Assisted dying is a topic that has always fascinated me, for various reasons. Firstly, the language used and the phrases to describe ‘assisted’ deaths reveal a lot of moral assumptions: euthanasia, assisted dying, assisted suicide, death with dignity are but a few. None of these are neutral terms.
The term I use myself, euthanasia, betrays my Dutch heritage, as it is the type of assisted dying practised in the Netherlands. In this case, a doctor administers a lethal injection, people don’t have to do this themselves. As I have reflected on in my paper “Doing death”: Reflecting on the researcher’s subjectivity and emotions”, having been raised in a society where euthanasia is available, has shaped the way I have been able to talk about death and dying, and has shaped how I feel about assisted dying. Importantly, the availability of a legal framework that allows euthanasia, does not mean that there is consensus in the Netherlands, as this is still a polarising issue. Some argue the practice should be banned, whilst others argue that more people should be allowed to die the way they want. People who experience ‘unbearable suffering’ can apply for euthanasia. Discussions in recent years have focused on both adding severe mental health problems as well as having a ‘completed’ life as a criteria that would potentially allow people to pursuit euthanasia.
But today we won’t discuss the Netherlands, instead we move to America as anthropologist Anita Hannig has written an ethnography called The Day I died: the untold story of Assisted dying in America. In this book Hannig shows how the US state of Oregon has taken a different approach; those approved to have an assisted death need to ingest the medicine themselves. This places a different pressure on those wishing to have an assisted death. Will they be able to swallow the bitter medication? Will they lose this ability and therefore miss their window to have an assisted death?
The Day I Die is based on Hannig’s ethnographic research. In the prologue you already see how closely she got involved in the project, and how intense this type of fieldwork can be. Hannig describes helping mixing together the cocktail of drugs that subsequently will be ingested by Ken, one of her participants. Assisted dying does not provide a singular death experience and Hannig’s account fleshes out both the diversity of people who consider opting for an assisted death, as well as these diverse dying experiences.
The Day I Die offers the patient perspective, the family perspective, the stories of hospice volunteers, and also includes the voices of doctors who are trying work within the law. The law in Oregon requires people to die within six months. This is mimicked after the timeframe to be eligible for hospice care but surely this has vastly different implications if you live beyond this timeframe. People desiring an assisted death thus need to receive the prognosis from a doctor that they won’t live beyond six months. If the doctor assumes a different timeframe, they are not eligible to pursuit this route.
The real-life accounts described in Hannig’s book show the implications of the 6 months requirement and the complexities of assisted dying. It is rarely a rushed decision, and people can always changed their minds. Hannig carefully shows both the pressure that is placed on doctors and those who wish an assisted death, as well as the relief and comfort when an assisted death goes well. Yet, just because there is a legal framework that allows for assisted dying, it is not made easy: an example of this is the fact that doctors are not told (or at least were not readily told) what combination of drugs would provide the best way to die. This has meant that people have received the wrong types or dose of medication, and in some cases people woke up again and had a very harrowing or prolonged dying experience.
As said at the start, the language around assisted dying is never neutral and always reveals some moral standing or hidden (but quite often an overt) assumption. The language used in Oregon is no exception, with the term ‘hastening’ death becoming a popular shorthand:
“Until recently, physicians and volunteers who participated in Oregon’s Death with Dignity law referred to an assisted death as “hastening”. They would say, “we’re going to a hastening” or “Sally is hastening”. The concept points to the idea of expediting an unavoidable fate- dictated by the patient’s terminal prognosis- rather than the active cessation of life that would otherwise continue””
— Hannig (2022, page 63)
Hannig notes that doctors often do not bring up assisted dying during consults, as they are afraid that patients are being coerced into making such a decision. I personally find this coercion argument rather odd, and it also makes me wonder what other information doctors choose to omit in consults with patients. Not bringing up assisted dying in fear of this causing patients to feel coerced implies a very specific doctor-patient relationship and removes the agency of the patient. Surely people are able to hear different treatment options and make a decision based on preference, why would assisted dying be different? But yet I am also not surprised this is the case in a country that is often reluctant to provide sex education, in fear that it will lead to more sex, instead of, better informed decisions.
“But even if a doctor is comfortable talking about death, they often run into logistical constraints. An end-of-life consult takes three to four times longer than a regular appointment, and many physicians can’t budget that much time for one patient. Physicians with no previous exposure to assisted dying fear having to deal with a mountain of bureaucracy, even though the forms are rather straightforward. Others worry about losing their license if they make a mistake or being shamed by colleagues for showing support for a law that remains controversial, even among physicians”
— Hannig (2022, page 138)
The Day I Die will be of interest to anyone wishing to learn more about assisted dying. Hannig writes in accessible and clear language. As she forefronts the lived experience of those wishing and/or undergoing an assisted death, as well as those working in the field of assisted dying, this book is an engaging and well rounded addition to the assisted dying literature that will hopefully help readers in reflecting on their own thoughts and feelings regarding this matter.
To learn more about Anita Hannig visit her website.
Leave a Reply