Elderly Suicide vs. Death With Dignity: Everything You Should Know

Suicide vs. Euthanasia vs. Death With Dignity: How They Differ

The words we use matter—often more than we realize. In relation to this topic, they are especially important. That's because they evoke strong feelings, and they are associated with entirely different contexts and situations.

The distinctions may seem subtle, but they have a large significance in the personal lives of those they impact. So although it's easy to find examples of the following terms being used loosely or interchangeably, many people believe that it behooves all of us to use them within their appropriate contexts.

Here's what you should understand:

Suicide, according to the simplest definition, is the act of intentionally killing yourself. Although many different factors can converge to motivate people to commit suicide, mood disorders such as depression are usually the biggest driving forces in that outcome, according to an article in Psychiatric Clinics of North America.

Unable to effectively cope with their despair, people eventually lose all hope and view suicide as their last remaining option. But although suicide seems like a logical choice to them, studies noted by an article in Clinical Interventions in Aging have shown that people with depression who have recently attempted suicide tend to exhibit cognitive impairments related to their memory, attention, and quality of decision-making.

That's why suicide is generally considered a tragic result of untreated or poorly treated mental illness. Lacking appropriate support, those attempting suicide often feel powerless to choose any other course of action. Suicide can also have lasting and traumatic effects on the friends and loved ones left behind.

Euthanasia (also known as mercy killing) is the intentional act of painlessly causing the death of someone who is in an irreversible coma or suffering unbearably from a painful and incurable medical condition. The action, where legally carried out, is usually performed by a physician or other health care professional when reasonable alternatives or expectations for improvement are absent. But there are different types of euthanasia: active and passive, which can each be either voluntary or non-voluntary.

• Active euthanasia: This is when someone (generally a medical professional) directly and intentionally causes the death of a patient, such as by administering a lethal dose of medication.
• Passive (or non-active) euthanasia: Under the most common definitions, this is when a patient's death is caused through the deliberate withholding of treatments that may otherwise sustain his or her life, even if just for a little while. So the difference between active euthanasia and passive euthanasia is that the former type requires a new and tangible lethal action, whereas the latter type involves stopping one or more life-sustaining measures that are already in use.
• Voluntary euthanasia: This occurs when a patient's death is hastened with his or her informed consent (i.e., approval).
• Non-voluntary euthanasia: This happens when a patient's medical condition makes it impossible for him or her to provide consent, so someone else makes the decision on his or her behalf in light of factors such as poor quality of life that is unlikely to get better.

Some people also use the term "involuntary euthanasia" to describe an action that is, essentially, murder. Under this scenario, the patient may have been capable of providing consent, but he or she wasn't given the opportunity. Or the patient may have stated a desire to live, but he or she was killed anyway. Either way, the patient's best interests were not put first—taking the action out of the domain of euthanasia and into the realm of something much more sinister.

Death with dignity gives some terminally ill people the option of legally hastening their own death with the assistance of a licensed physician. But death with dignity laws vary between the relatively few regions where they've been enacted. In Canada, for instance, the law makes it possible for a medical provider to perform voluntary euthanasia for certain kinds of patients, although the preferred term for it is medical aid in dying.

In the states where it is legal in the U.S., the typical death with dignity definition excludes any form of euthanasia. So, in those regions, the difference between euthanasia and death with dignity is that, with the latter form of dying, patients themselves must administer the lethal medication. Licensed physicians prescribe the lethal substances for their patients to self-administer once all the steps in a mandatory process have been followed.

In addition to medical aid in dying, death with dignity is also known as:

• Physician aid in dying
• Medical assistance in dying
• Physician-assisted dying
• Physician-assisted death

Of course, you are also likely to run across terms such as "assisted suicide," "doctor-assisted suicide," or "suicide with dignity" when reading about this issue. But to many of the terminally ill seniors who choose the path of dying with dignity, terms that include "suicide" are inaccurate and disrespectful. Their friends and family members also frequently find such terms to be offensive.

After all, "suicide" tends to carry negative connotations of emotional despair, impaired judgment, and immorality. But those who choose to die with dignity are required to be of sound mind. And they get the comfort of knowing that they do not have to experience unbearable agony, an unacceptable quality of life, or an unpeaceful death. In a sense, they do not see themselves as the ones causing their death; that blame falls on their terminal illness. Rather, they are merely decreasing the amount of time that they must suffer. They will die soon anyway.

