wrong to me."
Other members from different countries have also pointed out that, despite their conviction, they would sympathize with the suffering and respect the decisions of others. Many also express disappointment and frustration that palliative care is not yet up to the task of relieving the pain of patients and that the family of some patients are not up to the task of supporting their loved ones.
What is your opinion on assisted dying? Do you think there is a taboo around it? How could the law be improved?
Survey conducted in July - August 2019 among 3,007 Carenity members in France, Italy, United Kingdom, Spain, Germany and the United States. All members (patients and caregivers) were invited to give their opinions.