Since 2002, the clinic run by the assisted dying organisation Dignitas in Switzerland has been chosen by more than 500 Britons to end their lives. Here we look at some of those Britons who made their final journey to the facility.
First UK citizens to die at Dignitas
In 2002, a 77-year-old man with terminal throat cancer became the first Briton to take his own life at the assisted suicide clinic in Switzerland.
The former docker Reg Crew was the first named British person to have publicly travelled to die at Dignitas, in January 2003. The 74-year-old had had motor neurone disease for more than four years.
Craig Ewert
A former university professor with motor neurone disease, Ewert, allowed his death at the clinic in 2006 to be filmed and later shown in Britain in a documentary. The 59-year-old American father of two, who had moved to the UK after taking early retirement, travelled there from his home in Harrogate, North Yorkshire.
‘Mrs Z’
The woman publicly referred to as “Mrs Z” was at the heart of a landmark court case to determine whether she could travel to Dignitas with the help of her husband of 45 years. The 66-year-old had an incurable brain condition called cerebellar ataxia.
In 2004, she went to the high court over attempts to prevent her from dying at Dignitas. Her local authority brought the case after learning of her plans.
A judge decided not to frustrate her wishes to die abroad and lifted a ban on her husband, also 66, taking her abroad, in the first case of its kind.
Mrs Z died in Zurich on 1 December 2004.
Daniel James
At 23, James, who had played rugby for England as a teenager, became the youngest Briton to die at the clinic in September 2008 after being paralysed from the chest down in a rugby training accident.
West Mercia police initially investigated his death but three months later the director of public prosecutions announced that no action would be taken against his parents as it was not in the public interest, “although there was sufficient evidence for a realistic prosecution”.
His parents said James, a tetraplegic, felt his body had become a prison and he lived in fear and loathing of his daily life. His death led to widespread debate as he did not have a life-threatening condition.
Sir Edward and Joan Downes
In 2009, one of Britain’s most respected conductors, Sir Edward Downes, and his wife, Joan, ended their lives together at the clinic. Edward, 85, who was knighted in 1991, was almost blind and Joan, 74, was his full-time carer. He had a long and distinguished career with the BBC Philharmonic and the Royal Opera House, and conducted the inaugural performance at Sydney Opera House. The couple’s children, Caractacus and Boudicca, said their parents had “died peacefully, and under circumstances of their own choosing”.
Robert and Jennifer Stokes
In 2003, Robert and Jennifer Stokes, from Leighton Buzzard, Bedfordshire, died in Switzerland after contacting Dignitas. Robert, 59, had epilepsy and Jennifer, 53, had diabetes and back problems. Both had depression but neither was terminally ill. Family members demanded that the clinic be closed down.
Peter and Penelope Duff
Peter and Penelope Duff were the first terminally ill British couple to have an assisted death in 2009. Before Christmas 2008, they invited guests for a drinks party in an elegant Georgian townhouse overlooking the city of Bath. Their guests did not know that both hosts – he was 80, and she was 70 – were terminally ill with cancer and that they were, in effect, saying goodbye. In February 2009 they died at the clinic.
In a recently viral TikTok series, creator Ali Tate Cutler spends time with her terminally ill grandma who has made the choice to end her life through euthanasia.
While sharing start-of-life stories – such as ultrasound pictures or childhood milestones – is commonplace, posting end-of-life “journeys” online has users conflicted.
Such stories raise questions of autonomy, vulnerability and privacy, but are ultimately useful in changing how we talk about preparing for death.
In Cutler’s series of videos, they show off their outfits before their “last lunch” together. Cutler’s grandma “Bubbie” gives life advice, and they talk through their thoughts and feelings about the euthanasia process.
Cutler’s videos are divisive. Many commenters criticise the attention gained through this subject, commenting, “Why would you publicise this? So wrong.”