That's the meaning of death with dignity: being able to exercise your right to die a peaceful death when your fatal illness cannot be cured and you still have the freedom and capability to make such a decision. It's a personal choice that's exercised by rational people of legal age, from young adults to the elderly. "Assisted suicide," in their view, doesn't accurately describe the legal, medical, and conceptual choice they're making.

Still, whether you're talking about death with dignity or euthanasia, debate swirls around this topic. So it's only by understanding the arguments for and against dying with dignity that you can truly appreciate what it all means for the patients, loved ones, physicians, and caregivers impacted by it.

Elderly Suicide Facts and Statistics

As a culture, we tend to think of suicide as primarily occurring among young individuals. Many people also view suicide in the elderly population as somehow being less tragic than youth suicide. Some people even believe, mistakenly, that depression is a normal part of aging or, on the flip side, that seniors are able to cope much better with life's stressors than younger adults. Unfortunately, those beliefs cause too many of us to overlook the very real and widespread problem of suicide among older adults.

In fact, according to the most recent data on suicide rates from the Centers for Disease Control and Prevention, elderly men over 75 kill themselves at the highest rate of any age group in the U.S. (39.7 deaths per 100,000 people). And although older women have much lower rates of suicide than men, the rate of suicide among females peaks between the ages of 45 and 64 at 9.7 deaths per 100,000 people.

In many other countries around the world, elderly suicide rates are even higher. Worldwide, the senior citizen suicide rate (for those 70 and older) is about 27.5 deaths per 100,000 people, according to Our World in Data. Yet, in some nations, the rate is even more staggering. So, around the globe, which country has the highest rate of elderly suicide? That would be South Korea, with about 86 deaths per 100,000 people.

Here's another important stat: The article in Psychiatric Clinics of North America says that when it comes to completing suicide, elderly people die from their attempts at a much higher rate than young adults (25 percent vs. 0.5 percent).

Keep in mind that none of these statistics include physician-assisted death (i.e., so-called "assisted suicide"). For elderly people and younger adults with painful or debilitating terminal illnesses, the decision to seek medical aid in dying is an altogether different situation than contemplating suicide when comparatively healthy.

That's why it's essential that we all do a better job of understanding and recognizing the risk factors and warning signs that can affect or be displayed by a troubled senior. Suicide is not an inevitable consequence of mental health problems. Often, it can be prevented.

Why Suicide in the Elderly Happens

Despite progress in many other areas, our modern society still has shortcomings when it comes to how we think about aging, mental illness, and death. For example, many people stigmatize depression and mistakenly believe that suffering is always part of the aging process, which can make older adults reluctant to seek the right kind of help.

According to the article in Clinical Interventions in Aging, when it comes to suicide, senior citizens who've taken their own lives were much less likely to have visited a mental health professional in the month before their death than to have seen a primary care physician.

Some people also have romanticized notions about suicide, which may be holdovers from the past. For instance, in ancient Rome, suicide was often seen as a way to die with honor—as long as you didn't have any mental problems. A traditional Roman suicide ritual may have involved appeasing the gods for shameful actions and being surrounded by your loved ones, ensuring that one of them heard your final words.

Today, the reasons for late-life suicide are as diverse as the individual seniors who attempt it. But the risk of suicide is cumulative, meaning that multiple factors are usually involved. The Psychiatric Clinics of North America article says that each new risk factor affecting a senior increases the probability that he or she will attempt suicide. Adding to the overall risk is this fact according to an investigation by Kaiser Health News and PBS NewsHour (KHN): Baby boomers have committed suicide at higher rates than those in other generations, which may continue into their senior years.

The KHN/PBS NewsHour investigation reveals that among older adults, suicidal behavior is mainly associated with:

• Depression: This mental health condition is often the biggest risk factor for suicide. Affected seniors come to feel a sustained sense of hopelessness or a lack of meaning and purpose in their lives. They may not see any kind of path to a satisfying future or any new goals to pursue. They feel powerless to solve their problems, and they may even feel angry with themselves for not being stronger. But depression isn't the only mental health issue that can play a major role in suicidal behavior. Other psychiatric conditions that cause sustained psychological pain or discomfort (such as generalized anxiety disorder) can lead to suicidal ideation.
• Frailty: Feeling weak or consistently fatigued makes life harder and less enjoyable. Many physical illnesses can cause persistent debility in seniors, contributing to a sense of despair.
• Detachment: Some seniors feel secluded or disconnected from life, particularly in a social sense. They may suffer from chronic loneliness or feel ignored by their grown children or other loved ones. According to the Clinical Interventions in Aging article, one study found that seniors who attempt suicide are less likely to have children, be married, or participate in religion.
• Access to lethal means: When a senior has suicidal thoughts, he or she is more likely to attempt suicide if the means to do so are readily available. That's why guns are involved in 46 percent of all suicides in America, according to Our World in Data. But several other means are often available to older adults who seek to take their own lives.

