(Jim Van Buskirk has co-hosted death cafes for many years and currently volunteers as a regional coordinator with Final Exit Network (FEN), counseling callers on end-of-life options, and reviewing books and films for FEN’s quarterly magazine. Most recently he edited the anthology, There At The End: Voices from Final Exit Network – A Celebration of 20 Years.)
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I recently picked up a library book that had been brought to my attention.
“I’ll see myself out, thank you”: the arguments for medically assisted rational suicide was published in Warwickshire in 2015. Though nearly a decade old, and from a distinctly British perspective, this anthology of over three dozen essays by a variety of contributors nevertheless covers the salient points of the arguments for compassionate, considered end-of-life options.
In the preface, editors Colin Brewer and Michael Irwin propose the term Medically Assisted Rational Suicide (MARS). Not having heard the term, I assume it never quite caught on, among the many euphemisms for taking control of one’s death.
Contributors speak strongly about their position. Ann McPherson, founder of Healthcare Professionals for Assisted Dying, writes: “Let me be clear, assisted dying is about supporting a normal process – it is not assisted ‘suicide,’ with its connotations of despair, weakness and failure.”
And Melanie Reid – “journalist, severely disabled as a result of falling off a horse” – unequivocally states: “Because of a religious minority, a few antediluvian pressure groups, and the might of modern medicine, we are condemning growing numbers of elderly, terminally ill or disabled people to a terrible lingering twilight rather than a good death in the circumstances of their choosing. And we are condemning the people who want to assist them to the threat of criminal prosecution. This is a scandal.”
Similar sentiments are strongly stated throughout the anthology. Because of a novel and a movie, I was aware of Britain’s longstanding antipathy to self-deliverance, despite various attempts over the past 80-plus years to introduce legislation to permit physician-assisted death.
The protagonist of Belinda Bauer’s 2021 novel Exit is an older man volunteering with a group that supports people who have chosen to die with dignity. The description of their protocol seemed so similar to that of Final Exit Network (FEN), the national grassroots organization I volunteer with, that I felt compelled to research to determine it did not actually exist.
In the 2009 television movie, A Short Stay in Switzerland, Julie Walters stars as Dr. Anne Turner, who, in 2006, took her own life in a Zurich clinic having developed an incurable degenerative disease. Dr. Turner, after having watched her husband die from a neurological disease, is diagnosed with a nearly identical illness and determines to end her life once her condition has reached a critical point.
As her health deteriorates, Anne’s children struggle with their mother’s intentions. Anne must also face the fury of her best friend, whose opposing views bring them into direct conflict. Spoiler alert: Dr. Turner ultimately travels to Switzerland to carry out what was illegal in Britain.
But Switzerland has been embroiled in its own controversy surrounding the use of a Sarco capsule. The Netherland-based organization Exit International has spent over $1 million developing the 3D-printed device over many years. Because Dr. Florian Willet was present when the Sarco was used by a sick American woman in a Swiss forest in September, he was held for over two months in a Swiss prison. Swiss law allows assisted suicide as long as the person takes his or her life with no “external assistance,” and those who help the person die do not do so for “any self-serving motive,” according to a government website. Nevertheless, the case is eliciting examination of Switzerland’s end-of-life options.
Coincidentally, included in the Guardian’s weekend news feed was this provocative headline:
“Historic step”: what the UK papers say after landmark vote on assisted dying.
“Newspapers across the board cover the historic vote prominently, but with some more enthused about the outcome than others.” This references “steps taken by MPs toward legalising assisted dying in England and Wales by backing a bill that would give some terminally ill people the right to end their own lives.”
What followed was not an article, but images of the front pages of several publications, displaying in bold-face headlines the ongoing debate about control over how and when one dies.
All this sturm und drang is similar to the situation in the United States around choosing the time of one’s death. If no one is encouraging those opposed to hastening their death, I don’t understand why there is so much antagonism from the medical, religious, and legal communities?
Only a few US jurisdictions have legalized Medical Aid in Dying, and their criteria is so narrow that many people don’t qualify. Michigan, New York, and Massachusetts have been unsuccessful in their attempts to pass Death with Dignity legislation for many years. In November 2024, West Virginia voters narrowly passed a ballot measure amending the state’s constitution, prohibiting any person or healthcare provider from participating in “the practice of medically assisted suicide, euthanasia, or mercy killing of a person.”
There at the End: Voices from Final Exit Network – A Celebration of 20 Years, a new anthology I edited, offers personal perspectives from volunteers, family members, and clients about their experience using FEN’s support services.
FEN’s mission statement: “We hold that mentally competent adults who suffer from a terminal illness, intractable physical pain, chronic or progressive physical disabilities, or who face loss of autonomy and selfhood through dementia, have a basic human right to choose to end their lives when they judge their quality of life to be unacceptable.”