However, some recognise it as an important story to tell and reply with their own stories about loved ones, showing kindness to Cutler’s family. Some recent comments have said:
This needs to be regular practice. Thank you for sharing your story.
It’s a blessing to be privy to conversations like this.
Sending her love on her next adventure. Safe travels to a beautiful soul.
It’s telling that many commenters thank Cutler and mention being “privy” to a usually private moment; we hear far fewer end-of-life stories than start-of-life stories.
Talking about death and dying
As scholars who research health, death and grief, we know there can be stigma and silence around end-of-life stories, despite an underlying obsession with death which pervades our media and social circles.
Experts in the field, such as those working in palliative care, call for more open conversations and stories about dying. They argue that not doing so is hindering happier deaths.
Mentioning death and happiness in the same breath may seem like an oxymoron. It’s natural that death and dying bring feelings of worry, fear, grief and regret. Those who talk about death and dying publicly (as we can attest as researchers in these fields) are often labelled grim, maudlin and even “clout-chasing”.
These reactions are understandable – we are biologically and socially conditioned to fear death. Our brains “shield” us from the reality of death, leading us to imagine it as something which happens to others rather than ourselves.
The “other people” we often imagine dying are elderly people. They can face infantilisation and assumptions that they are forgetful or incapable of making choices and speaking for themselves. Maturity of age, experience, autonomy and storytelling capabilities are overlooked.
Commenters assume Cutler is milking her grandma’s death for “clout” rather than enabling her grandma to tell stories which are important.
Cause to be cautious
Concerns of safety and vulnerability are legitimate and, of course, not all those at the end of their lives can tell their own stories. As life narrative theorist Paul John Eakin states, the breakdown of adult life and memory brings us “face to face with the end of an identity’s story”.
However, assuming that all elderly or dying people are beyond constructing stories of their identities or lives is folly. We must share end-of-life stories – safely, collaboratively – or risk oversimplifying the complexity of dying and denying the autonomy of dying people to share their feelings.
Out of pages and into our screens
End-of-life storytelling isn’t new, autothanatography – writing about one’s own imminent death – is an established literary genre.
This unique genre not only helps us process death (our own or a loved one’s), but also normalises anticipatory grief (grieving before the fact). Australian authors such as Cory Taylor and Georgia Blain have penned their own deaths.
This miniature is my life in words, and I have been so grateful for every minute of it.
As writers and creators like Cutler demonstrate, the end-of-life stage can be difficult and heartbreaking, but is also a time to reflect. Autothanatological stories, whether written or digital, are a chance to “shape” death and to contemplate the past and the future at once.
The platform is the message
Backlash aimed at Cutler may be due to her platform of choice. TikTok can be denounced as an app for young, vain people creating dance videos and “thirst traps”.
But content about dying is in demand, as evidenced by popular sub-categories “DeathTok” and “GriefTok”. The juxtaposition between lighthearted posts and stories about dying on the “video dance app” can be an adjustment.
Cutler, a Victoria Secret model, posts both kinds of content concurrently. Some users may find this jarring but it demonstrates that loss is an integrated part of life, not something separate. TikTok and similar sites are ripe for developing such nuanced conversations and even cultural practices around death.
Sites like TikTok create a unique space for end-of-life narratives to reach vast audiences through visual, auditory and algorithmic timelines, suggesting content, and encouraging engagement. Users interact with one another, and explore the complexity and inherent contradictions in reflecting on a life while preparing to lose the person who lived it.
As Cutler responds to a commentor, “This was the hardest and most beautiful conversation I’ve ever had”.
These narratives are moving rapidly from the pages of memoir to the instant accessibility of our mobile phones and we must make conscious efforts to be open to diverse stories about dying.
If we interrogate how we feel when we encounter challenging or surprising end-of-life stories, we can broaden the ways we think and talk about dying, and, indeed, even celebrate happy moments among the sad.