The article in Clinical Interventions in Aging says that seniors who've lost a close family member within the previous six months have the highest risk of suicide. Other factors that can increase an older adult's risk of suicide include:

• Alcohol abuse
• Chronic pain
• Cognitive impairment
• Divorce
• Elder abuse
• Employment changes
• Family conflict
• Fear of being a burden on others
• Lack of access to mental health care
• Loss of independence
• Loss of friends or pets
• Being male
• Money problems
• Physical disability
• Regret
• Shame
• Stress
• Stubbornness
• Trouble adapting to change

Warning Signs of Potential Elder Suicide

When it comes to the potential for suicide in older adults, the danger signs can sometimes be easy to miss. After all, many seniors have fewer social interactions than younger people, and they may have extra determination to take their own lives. They may even work harder at hiding their intentions so as not to ruin their plans. Plus, seniors who live independently or semi-independently often have more ability to keep their suicidal thoughts and preparations to themselves.

Even so, it is possible to assess the risk of suicide. In elderly people, the potential for suicide can reveal itself in many different ways. Some of the things to watch out for include:

• Communication of suicidal thoughts or intentions: This is usually the clearest indication that someone may be seriously considering suicide. For example, you may hear a senior say things like, "Maybe you won't see me after this" or "I wish I wasn't alive" or "You'll be happier when I'm gone." Such statements aren't always related to suicidal contemplation, but they are definitely red flags that warrant the attention of a mental health professional right away.
• Problematic changes to the usual routine: Seniors who are contemplating suicide sometimes quit performing normal daily habits related to their self-care. For example, they may not pay as much attention to their appearance or personal hygiene. They may adopt poor eating habits. They might stop taking essential prescription medications. Or they may have trouble sleeping or adopt an unhealthy sleep schedule.
• Unusual behavior or changes in mood or personality: Some older adults with suicidal thoughts or intentions begin to take risks that are out of the ordinary for them. Or they display other patterns of thought or behavior that their friends and loved ones perceive as inconsistent with their typical personalities. For example, a troubled senior might hoard medications, start abusing drugs or alcohol, give away cherished belongings, drive recklessly, display a sudden fascination with dark topics, or act in a high-strung manner.
• Loss of interest in current or future activities: This can be a symptom of depression, which is a big red flag. But a senior who is seriously contemplating suicide due to a combination of other factors may also display a lack of desire in doing things that he or she would ordinarily pursue.
• Grief over family-related issues: The recent loss of a spouse or other close family member can cause intense sorrow and/or loneliness for a surviving senior, which may contribute to suicidal ideation. But conflicts among living family members can also lead to deep feelings of distress, social isolation, and thoughts of escape.
• Despair over recent changes in health or independence: Anything that significantly diminishes the quality of life that a senior previously enjoyed can cause deep grieving. For example, having a chronic or terminal illness can trigger a large range of troubling emotions, as can an unwanted change in lifestyle or living arrangements (especially if it involves losing personal autonomy).

Seniors who have previously attempted suicide may also be at higher risk of making future attempts.

Elderly Suicide Prevention

If you suspect that a senior is seriously thinking about taking his or her own life, it's essential to respond to the issue as quickly as possible. Preventing suicide in the elderly often requires action on multiple fronts. According to Mayo Clinic, intervening is always the most appropriate option—even if you have doubts about what to do. You're unlikely to make things worse; on the contrary, you may help reduce the person's suicidal impulses.

