My thoughts as a death doula and former hospice director on one of the most ethically loaded, emotionally charged topics within the deathcare space: Medical Aid in Dying (MAID)
Maura, I appreciate your candor around not knowing quite how you feel, and that you shared your belief within the context of “at this time.” One of the most unfortunate aspects about aid in dying (and all other legislation around choice of any kind, really) is that so much of it is based on opinion (and religious beliefs) about what peoples’ rights “should” be.
I was very disheartened (read furious) at the conference when in one of the breakout sessions some providers were discussing their thoughts around whether folks with a history of suicidal ideation (SI) should have access to MAID. I passionately remarked that if I, someone who has wanted to die since the age of eight but has chosen to stay decades beyond that, was told upon having a terminal diagnosis that I couldn't access a clean and peaceful death because of my past SI (which I never acted on but clearly could have) I would 100% lose my shit.
At the end of the day, those who want to die are going to kill themselves, anyway, most likely with violent means (like a firearm). I have one friend whose father suffered for a decade from debilitating back and neck pain from a work accident and he shot himself in their home. Another friend's father shot himself as his dementia worsened. He couldn’t access MAID because of “capacity” and what’s worse his DNR was rendered null and void and he was resuscitated against his wishes (and later had to be removed from life support) because suicides in many states negate a DNR. My old employer’s father with dementia hung himself. Rather than having the blessing of their people, and the ability to be handheld through their chosen transition these folks died alone in traumatic ways (and I have so many more stories within one to two degrees of separation like this).
As someone who lives with chronic depression that isn’t like the temporary situation you shared about (like when folks are deep in the throes of grief) I get to decide when enough is enough. Full stop. I, and others like me who have tried endless treatments throughout their life (SSRIs, electroconvulsive therapy, ketamine, psilocybin, and more) deserve the right to say when we are done trying. Seriously.
I had a friend who never understood anything about my depression or ideation…that is until she got postpartum depression. She cried and cried to me about how sorry she was for downplaying my lived experience saying, “I had no clue.” and, “I just didn't know” I cried with her replying, “I’m just glad yours is most likely temporary." And it was. 10 years later she’s forgotten what it was actually like and has lost the empathy and compassion she had for my experience. She is back to trying to “silver lining” me and talking about how “great of a life” I have.
I teach about non-carceral support for SI and have moved in ideation spaces for 30 years. I 100% believe in people's rights to choose to live or die, regardless of circumstances around why (including terminality). I agree that the systems we live in are failing us and that poverty and lack of access to things like healthcare are heartbreaking reasons for people to want to die. That said, our standard suicide “prevention” models are rooted in control and coercion.
I also live with chronic pain from a genetic condition. The pain has, and will continue to be, lifelong. The irony of my mom’s favorite anti-suicide quip that it’s a "permanent solution to a temporary problem” is so out of touch because it’s literally not a temporary problem. I believe in the right of folks to choose to end their life for any reason, and to have support in doing so. But we are VERY far off from that being an option in our country where not even a quarter of our states even have MAID for terminal DX.
Tawnya, your lived experience and clarity are a powerful voice in this conversation. I was deeply moved reading your words, especially your point that those who want to die will often find a way, and that denying access to MAID for people with a terminal illness doesn’t protect them, it isolates them. The stories you shared are devastating, underscoring the real human cost of our current policies.
Also, as a side note, I’m so grateful you called out my “at this time” language. This is an evolving topic for me, and hearing your perspective gives me even more to sit with. Thank you for being in this work, and for saying what so many are afraid to say out loud.
This may be too controversial. And not everyone will understand this belief. So it’s difficult sharing this. But I believe when it comes to our death, it’s our own free will. It’s our soul’s choice when we leave this physical earth. Regardless of the manner of death (suicide, cancer, accidents, MAID, heart attack) we choose when it’s our time to leave. Not God, but me. Or you. Or the thousands of people around the world dying this moment.
Many people will push back and say, “what about murder? Was it their choice?!
And my answer is yes. Sadly, yes. 💔
It goes much deeper than most can comprehend.