George Carey, the former Archbishop of Canterbury, leads a ceremony of prayer in the Crypt Chapel at his official residence in central London on Oct. 5, 2001.
Lord George Carey, former Archbishop of Canterbury, has challenged the official stance of the Church of England on assisted suicide, urging the British government to set aside time for debate on the law governing assisted dying. A Christian group is warning that it would be “a very dangerous thing” to do, however.
Carey, who served as archbishop from 1991 to 2002, framed this issue as being “profoundly Christian,” asserting that it’s crucial to prevent individuals from suffering against their will, The Telegraph reported Monday.
The former archbishop diverged significantly from the position of the Anglican Church, ignoring its warnings that such legislation could pressurize vulnerable individuals, particularly among the half-million elderly people mistreated annually, to end their lives prematurely.
The Church of England has also cautioned that nations that have legalized assisted dying have experienced a “slippery slope,” with the process becoming progressively easier over time.
Carey has been calling for assisted dying since 2014, when he lent his support to a bill introduced in the House of Lords by Labour’s Lord Falconer. Although the bill did not pass, the issue has resurfaced as lawmakers on the health select committee are reconsidering assisted suicide and euthanasia.
The proposal includes an evaluation of safeguards needed to prevent coercion and the requirements for an individual to consent to the termination of their life.
In his submission to the inquiry, Carey emphasized his belief that one of the many Christian values is to ensure no one endures suffering against their will. He stressed that assisted dying should only be an option for those expressing a clear, persistent wish for it and suggested it was an “act of great generosity, kindness and human love” to aid those wanting to end their suffering.
Carey also contended there is a need for laws reflecting the “compassionate society” we live in, encouraging the government to gather evidence from a variety of sources and ensure an appropriate debate to facilitate law change.
He pointed to evidence from Oregon, California, Australia and New Zealand, asserting that laws allowing choice over the manner of death, with adequate safeguards, can be enacted successfully.
However, the CofE’s submission contradicts his perspective, noting that evidence from the same regions indicated a “slippery slope in operation.” It contended that no systems could effectively rule out coercion in such scenarios.
The CofE has raised concerns over “improper psychiatric testing” in places like Oregon and the prevalence of “doctor shopping,” with patients looking for medical professionals willing to administer lethal drugs. It further warned about challenges to the original law, expanding the definition of assisted dying to include those with non-terminal but “grievous and irremediable” medical conditions.
In an op-ed, Christian Concern Communications Manager, Paul Huxley, reinforced the CofE’s position, asserting that legalizing assisted suicide would be “dangerous, unnecessary and wrong.”
He cited evidence from other jurisdictions where vulnerable people felt pressured into ending their lives prematurely, and highlighted the Christian perspective that views death as an enemy and noted that suffering is an opportunity to strengthen one’s faith in God.
“It would be a very dangerous thing to do. … Assisted suicide changes the way doctors think about how they care for people. They think, ‘oh well, we can offer you euthanasia’ rather than thinking about how can we look after this person…,” Huxley wrote. “I think it’s a very concerning message that we are sending to people.”
He pointed out that “the most dominant symbol of Christianity is the cross – a man dying,” and, therefore, “life and death are put right at the center of the Christian message (the Gospel) as Jesus died for our sins and was raised for our justification.”
A 2020 Gallup poll showed 74% of Americans surveyed said doctors should be allowed to end the life of a patient with an incurable disease “by some painless means” if the patient and the patient’s family requests.
More states and countries are enacting laws to let terminally ill patients in great pain decide when to die
By Donna Apidone
In January, just a few days after the start of 2023, a woman walked into the Daytona Beach, Florida, hospital where her terminally ill husband was a patient and shot him. She said she intended to kill herself as well, but hospital staff stopped her before she could carry out the second part of her plan.
Ellen Gilland told police the shooting was by mutual consent, that she and her husband agreed that it was the best way for them to handle his decline in health. He was too weak to take his own life.