Get immediate help if you believe that a suicide attempt is imminent. Otherwise, here are some actions you may be able to take:

• Have a compassionate conversation: Gently asking relevant questions and listening attentively to the answers is a great way to show the person that you care. Just make sure you do so without interrupting or passing judgment. Allow the person to freely express his or her thoughts and emotions, but listen for clues that may indicate the seriousness of his or her intentions. Ask how the person is coping, what's going on to trigger the distressing feelings, whether death or suicide are explicitly being thought about, what kind of harmful or lethal means may be readily available, and so on.
• Refer the senior to the Institute on Aging's toll-free Friendship Line (1-800-971-0016): This 24-hour service is one of the best resources for suicide prevention. Elderly people and seniors who are 60 or older can call at any time for friendly emotional support or crisis intervention. For many seniors, ongoing outreach can also be set up so that they regularly receive calls from volunteers who check in on their well-being.
• Make it harder for the person to access lethal means: The longer it takes for someone to act on a suicidal impulse, the less likely it is that he or she will die from an attempt. That's why, whenever possible, it makes sense to remove weapons and other potentially lethal items from a troubled senior's home environment. If that isn't possible, you still may be able to make the items harder to use. For example, guns can be stored in a locked cabinet or closet with trigger locks on each gun (and the ammo and keys can be stored in separate places). Prescription medications can be left with a caregiver who only provides them as needed. In some situations, access to alcohol or illicit drugs might also need to be managed since the person may be more likely to attempt suicide while under the influence.
• Encourage participation in a support group: A sense of belonging can help prevent suicidal ideation in an older adult, according to the Clinical Interventions in Aging article. So it may be useful to find a local support group where the senior you care about can meet and talk with people who share similar experiences. Look for support groups related to the specific problems that are contributing to the person's distress (such as grief or a particular illness).
• Invite the senior to attend physically and mentally stimulating activities with you: Whether it's a yoga or exercise class or a workshop related to a new or existing hobby, getting the person out and engaged in fresh pursuits can help revive his or her appreciation for life, at least temporarily.
• Help the person find a mental health professional: Regardless of what else you do, always help connect a troubled senior with professional counseling or therapy. One place to start is the Institute on Aging, which offers both in-home and outpatient therapy services for seniors.

Getting Immediate Help

First, take a slow, deep breath and tell yourself that you can get through this—no matter how upsetting the situation may be.

If the person intends to commit suicide but hasn't yet made an attempt:

• Encourage the senior to call the Friendship Line at 1-800-971-0016.
• Call 911 on a separate phone, if possible.
• Stay close by. Do not leave him or her alone until help arrives.

If the person has already attempted suicide:

• Call 911 and stay with the senior, following the instructions you're given.
• Alternatively, drive the senior to the emergency department of a nearby hospital (but only if you can do so safely).
• Take notice of any medications, alcohol, or other substances the senior may have used.

In the event that someone you care about doesn't survive a suicide attempt, seek grief counseling as soon as possible. Also, you may benefit from attending a local support group for survivors of suicide loss.

If YOU have the impulse to attempt suicide:

• Go to a place where other people are nearby. Do not isolate yourself.
• Call your counselor or therapist if you have one.
• Alternatively, call the Friendship Line at 1-800-971-0016.

Death With Dignity Facts and Laws

Death with dignity (i.e., physician-assisted dying) takes place in a completely different context than suicide. It empowers eligible terminally ill adults to plan peaceful deaths at the times and locations they choose.

In the U.S., Oregon's Death with Dignity Act was the first law of its kind. It came into effect in 1997. Washington state followed with its own law roughly a decade later.

At the time of this writing – September 2023 – death with dignity was legal in the following states and jurisdictions:

• California
• Colorado
• Hawaii
• Maine
• Montana
• New Jersey
• New Mexico
• Oregon
• Vermont
• Washington
• Washington, D.C.

In addition, death with dignity is legal in Canada, where it's known as medical assistance in dying (MAID). According to an article from The Conversation, it is also legal in Columbia, the state of Victoria in Australia, and a few European countries, including Belgium, the Netherlands, and Luxembourg. In Switzerland, the practice isn't explicitly authorized by law, but it also isn't forbidden as long as it is carried out for so-called "non-selfish" reasons.

Basic Eligibility

According to the Death with Dignity National Center, in the places where it is legal in the United States, the requirements for death with dignity are generally that you must be:

• At least 18 years old
• A resident of a state (or DC) that has a death with dignity law
• Terminally ill with a medical prognosis of six months or less to live
• Mentally capable of making and communicating your own medical decisions
• Physically capable of self-administering and ingesting the lethal medication prescribed for you

In terms of the residency requirements, you simply need to prove that you currently live in the region where you intend to die with physician assistance. It isn't necessary to show that you've been a resident for any minimum length of time. But you do need to provide documentation of your current residence.

