One Year, Five Surprises—and a Growing Movement for Choice in Dying

1. The need for greater choice at the end of life is enormous.
This may have been the most sobering lesson of my first year. Every year in the United States, an estimated 1.85 million people die in settings where comfort-oriented hospice or palliative care is absent or limited—without the full support that can best manage pain, distress, and quality of life. Behind that number are real people and real families navigating some of the most difficult moments of their lives. We have made tremendous progress in end-of-life care. But far too many people still reach the end of life without knowing all their options—or without having access to the kind of care, information and autonomy they want.

2. While the need is enormous, the available solutions remain remarkably limited.
Medical Aid in Dying (MAID) has received growing attention and is now authorized in 13 States and DC. That is important progress. But qualifying for MAID can still be extremely difficult. Strict eligibility requirements mean that many people suffering from serious, debilitating, or degenerative illnesses simply don’t qualify. And here’s the statistic that surprised me most: In nearly 30 years of legal Medical Aid in Dying in the United States, fewer than 13,000 people have used the option to end their lives. Across the entire country, that works out to only about one person per day over that period. MAID is an important option—but it is not an option for everyone. And that leaves a significant gap for people who want greater autonomy at the end of life.

3. Choice in dying isn’t just an American movement. It’s a global one.
One of the most exciting discoveries of my first year has been seeing just how connected this movement is around the world. The World Federation of Right to Die Societies brings together organizations and advocates from across the globe who are working toward greater autonomy, dignity and choice at the end of life. Final Exit Network is proud to be an active member of this vibrant international community. The laws, cultures and approaches may differ from country to country, but the underlying question is remarkably universal: How much choice should each of us have over the circumstances of our own death? It is a conversation taking place around the world.

4. FEN’s reach is much larger than I realized.
Here’s another surprise that makes me especially proud: Final Exit Network reaches people in all 50 states—and our members and supporters extend across 12 countries. Every year, thousands of people turn to FEN for education, information, and support. Some are planning far ahead. Others are facing an immediate health crisis. Some are helping a spouse, parent, or friend. And many simply want to understand what choices may someday be available to them. None of this would be possible without the generosity and commitment of our members, donors, volunteers, and supporters. You make this work possible.

5. FEN offers something truly unique.
Perhaps the biggest revelation of my first year has been understanding just how distinctive Final Exit Network is within the U.S. end-of-life movement. FEN educates people about the full range of major choice-in-dying pathways—not simply Medical Aid in Dying. That distinction matters. There is no single path at the end of life. Some people seek information years before they may need it. Others come to Final Exit Network in the midst of a health crisis, searching for answers they never expected to need. Some want to better understand Medical Aid in Dying. Others are exploring Voluntarily Stopping Eating and Drinking (VSED), advance directives and dementia planning, Voluntary Assisted Dying (VAD) in Switzerland, or FEN’s compassionate Exit Guide service. Many simply want to know that they are not alone.

What unites them is a desire for information, autonomy and compassionate support. And what unites all of us at Final Exit Network is our commitment to meeting that need—to provide reliable education and compassionate guidance so individuals and families can navigate deeply personal decisions on their own terms.

And one thing didn’t surprise me at all…

The extraordinary impact this organization can have when passionate people come together around a shared mission.
Over this past year, I’ve watched our volunteers give generously of their time and expertise. I’ve seen our educational programs reach new audiences. I’ve heard from people who found FEN at precisely the moment they needed information and support. I’ve watched our Good Death Society Blog pass the 820,000 views threshold. And I’ve watched our organization continue to evolve, strengthen, and grow. As I begin my second year as executive director, I feel tremendous pride in what we’ve accomplished—and even greater excitement about where we’re headed. There is much more work ahead.

So as we look back on the successes of this past year, I invite you to take a moment to celebrate what you have helped make possible. Please take the time to read our newest magazine and annual report. Consider becoming a member. Donate to help us grow our impact. Subscribe to our blog. Then let’s keep moving forward together—growing with purpose, educating with courage, and serving with compassion.