Medically assisted deaths are illegal in all other states and U.S. territories, including Florida. No jurisdiction permits the use of firearms to end a human life.
Words matter
Medical aid in dying is not euthanasia. The latter term includes the act of one person killing another who is terminally ill or hopelessly injured and suffering great pain. Euthanasia is illegal throughout the United States. However, if the person who is dying self-administers, the act is not considered euthanasia.
In the U.S., terminology has evolved. The current acceptable wording is “medical aid in dying” or “medical assistance in dying” indicating that a medical professional will make a lethal dose of one or more drugs available to the patient but leave it to the patient to decide whether to take it. The terms are abbreviated as MAID.
The word “suicide” is not accurate, although is it sometimes incorrectly applied. Death certificates state a patient’s underlying illness as cause of death.
Although 22% of Americans have access to medical aid in dying, fewer than 1% of people in the 10 states and Washington, D.C., where this option is legal actually obtain the medication, and only two-thirds of them ultimately decide to take it, according to Compassion and Choices, a nonprofit group that advocates for end-of-life options including, but not limited to, medical aid in dying.
Where it is legal in the U.S.
In addition to reaching a consensus on the language describing medical aid in dying, the 11 jurisdictions that authorize the practice are consistent in their intent, said Kim Callinan, president and CEO of Compassion and Choices.
“Most of the laws across the states are very similar,” she said. “The eligibility criteria are the same. And the safeguards are the same.”
Geoff Sugerman, who served as campaign manager for Oregon’s Death with Dignity law, which was enacted in 2012, and works closely with the national organization called Death with Dignity, laid out the four cornerstones of the laws in in the 11 jurisdictions:
Patients must be adults with a terminal illness and a prognosis of six months or less to live.
Attending physicians must verify patients are acting voluntarily.
Patients must be able to make and communicate their decision to healthcare providers.
Patients must be able to self-administer (ingest) the medication.
Differences among laws
There are some differences in the laws. Where it is legal, a common waiting period for approval of medical assistance in dying is 15 days. Hawaii mandates 20 days. New Mexico and Oregon are less than 15 days. In California, a 2022 adjustment to the law reduced the time from 15 days to 48 hours.
Most medically assisted deaths are limited to residents of states that have legalized the procedure. However, the Vermont legislature in April passed a bill that would eliminate the residency requirement; Gov. Phil Scott has said he would sign it into law. Meanwhile, Oregon officials have said the state will not prosecute nonresident cases.
The number of states considering medically assisted death continues to grow. Minnesota and Florida have bills in their legislatures.
While some states debate new MAID laws, others are weighing changes to existing laws. As public opinion adjusts and data is collected, legislators in several states are considering amendments. Some details in the original laws may have “served as barriers to the patient,” Sugerman explained.
Changes to legislation may include the length of the waiting period and expanding the definition of “medical professional” to include Physician Assistants and Nurse Practitioners. Some states may remove their residency requirements so that patients can travel from other jurisdictions for the process.
A patient’s first consideration of medical aid in dying may come in a conversation with a primary care physician or specialist when treatment options have been exhausted.
Dr. Nathan Fairman is a physician with UC Davis Health in California. He was selected to provide medical information to the state’s legislators as they prepared wording for the End of Life Option Act, enacted in 2015. Fairman explained how the process might go in his health system.
A UC Davis Health patient sees a primary care physician until a diagnosis necessitates care from a specialist. If treatment of a disease or condition is no longer beneficial, the specialist is likely to discuss end-of-life options with the patient.
Depending on the illness, medical aid in dying may be one of several options. Others may include palliative care and cessation of eating and drinking. Each option comes with its own set of considerations.
The patient makes the choice. A team is put in place to help the patient and doctors through the qualification process. “We employ navigators,” Fairman explained. These are two trained professionals who “make sure the patient has gone through all of the required steps — and there are a lot of them” — to qualify for medical aid in dying, if that is the choice.