For example, if you want physician-assisted death in Oregon, your proof of residency could be an Oregon driver's license or ID card, a copy of your recent state tax return, proof of voter registration in the state, or papers that show that you currently own or rent a home in the state. But to qualify for death with dignity, you do not have to live in Oregon for any specific amount of time.

California, Colorado, Hawaii, and Washington have the same residency requirements as Oregon. In the other regions where death with dignity is legal, the documentation requirements are similar but a little more varied.

In addition to the above requirements, you must follow all of the required steps in the process, which include getting approval from two physicians and adhering to two waiting periods.

In Canada, the law is more flexible. For example, it allows for voluntary euthanasia, meaning that a doctor or nurse practitioner can administer the lethal medication if you prefer not to self-administer it. Also, you do not have to be terminally ill for euthanasia or medical assistance in dying in Canada, but you do have to meet certain requirements, including:

• Being at least 18 years old
• Qualifying for publicly funded health care in Canada
• Having a serious illness or disability that has progressed to a state of irreversible functional deterioration, causes intolerable physical and mental suffering, and makes your natural death "reasonably foreseeable"
• Making a voluntary, uncoerced request for medical assistance in dying
• Providing informed consent after being told that other options like palliative care are available to help ease your suffering
• Having the ability to provide informed consent at the moment when medical assistance in dying is to be carried out

Some Canadian courts have ruled that the "reasonably foreseeable" clause is invalid if interpreted to mean that someone has to be at or near the end of life. So going forward, that clause may not be an obstacle to eligibility for certain patients who are experiencing intolerable suffering but are not expected to die from their conditions in the near future.

Simply put, a wide variety of suffering patients qualify for voluntary euthanasia in Canada if they don't want (or are physically unable) to self-administer lethal medications. But they must be evaluated by at least two independent health care practitioners in order to qualify for medical assistance in dying. Canadian law also has other requirements that must be followed, such as a waiting period and independent witnesses to your request.

Additional Facts

Under state laws for death with dignity, it is incorrect to label the practice as physician-assisted "suicide." Statistics, moreover, show no indication of these laws being widely abused, according to an article in JAMA: The Journal of the American Medical Association. In fact, you may be surprised to learn that:

• In the places where euthanasia and/or physician-assisted dying are legal, they account for only 0.3 to 4.6 percent of all deaths, according to the JAMA article.
• The Death with Dignity National Center says that about 90 percent of people who choose death with dignity are receiving hospice care at the time of their passing. And the article in JAMA says that over 70 percent of them have cancer.
• The JAMA article notes that fewer than one in five physicians have received a request for medical aid in dying or euthanasia. And only five percent or less of physicians have ever complied with such a request.
• Only patients themselves can request death with dignity; no proxies are allowed, according to the Death with Dignity National Center. (Even if a person has medical power of attorney, he or she cannot make such a request on behalf of someone else.)
• As long as death with dignity is carried out in a state where it is legal (and where you requested it), it doesn't have any effect on life insurance or similar policies. That's because, legally, your death will not be considered suicide, according to the Death with Dignity National Center.

As previously mentioned, among other places, death with dignity is legal in California, Colorado, Oregon, Vermont, and Washington. ProCon.org says doctors have written thousands of prescriptions for self-administered lethal medications under laws for physician-assisted dying. However, only about 66 percent of people who receive such prescriptions have used them to end their life. (Many people request death with dignity but ultimately choose not to go through with it.)

Why Death With Dignity Is Different Than Archaic Cultural Customs

It's important to distinguish today's medical aid in dying laws from past cultural customs and practices that many people associate with elderly euthanasia. History, after all, includes unsettling stories from various cultures around the world about the killing of old people.

Also known as senicide or geronticide, the practice of killing elderly people through abandonment or other means (sometimes at their request) has shown up in many historical narratives. According to an article from Nowhere, although reliable information about such practices is relatively sparse, some cultures from the past have been said to engage in traditions like:

• Leaving elderly people alone on the top of mountains
• Sacrificing and eating old men
• Ritualistically killing older adults with certain weapons
• Having children slay their elderly parents with swords
• Throwing elderly people to dogs that have been trained to kill them

Most of us who are alive today would probably view such practices as grisly and barbaric. But those customs didn't always constitute murder; sometimes they were a form of voluntary euthanasia. Elderly people, in certain cultures, wished to die in accordance with traditions that would be outrageous and illegal by today's standards.