We come here on earth to experience love, joy, grief, fear, hate, happiness, envy. All the things. Which includes when we die.
We think death is the worst outcome anyone can experience. What if death is a gift? A gift the for the person who died and a gift for the living. This life is so beautiful and sacred. And if someone chooses to not suffer towards the end of a terminal illness, that is their choice. There is no right or wrong way to die.
This is most definitely a subjective opinion. Thanks for giving me the space.
What you’re writing is so important. And I am here for it.
Thank you for sharing so openly. Your words made me think of the powerful conversation between Stephen Colbert and Anderson Cooper on grief—how we must be grateful for all of it.
Colbert says: “It’s a gift to exist, and with existence comes suffering, and there’s no escape from that... If you are grateful for your life—which I think is a positive thing to do—then you have to be grateful for all of it. You can’t pick and choose what you’re grateful for.”
Appreciate this article, Maura. My grandmother died a slow, painful death that was incredibly hard for everyone involved. No one should have to die like that, and despite the complications and challenges that come with MAID, I believe it is worth finding a way to make work. Your considerations and insights here are a great contribution to the space.
Eric, thanks for the kind words. I'm sorry to hear about your grandmother's challenging experience at the end of her life. No one should have to go through that. I'm so grateful you took the time to read my piece!
This reminds me of the film, The Sea Inside/Mar adentro (https://en.wikipedia.org/wiki/The_Sea_Inside) - a film we watched in 11th grade Spanish class! We had to reflect on the film afterwards (in Spanish of course) and it was a very vulnerable and kind moment of discussion and care. We deserve the space to explore and contemplate, especially when it comes to something like MAID. Great post and looking forward to the next Death over Coffee.
Maura, I appreciate your candor around not knowing quite how you feel, and that you shared your belief within the context of “at this time.” One of the most unfortunate aspects about aid in dying (and all other legislation around choice of any kind, really) is that so much of it is based on opinion (and religious beliefs) about what peoples’ rights “should” be.
I was very disheartened (read furious) at the conference when in one of the breakout sessions some providers were discussing their thoughts around whether folks with a history of suicidal ideation (SI) should have access to MAID. I passionately remarked that if I, someone who has wanted to die since the age of eight but has chosen to stay decades beyond that, was told upon having a terminal diagnosis that I couldn't access a clean and peaceful death because of my past SI (which I never acted on but clearly could have) I would 100% lose my shit.
At the end of the day, those who want to die are going to kill themselves, anyway, most likely with violent means (like a firearm). I have one friend whose father suffered for a decade from debilitating back and neck pain from a work accident and he shot himself in their home. Another friend's father shot himself as his dementia worsened. He couldn’t access MAID because of “capacity” and what’s worse his DNR was rendered null and void and he was resuscitated against his wishes (and later had to be removed from life support) because suicides in many states negate a DNR. My old employer’s father with dementia hung himself. Rather than having the blessing of their people, and the ability to be handheld through their chosen transition these folks died alone in traumatic ways (and I have so many more stories within one to two degrees of separation like this).
As someone who lives with chronic depression that isn’t like the temporary situation you shared about (like when folks are deep in the throes of grief) I get to decide when enough is enough. Full stop. I, and others like me who have tried endless treatments throughout their life (SSRIs, electroconvulsive therapy, ketamine, psilocybin, and more) deserve the right to say when we are done trying. Seriously.
I had a friend who never understood anything about my depression or ideation…that is until she got postpartum depression. She cried and cried to me about how sorry she was for downplaying my lived experience saying, “I had no clue.” and, “I just didn't know” I cried with her replying, “I’m just glad yours is most likely temporary." And it was. 10 years later she’s forgotten what it was actually like and has lost the empathy and compassion she had for my experience. She is back to trying to “silver lining” me and talking about how “great of a life” I have.
I teach about non-carceral support for SI and have moved in ideation spaces for 30 years. I 100% believe in people's rights to choose to live or die, regardless of circumstances around why (including terminality). I agree that the systems we live in are failing us and that poverty and lack of access to things like healthcare are heartbreaking reasons for people to want to die. That said, our standard suicide “prevention” models are rooted in control and coercion.
