An intimate investigation of assisted dying in America and what it means to determine the end of our lives.In this groundbreaking book, award-winning cultural anthropologist Anita Hannig brings us ...into the lives of ordinary Americans who go to extraordinary lengths to set the terms of their own death. Faced with a terminal diagnosis and unbearable suffering, they decide to seek medical assistance in dying-a legal option now available to one in five Americans.Drawing on five years of research on the frontlines of assisted dying, Hannig unearths the uniquely personal narratives masked by a polarized national debate. Among them are Ken, an irreverent ninety-year-old blues musician who invites his family to his death, dons his best clothes, and goes out singing; Derianna, a retired nurse and midwife who treks through Oregon and Washington to guide dying patients across life's threshold; and Bruce, a scrappy activist with Parkinson's disease who fights to expand access to the law, not knowing he would soon, in an unexpected twist of fate, become eligible himself.Lyrical and lucid, sensitive but never sentimental, The Day I Die tackles one of the most urgent social issues of our time: how to restore dignity and meaning to the dying process in the age of high-tech medicine. Meticulously researched and compassionately rendered, the book exposes the tight legal restrictions, frustrating barriers to access, and corrosive cultural stigma that can undermine someone's quest for an assisted death-and why they persist in achieving the departure they desire.The Day I Die will transform the way we think about agency and closure in the face of death. Its colorful characters remind us what we all stand to gain when we confront the hard-and yet ultimately liberating-truth of our mortality.
Intentionally terminating life (ITL) is usually assumed to require a doctor to perform it. However, it does not. Two questions have been conflated. First, is it a moral good for society to facilitate ...people ending their lives, and if so, in what circumstances? And second, how and by whom is it to be done? If ITL becomes a medical responsibility, the profession changes to incorporate a new duty to end some people's lives. This is the most significant moral question in medicine. Because the political movement to legalize assisted suicide and euthanasia is vocal, organized and well-funded, the first question may become redundant soon. The second will then be upon us without due consideration. This article clarifies several ethical confusions that could derail your analysis. You may favour the legalization of ITL without compunction, oppose it in any form, or you may favour ITL but see it as safe only if implemented separate from medicine. Our intention is that you engage with the moral reasoning and not the emotional polemic of this postmodern debate.
Over the second half of the twentieth century, advances in medicine enabled treatment of previously life-ending illnesses. The resulting shift in place of care for mortally sick people from home to ...hospital succeeded in preventing many premature deaths, yet it also caused the public to lose familiarity with the process of 'ordinary dying.' The loss of public understanding of dying has resulted in avoidance of conversations about dying, in failure to anticipate and plan ahead, and in avoidable distress as deathbed companions misinterpret features of the dying process as suffering.
This opinion piece reflects on the need for health and care workers to understand, recognise and talk about the process of dying, the better to prepare and support the elderly and sick people in our care and their companions.
On June 19, 2019, Assisted Dying (AD) was legalized in the Australian state of Victoria, joining a small but growing cohort of jurisdictions internationally where AD is permitted. Few studies have ...examined perspectives of doctors who have participated in AD in jurisdictions where it has become legal, despite their pivotal role in the system.
This study aimed to describe the beliefs, experiences and perspectives of doctors who had provided AD during the first 12 months of its operation in Victoria, Australia.
In-depth, semi-structured interviews were conducted between April and July 2020 with 32 Victorian doctors who had been involved in the AD process during the first 12-months since it became legal in Victoria. The assumptions underpinning our methodology were guided by a phenomenological approach and reflexive thematic analysis was used to analyze the data.
Five major themes were identified: a nascent approach to care, practising within clinical and legal uncertainty, confronting practices, personal sacrifices and coping amid new challenges. A thematic schema was developed, illustrating that these themes were expressed as a balance of competing tensions of identity for doctors who provided AD for their patients in practice. A major tension was not just how doctors' perceptions impacted their own wellbeing and satisfaction, but also how these challenged their continued involvement in AD and, therefore, the system's overall ability to function.
Our findings show that while doctors discussed AD as an ethical practice, it also involved multiple identities with varying sources of meaning, and these identities were sometimes overlapping depending on context. As other jurisdictions increasingly move to legalize AD, a greater appreciation of the different role-based and group-based challenges involved in AD may improve AD implementation strategies.
•Assisted dying (AD) raises competing tensions of identity for doctors providing it.•Addressing personal sacrifices for doctors could improve patient access to AD.•AD is satisfying for doctors when it gives patients control over their lives.•Formal guidance and support helps doctors to cope if they find AD confronting.•This strict AD law promotes compliance and confidence in the system.
To explore nurses' experiences of assisted dying and understand how their perspectives inform their participation decision-making.
Assisted dying is a complex and contentious issue with the potential ...to create moral unrest for nurses. The nursing role in assisted dying varies between jurisdictions.
Systematic review. A meta-synthesis using thematic analysis.
Three electronic databases were searched for primary qualitative studies published in English, from New Zealand, Australia or Canada, up to October 2022. Seven articles were included; themes were analysed and key themes were established. Reporting adhered to PRISMA.
The findings highlight the complexity of nurses' decision-making about participation or non-participation in assisted dying and the moral, philosophical and social influences that impact on their decision-making. This is presented as a spectrum of influence which persuades or dissuades nurses to participate in assisted dying. The 12 themes have been categorised into four key themes: personal persuaders, personal dissuaders, professional persuaders and professional dissuaders.
The findings suggest that nurses should be involved in policy and procedure guideline development and be offered education and training programmes to ensure safe, confident and informed practice. The need for mentorship programmes was also prevalent in the research.
It is crucial that nurses be offered education and training in assisted dying. Clear policy and procedure guidelines are essential, and nurses should be involved in the development of these.
Aim
Describe the reported lived experiences of nurses who have participated at any stage of voluntary assisted dying (VAD), from the initial request to the end of life.
Design
A qualitative ...meta‐synthesis.
Data sources
Databases searched were CINAHL, MEDLINE, Emcare, Scopus and PsycInfo. The search was undertaken in September 2021 with no date limitations. Qualitative studies were considered if published in English, reported primary data analysis of nurses' experiences who had been involved in VAD and reported direct quotes from nurses.
Review methods
Qualitative studies meeting the selection criteria were critically appraised, then an open card‐sort method was applied. Quotes from nurses were organized to group similar experiences, constructing themes and metaphors across studies as a new understanding of nurses' experiences of VAD.
Results
Eight studies were included. Three major themes were constructed: An orderly procedure, reflecting the need for structure to feel adequately prepared; A beautiful death, reflecting the autonomy the patient exercised when choosing VAD facilitated an exceptionally positive death; and Psychological and emotional impact, where nurses recognized the emotional and ethical weight that they carried for themselves and the team when undertaking VAD.
Conclusion
Nurses may benefit from clear policy, supervision and communication training to support them as countries transition to providing VAD services. Policy provides nurses with confidence that they are undertaking the steps of VAD correctly and provides a layer of emotional protection. Communication training specific to VAD is necessary to prepare nurses to recognize their own emotional experiences when responding to the needs of the patient and their family.
Impact
VAD is increasingly becoming a legal option that nurses are encountering in their professional practice. Understanding nurses' experiences of being involved in VAD is required to support nurses in countries where VAD is becoming available to prepare professionally and psychologically.
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