One of the most widely circulated stories concerns the Inuit (often referred to by terms that many people find derogatory, such as "Eskimo"). The Nowhere article notes that elderly Inuit people are said to have been put on ice floes and left to die from freezing and starvation—a rare, abandoned practice that some Inuit people and anthropologists have verified but that some scholars have disputed. For those who believe the practice took place, it's thought that some Inuit elders viewed that form of death as an appropriate way to end a life that had become "too much." Other Inuit death rituals involved placing a deceased person's body within a ring of rocks so that the wind wouldn't blow away his or her disintegrating bones.

Today, when debating whether to make physician-assisted death or voluntary euthanasia legal, some opponents of the idea like to equate it with archaic cultural customs (such as those just mentioned). But proponents of dying with dignity believe that such characterizations are unfair and intellectually dishonest. They argue that death with dignity laws allow for humane, non-violent deaths—without cultural coercion—for those who will die soon anyway and don't wish to prolong their suffering (not for those who feel they've gotten "too old").

Arguments For and Against Death With Dignity

Although it's legal in multiple states, physician-assisted dying remains highly controversial. Still, most Americans support the idea of allowing physicians to help terminally ill patients end their lives. In fact, when the phrase "commit suicide" isn't part of Gallup's survey questions about this issue, more than 70 percent of Americans express support for death with dignity. Even when that phrase is included, about 65 percent of Americans still support the concept.

Death with dignity is a particularly divisive issue among physicians. The American Medical Association is against the practice; however, many other medical associations in the U.S. and elsewhere have endorsed the idea. A lot of physicians believe that medical aid in dying goes against the Hippocratic Oath, which, in some modern variations, says:

If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

Yet, opinions vary as to whether the oath is adequate or even still relevant. That's partly why, according to one poll by Medscape Medical News, about 56 percent of physicians have a positive opinion of death with dignity laws. And among physicians in states that don't have such laws, more than 60 percent say that they've had cases in which they would have liked their patients to have the option of physician-assisted death.

But the many arguments for and against making death with dignity legal can be incredibly varied.

Arguments in Support of Physician-Assisted Dying

• Peaceful death should be a human right. Proponents believe that terminally ill people who don't want to endure needless suffering deserve the freedom to choose to die with dignity, on their own terms. If a person is still mentally competent and physically capable of making that decision, why should anyone else have the right to say no?
• Patients already have the right to refuse treatment. As long as medical patients are deemed mentally competent and have been adequately informed of their rights and options for care and treatment, they can decline any further medical interventions that might prolong their lives. That's why some people argue that a physician withholding treatment isn't that much different than a physician providing medical aid in dying. Whether the deed is passive or active, the final outcome is the same. But the active deed often involves less suffering.
  
  Some patients request physician-assisted death because it means that they won't have to go through treatments (or any withholding of treatments) that might prolong or add to their pain or distress. They don't want to experience a lower quality of life that they find unacceptable. Besides, death with dignity laws provide safeguards to confirm patients' prognoses as well as their mental fitness for decision-making.
• It's humane. Most people would never want their friends or loved ones to suffer unbearably for any amount of time. Yet, sometimes patients' expressions of pain or distress aren't taken as seriously as they should be, especially when their loved ones can't bear the thought of losing them. Proponents argue that offering dignity in dying is a greater act of compassion than forcing someone to endure an intolerable quality of life when healing is no longer possible. Plus, physician-assisted deaths tend to be peaceful and relatively easy (in comparison to a lot of deaths in which intensive medical care is involved).
• We provide it for our pets. When it comes to our animal companions, we tend to be far more willing to act with compassion in order to prevent additional suffering and poor quality of life. Shouldn't we extend that kindness and compassion to human beings? Why do we find it easier to recognize that an animal's life doesn't need to continue at any cost? Like us, animals suffer. According to an article in Animal Sentience, there is even evidence for the possibility that some animals choose to take their own lives.
• Intolerable suffering is painful for everyone involved. Needless pain and distress is hard for terminally ill patients, of course. But it also causes significant distress for their friends and loved ones. That's one reason why some people who've witnessed the prolonged deaths of those they care about are proponents of dying with dignity. They recognize that, when chosen by a patient and supported by loved ones, it can reduce the amount of time that everyone spends grieving.
• It can improve other end-of-life care options. Many proponents like to point out that, in the places where death with dignity is legal, other options like pain management, palliative care, and hospice services get better. After all, it provides extra motivation for physicians and patients to talk about the full range of end-of-life care options—openly and honestly. Plus, even though most patients won't ever choose physician-assisted death, having it as an option can greatly improve their peace of mind.