“We were intentional about having a clinical social worker in this role,” he said. “It requires a high degree of advocacy and health system literacy. You need to have someone who is jumping through those hoops.”
Doctors may opt out
Doctors may disagree with the state law or their system’s policy. Professionals are not required to participate in aid in dying. Depending on personal beliefs, a doctor may refer a patient to a colleague in the same system.
In California, although referrals are allowed, they are not guaranteed. In the region served by UC Davis Health, most of the major health systems have policies for the process. The exception is Dignity Health, a Catholic healthcare system. A patient may have to change health systems to have access to aid in dying.
On the other side of the country, Providence St. Joseph Health is a Catholic healthcare system serving residents of Maine and Vermont, two states that have legalized medical aid in dying. The healthcare system has published its end-of-life policy. “PSJH considers intentionally hastening death to fall outside the scope of legitimate medical practice,” according to the document.
The PSJH policy acknowledges its patients may request a service it will not provide. “Providers and caregivers must not actively obstruct eligible patients from discussing, exploring or pursuing legal avenues to hastening death. Within the context of a therapeutic relationship, providers and caregivers should discuss with the patient why they may be inquiring about hastened death and what unmet needs there may be.”
Final exit network
A nonmedical end-of-life option is available through the Final Exit Network (FEN), a nonprofit organization based in Tallahassee, Florida, with about 20 “exit guides” who volunteer in all 50 states.
Wendell Stephenson lives in California and is a member of FEN’s board of directors. He said the organization is “devoted to providing information to people about how they can end their lives in a peaceful manner.”
FEN volunteers may be present at a death, but that is not required. Because physicians are not a part of the Final Exit Network process, medications are not used. Instead, FEN volunteers suggest using an inert gas and explain how to obtain and use it. Family members also receive guidance on observing the process but not helping, to avoid criminal charges.
Do patients measure up?
FEN has a medical evaluation committee consider applications from patients seeking to end their lives. The committee (composed of MDs and others with medical and mental health backgrounds) review applicants’ medical records with a couple of key considerations.
One of FEN’s rules is that applicants have conditions that “cannot be cured,” Stephenson said. They must have an intractable medical condition that seriously impairs quality of life. Most of these can be expected to shorten the applicant’s life, but death does not have to be imminent.
Another requirement is that applicants be physically able to manipulate the equipment that delivers the gas, Stephenson explained.
FEN does not provide the inert gas or related equipment, nor does it publicly discuss the content of the information they provide. For details, they refer to “Final Exit,” one of the books written by the organization’s founder, Derek Humphry.
Supporters and opponents
The Pew Charitable Trusts, a nonprofit research organization, issued a report summarizing the viewpoints of several of the world’s major spiritual groups regarding medical aid in dying. The report, published in 2012, provides more perspective from each religion than a simple “yea” or “nay.” Many faiths do not approve of MAID, a few allow for it, none endorse it. Some acknowledge the request for reduction of lifesaving techniques at the end of life.
In a Gallup poll in 2020, 74% of the 1,028 Americans surveyed said doctors should be allowed to end the life of a patient with an incurable disease “by some painless means” if the patient and the patient’s family requests it.
Activists are often family members of patients who have died painful deaths.
Will insurance cover medical aid in dying? “Sometimes,” Fairman said. “Many private insurances will cover it. MediCal [California’s version of Medicaid] will cover it for the state portion. Any federal insurance will not cover it.”
The Compassion and Choices website reports, “Regardless of whether a state has authorized medical aid in dying, insurance providers cover treatments that are deemed effective and proven, and not those considered unnecessary, experimental or below the standard of care.”
Countries outside the U.S. allow different end-of-life options. Callinan, CEO of Compassion and Choices, warns against comparisons “because the healthcare systems, the political systems, the economic systems, the cultures are entirely different.”