I continue to hope that by reading these heartfelt stories, people will understand the importance of having some control over an uncontrollable situation: the time and place of our own death.
I’ll leave the last word with an excerpt from a letter received from a woman I recently worked with in my role as a regional coordinator: “Just wanted to send you a note to tell you how much I appreciate all your kindness and help. I always felt you had real concern and sense of urgency. We would have made some great memories under different circumstances … The world is a better place with you in it.”
(Please scroll down to comment.)
Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s right to choose. For more information, go to www.finalexitnetwork.org.
Payments and donations are tax deductible to the full extent allowed by law. Final Exit Network is a 501(c)3 nonprofit organization.
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Nice work, Jim!
Advancing Old age is by any intelligent definition “a debilitating condition which leads to pain and suffering, diminished capacity to care for one’s self, loss of enjoyment of life including dignity and the pursuit of happiness. Recognizing “Personal Autonomy in Death and Dying” is a no brainer, there should be a professionally trained staff and a ‘PADD’ department in every hospital to offer palliative/hospice care for those mentally competent patients who choose Personal Autonomy, especially those with no remaining family capable of giving them care without sacrifycing their own health, wellfare, and remaining time.
Yes, something like a PADD is what we should be talking about, rather than having to convince people we have a right to decide when we wish to die. Thank you, Traci.
EXCELLENT!!! THANKS FOR BEING THERE FOR US!
Because if one leaves early lots of billing is lost. Just imagine, if people chose not to suffer, while they are dying, what havoc the economy would suffer.
It must be that none of them has had a front row seat to a loved one dying from Alzheimer’s disease, or stage four cancers of any kind. Also the money lost to Big Med and Big Pharma would be substantial. I think those of us who have witnessed long, slow agonizing deaths of those we love should have the biggest voice in the room — I do NOT want to go through this myself!
I have seen my late father and late mother-in-law die due to Alzheimer’s disease and my late husband die of complications of frontotemporal degeneration. All died natural deaths and were private-pay long-term care residents for years. No one was bankrupted because of this. My three siblings and I each received about $50K from our widowed father after his time in assisted living memory care and a nursing home, as well as the proceeds of a small life insurance policy. My husband and his three siblings each received about $80K from his widowed mother after years in assisted living memory care. I used this money to help pay my husband’s long term care expenses (he was a private-pay resident for six years, four months). When he died I received $100K from his life insurance and the remaining $120K in his 403b account. I also used *my* money to prepay for a funeral plot, casket, headstone, and clergy and musician honorariums for his Requiem Eucharist. With these inheritances and the remainder of my 401k and IRAs, I am more than financially secure. I don’t begrudge one cent spent for my late husband’s care. Should I one day develop a neurodegenerative condition, I’ll enroll in every clinical trial necessary and ask that everything done to keep me alive (I’ll never accept a DNR).
Good for you. You have helped support our economy and long term suffering. I, for one, have no plans of promoting any of the myths you have spent your money on. I choose to put my money into the pursuit of “my life, my death”, and not a penny on my vanity after death.
Our Anglican faith is sometimes called “Catholic-lite” by my Roman Catholic friends. We have a lot in common with our Catholic brothers and sisters, including seven sacraments. One other common practice refers to death. Cremation is acceptable, as long as the deceased’s remains are placed in an urn and kept in a mausoleum, buried in a funeral plot, or buried in a memorial garden (our Anglican parish has one) with a marker, but burial with a casket is preferable. I could have had my late husband cremated and his urn buried in our parish memorial garden, but he explicitly told me he wanted to buried. I also donated money to our Tech Services ministry even though they would have live-streamed his Requiem Eucharist at no charge. I was able to give the link to the live stream to a number of his high school and college friends (we live over 400 miles from the city where we met)l I’m saving a little bit of money on my funeral, though. The visitation will be in our parish hall (not a funeral home), as my late husband’s was. And I’ll be cremated and my urn will be buried beside my husband’s casket. I’ll only have two obituaries published for me (instead of the three i had for my husband).
Well said, Bruce. Thank you!
One might say you want assisted Life, Sue, which is your right. Just as it’s other people’s right to want assisted dying.
The dying person’s choice should prevail, including “that everything be done to keep me alive.” But the choice should be clearly and freely expressed and well-documented.
Thank you, Jim.
I’d read about the issue involving the Sarco. It’s discouraging, particularly since the organization involved seems to want to assist people to die without charging the high fees that the other two assisted dying organizations in Zurich charge.
Also discouraging because it may make Switzerland reconsider if it really *wants* to help people in this endeavor.