Arguments Against Physician-Assisted Death

• It might make us undervalue human life. Many opponents of death with dignity laws believe that it is immoral for people to take their own lives or for anyone to assist someone else in doing so—regardless of the circumstances. In a lot of cases, their opposition is based on religious teachings about the sanctity of human life. They find the ideas of physician-assisted dying to be a sort of "phony compassion" that actually dehumanizes those who are suffering. And they worry that such laws may initiate a "slippery slope" in which assisted dying is eventually encouraged as an option for a much wider range of people.
• Physicians are meant to heal, not take lives. Many medical practitioners wonder why "doctor-assisted suicide" should be legal since it seems to go against the practice of doing no harm. They refuse to violate the Hippocratic Oath or undermine their professional values by actively causing a patient's death. In their view, suffering can be alleviated by proper palliative care, and they don't want assisted death to become an appealing default option.
  
  Similar arguments are made with regard to the death penalty. In some states, doctors can perform executions (or assist with them), primarily through lethal injection. In fact, physician involvement is required by law for executions in some states. However, participating doctors usually keep their involvement confidential since it violates the American Medical Association's code of ethics and goes against the views of many in the general public.
• It may demean people with disabilities or chronic illnesses. Some opponents worry that assisted-death laws will expand or intensify incorrect assumptions that those with disabilities or long-term medical issues always have a poor quality of life and would rather be dead. They're concerned that the lives of people with disabilities will be less valued, resulting in more discrimination.
• The practice may become overused as a way to lower health care costs and reduce caregiving burdens. Opponents sometimes equate all assisted-death laws with euthanasia and wonder why euthanasia should be legal when financial and caregiving obligations may provide incentives for families to coerce their sick loved ones into that option.
• It can be difficult to judge someone's mental competence. This is especially true if a patient has an undiagnosed illness like dementia or depression that affects his or her abilities to understand all care options and make rational decisions. In some cases, it also may be hard to tell whether a person has been coerced into pursuing physician-assisted death.
• Medical diagnoses are sometimes wrong. Some opponents of physician-assisted death point out that doctors, albeit relatively rarely, sometimes incorrectly diagnose certain patients as being terminally ill. So there is a risk that some patients may choose assisted dying based on false information.

Dying With Dignity: The Typical Process

Before going down this path, it's important for terminally ill seniors to carefully consider all available options for their end-of-life care. This is especially critical if you have a progressive illness that might make you unable to provide informed consent, make decisions, or ingest the lethal medication prescribed for you when the time comes to do so. Under state death with dignity laws, you must be mentally competent and physically capable of ingesting the necessary medications at the time of your planned death.

So make sure you explore your options for palliative and/or hospice care. Besides, even if you choose physician-assisted dying, you can still benefit greatly from such care in the weeks or months leading up to your death—especially if your illness causes pain or other distressing symptoms. On average, palliative care costs about $95 per day. But that cost is frequently covered by Medicaid, Medicare, or private insurance.

In the states where death with dignity is legal, the entire process often takes at least a few weeks. Here's what you typically need to do:

1. Speak with your physician, make your first verbal request, and get authorization.

A good time to bring up death with dignity is when you and your doctor are talking face-to-face about other end-of-life options like palliative and hospice care. Just remember that a lot of physicians aren't receptive to this idea, at least initially. You'll need to share your reasons for wanting physician-assisted death, making it clear that you understand your prognosis, have been considering the alternatives, and don't wish to suffer needlessly.

Verbally ask your physician whether he or she would be willing to support your decision to die with dignity by writing you a prescription for lethal medication in accordance with the applicable state law. Request a simple answer: yes or no. If your physician says no, accept his or her decision. But make sure that your request gets documented as part of your medical record.