I also live with chronic pain from a genetic condition. The pain has, and will continue to be, lifelong. The irony of my mom’s favorite anti-suicide quip that it’s a "permanent solution to a temporary problem” is so out of touch because it’s literally not a temporary problem. I believe in the right of folks to choose to end their life for any reason, and to have support in doing so. But we are VERY far off from that being an option in our country where not even a quarter of our states even have MAID for terminal DX.
Tawnya, your lived experience and clarity are a powerful voice in this conversation. I was deeply moved reading your words, especially your point that those who want to die will often find a way, and that denying access to MAID for people with a terminal illness doesn’t protect them, it isolates them. The stories you shared are devastating, underscoring the real human cost of our current policies.
Also, as a side note, I’m so grateful you called out my “at this time” language. This is an evolving topic for me, and hearing your perspective gives me even more to sit with. Thank you for being in this work, and for saying what so many are afraid to say out loud.
This may be too controversial. And not everyone will understand this belief. So it’s difficult sharing this. But I believe when it comes to our death, it’s our own free will. It’s our soul’s choice when we leave this physical earth. Regardless of the manner of death (suicide, cancer, accidents, MAID, heart attack) we choose when it’s our time to leave. Not God, but me. Or you. Or the thousands of people around the world dying this moment.
Many people will push back and say, “what about murder? Was it their choice?!
And my answer is yes. Sadly, yes. 💔
It goes much deeper than most can comprehend.
We come here on earth to experience love, joy, grief, fear, hate, happiness, envy. All the things. Which includes when we die.
We think death is the worst outcome anyone can experience. What if death is a gift? A gift the for the person who died and a gift for the living. This life is so beautiful and sacred. And if someone chooses to not suffer towards the end of a terminal illness, that is their choice. There is no right or wrong way to die.
This is most definitely a subjective opinion. Thanks for giving me the space.
What you’re writing is so important. And I am here for it.
Thank you for sharing so openly. Your words made me think of the powerful conversation between Stephen Colbert and Anderson Cooper on grief—how we must be grateful for all of it.
Colbert says: “It’s a gift to exist, and with existence comes suffering, and there’s no escape from that... If you are grateful for your life—which I think is a positive thing to do—then you have to be grateful for all of it. You can’t pick and choose what you’re grateful for.”
Here's the full interview: https://www.youtube.com/watch?v=YB46h1koicQ
Thank you for keeping an open heart and mind.
I can’t wait to listen to this interview. I appreciate the share.
Keep shining your light and doing your thing 😊
Appreciate this article, Maura. My grandmother died a slow, painful death that was incredibly hard for everyone involved. No one should have to die like that, and despite the complications and challenges that come with MAID, I believe it is worth finding a way to make work. Your considerations and insights here are a great contribution to the space.
Eric, thanks for the kind words. I'm sorry to hear about your grandmother's challenging experience at the end of her life. No one should have to go through that. I'm so grateful you took the time to read my piece!
We come here not only as students but as teachers for those around us.
Our choices, while still our own, affect others and (this may not sit well with others) were agreed upon before entering the body.
I believe in death with dignity and not many are afforded such a luxury.
It is the second greatest event for all of us while on this earth and a gift.
What better way to engage with it surrounded by loved ones and feeling at peace know that you made this choice out of love for yourself?
Marty, thank you for reading and for taking the time to share your perspective. I’m grateful for this kind of thoughtful reflection and conversation.
This reminds me of the film, The Sea Inside/Mar adentro (https://en.wikipedia.org/wiki/The_Sea_Inside) - a film we watched in 11th grade Spanish class! We had to reflect on the film afterwards (in Spanish of course) and it was a very vulnerable and kind moment of discussion and care. We deserve the space to explore and contemplate, especially when it comes to something like MAID. Great post and looking forward to the next Death over Coffee.
I also watched this in Spanish class! Must re-watch now. Thanks for sharing.