Estate planning (setting up a trust, specifying who gets what, and having medical directives) is one of our many household goals for 2015, and one we’ve almost finished. Whew! I won’t lie: it’s been a lot of work.
I have accompanied three dying people as they shed this mortal coil for whatever comes next, and those experiences inspired me to write an Advanced Directive for Aid in Dying (AD-AID) to add to my Advanced Directive. I share the text here in case it might be useful to someone else looking for language to use or adapt, as I had a challenging time finding any. I reviewed legal cases and numerous articles to create what I’ve posted here. Let us hope that none of us ever need it but that, if we do, we can be treated at least as well as any suffering sheep. Use it as you will.
How people end life is an important part of the meaning of their lives. Respect for persons includes giving them control over that end. I believe I have just as much right to choose death to avoid living long in dementia or other distressing, protracted circumstances, or if I am no longer capable of making medical decisions, as I do to choose death if I become terminally ill.
I, YOUR NAME HERE, am a proponent of and hereby request voluntary, assisted dying in the circumstances described herein. In plain language, I want someone to supply lethal drugs to me if I am terminally ill or not expected to recover my normal physical and/or cognitive functions. I request voluntary, assisted dying in case I am unable to administer lethal drugs myself, and even if I am not considered competent.
It is difficult, if not impossible, for competent individuals to predict our interests in future treatment situations in which we have become incompetent, because our needs and interests will have radically changed. I acknowledge this but believe that the law’s insistence (in states like Oregon and Washington) on contemporaneous competence is problematic and that contemporaneous competence should not be required for aid in dying. Otherwise, a requirement for contemporaneous competence means that someone with dementia is ruled out as a candidate for assisted dying, even if she is terminally ill and suffering terrible pain that cannot be relieved. It also rules out individuals who have strong and unwavering desires not to end their lives in dementia, or similar. Many people, myself included, are more afraid of living in a severely compromised state for years than we are of death.
Something is wrong when we treat formerly competent patients as if they were never competent. Someone who makes a prior directive, like this one, does so because she sees herself as a unified subject of a human life. My concern for my body, my goals, and my family transcend my incapacity. One component of treating persons with respect is that we view them as they view themselves. If you are to do this, you must not ignore my prior choices and values, stated here.
It may help loved ones to have doctors certify that my decision, as stated herein, is voluntary and informed, and that my desire to die stems from hopeless and unbearable suffering.
Do not be dissuaded if, in dementia or similar circumstances, I might have a period in which I seem happy or as if I am enjoying my life. I want to die even in that situation because, given my deepest values and character, I regard death as preferable to being sustained in “pleasant dementia.” Though I may retain a capacity for enjoyment, know that I no longer have the cognitive capacity to consider or reflect on what makes my life as a whole worth living, and therefore that I am not capable of revising or rejecting the values I have expressed here.
I request voluntary, assisted death if I experience any three of the following:
- I cannot recognize either my loved ones, or myself, or my home.
- I require assistance with dressing, eating, bathing and toileting for a period greater than one month.
- I have urinary or fecal incontinence.
- I am unable to speak daily more than five to six words at all or more than two words clearly, or I have lost all verbal abilities and cannot respond in conversation.
- I lack either the ability to walk, to sit up, to hold up my head, or to smile, or all psychomotor skills.
I refuse hospitalization from nursing homes. I request the withholding and withdrawal of feeding tubes in all cases. Palliative care is sometimes insufficient. When it fails, all it offers is refusal of life-sustaining treatment and ends in death over some days. I would prefer another option.
Thank you for granting this final request. Better too soon than too late.