It's possible that your doctor will not be willing to prescribe the lethal medication for you but would still be willing to act as a consulting physician—confirming your mental competence, diagnosis, and prognosis. Regardless, you will need the participation of two physicians. Both will need to evaluate your medical condition and mental judgment. But only one (the attending physician) will need to be willing to prescribe lethal medication.

Since you need two participating doctors, ask for a referral to another physician, no matter how he or she answers. And keep in mind that any type of licensed physician can participate, regardless of specialty.

You won't be able to proceed until you receive physician authorization.

2. Tell your friends and family.

Although it isn't legally required, talking to your loved ones about your plans for a physician-assisted death is highly recommended. After all, they'll need time to digest the information and process their feelings, regardless of whether they support the idea. In the best-case scenario, your loved ones will come to understand your decision, stand by you, and provide aid in planning the peaceful death that you want and deserve.

3. Comply with the first waiting period.

After receiving physician authorization, you typically need to wait at least 15 to 20 days before proceeding to the next step. The exact waiting period depends on your state's death with dignity law.

4. Make your second verbal request.

Speak to your attending physician, again requesting assistance to die with dignity in accordance with the relevant law in your state.

5. Submit a request in writing.

Each state with a physician-assisted dying law has its own forms to use for this purpose. So the requirements vary a little, depending on where you're going through this process. Generally, you must wait to submit your written request until any time after you've made your first verbal request. However, in the District of Columbia, you must also make this written request before your second verbal request. In addition, you may need to have your signature witnessed by two people who meet specific requirements.

6. Observe the second waiting period.

This doesn't apply in Colorado or California. For other regions where death with dignity is legal, your attending physician can only write the prescription for your lethal medication after waiting at least two full days from the time of receiving your written request.

7. Pick up your prescribed medication.

Under state laws for death with dignity, medication prescriptions must be delivered directly by your attending physician to a pharmacy. Once your pharmacy has the prescription, you can choose when to have it filled. And you can designate someone else to pick up the medication when it is ready. But remember: You do not have to fill the prescription if you end up having a change of heart.

Physicians aren't required to prescribe any specific medications. So prescriptions can vary from patient to patient and region to region. And the preferred medications for physician-assisted dying have changed over the years. Today, a commonly recommended combination of diazepam, morphine, digoxin, and amitriptyline is given for death with dignity in the U.S., according to a MarketWatch article. (Another common protocol uses propranolol instead of amitriptyline.)

The MarketWatch article notes this fact: Using that four-drug cocktail means that it costs roughly $700 to $750 to die with dignity, unless you can afford and access the medications commonly used in Europe. According to the Death with Dignity National Center, Seconal is frequently unavailable in the U.S., and even if you can access it, it tends to cost between $3,000 and $5,000. Pentobarbital is also notoriously hard to access in America because the European Union has banned its export. Both of those medications are known to be fast-acting and provide for painless deaths.

That's why a non-profit organization in Switzerland called Dignitas often uses pentobarbital to kill patients who seek their help in dying with dignity. But it can cost thousands of dollars for assisted dying if you're an American who wants to die overseas by using that medication. (Most of your expenses would be travel-related.)

By staying back in the U.S., you'll be able to die with dignity at home, a lot more affordably. At this point in the process, you just have to decide when the time is right to commence your final act.

8. Plan a time and location, then ingest your medication.

Remember that in order to retain your legal protections, you can only take the lethal medication in the state where you received it. Otherwise, you are free to choose when and where you wish to die—if you still want to. (A significant number of patients ultimately choose not to end their lives this way. You're under no obligation to ingest the medication, even if you've come this far in the process.)

Many patients choose to be surrounded by close family and friends during their final moments. Others prefer to have privacy for this part of their journey. Whatever you decide is OK. Either way, you will need to administer the medication yourself. You can, however, have someone help you prepare it.

You may need to ingest multiple medications in a particular sequence, including meds to prevent nausea, to put you to sleep (and keep you asleep), and to ensure that you don't feel pain. The time it takes to fall asleep and pass away varies depending on the patient. Regardless of how long it takes for you to pass away, the medications should keep you in a comfortable state of painless, unconscious sleep until your peaceful end finally comes.

Embrace Knowledge and Compassion

Elderly suicide and death with dignity may be separate issues, but it's important to understand the facts surrounding both. That way, you can be better prepared to support a troubled or ailing senior in your life—as well as yourself.