Canada passed its MAID law in 2016, covering residents eligible for Canadian healthcare. It has been updated several times. By 2024, a decision will be made regarding the inclusion of mental illness as a criterion.
Outside the U.S.
While euthanasia — medically assisted death performed by someone other than the patient — is illegal throughout the U.S., it is allowed in some other countries.
End-of-life options vary around the world. The practice is legal in Belgium, Luxembourg, Netherlands, Switzerland, Austria and Spain. Some processes resemble medical aid in dying and others are closer to euthanasia, though at the request of the patient.
Several Swiss organizations offer medical aid in dying to nonresidents. The oldest and best known is Dignitas, which has been featured in BBC and PBS documentaries. In addition to a membership fee, a patient pays a considerable sum for the end-of-life procedure.
Medical aid in dying is legal in New Zealand. In Australia, five of the six states either allow medical aid in dying or will by the end of 2023. Colombia allows the practice, while Chile, Uruguay and Argentina have introduced bills to decriminalize the procedure.
Several other countries have laws that allow patients to decline treatment and/or nourishment that would sustain life, according to World Population Review.
— A filmmaker spent three years with Paralympian and triathlete Marieke Vervoort to explore her wish to die by euthanasia
By Amy Woodyatt
Throughout her storied career, triathlete and Paralympian Marieke Vervoort captured the imagination of her native Belgium and the wider world.
But it wasn’t just her stack of sporting achievements that drew attention.
Vervoort lived with a degenerative spinal and muscle condition and had long been vocal about how one day she wanted to – and would – end her life by euthanasia.
Euthanasia involves a physician administering a drug to end the life of a patient who is suffering, usually with a debilitating or life-limiting condition.
“Everyone is pushing me and asking me, ‘When are you going to die? Do you know already the date that you’re going to die?’” she told documentary maker Pola Rapaport, who last year directed the film “Addicted to Life” about Vervoort.
“I said, ‘F**k you.’ … You don’t know when you want to die. When the time comes, when I feel it’s enough, then I will decide.”
She was a Paralympic gold medalist at London 2012, winner of silver medals at Rio and holder of a European record for the T52 100 meters, but Vervoort’s condition caused her near-constant pain and made sleeping very difficult.
She received euthanasia approval in her native Belgium in 2008, but far from signaling the end of her life, Vervoort was very vocal about how the ability to control her own destiny empowered her to continue to compete at the highest level and make the most of her remaining days.
Documentary maker Rapaport, who encountered Vervoort’s story after reading a news report about her, says she was instantly captivated by the athlete and how the “paradoxical” permission to die “had given her a kind of liberation of spirit.”
“Her knowing that she could choose her date of dying and the conditions under which she would die, and whom she would have with her. … The fact that that had given her so much mental liberation and spiritual liberation, I thought, was a fantastic story,” Rapaport told CNN Sport.
Vervoort had been living with her illness, which caused paraplegia, since her teens, and as she got older, she became involved in wheelchair basketball, swimming and triathlons. By the time she applied for euthanasia, she had already considered and planned to die by suicide.
“I no longer have a fear of death,” she explained. “I see it as an operation, where you go to sleep and never wake up. For me, it’s something peaceful. I don’t want to suffer when I’m dying … When it becomes too much for me to handle then I have my life in my own hands.”
Rapaport added: “She told us on day one, ‘The time is not here for me to call my doctor and tell him that I want to go now. But when the bad days outweigh the good days, that’s when I will do it.’”
Ultimately, that moment ended up coming over a decade after she was granted the approval for the procedure.
A love for life
Vervoort won gold in the T52 100m wheelchair race and silver in the 200m race at the London 2012 Paralympics, then claimed two further medals at Rio 2016.
Apart from her athletic endeavors and achievements, Vervoort made sure to live to the fullest toward the end of her life, making time for wheelchair bungee jumps, Lamborghini racing with driver Niels Lagrange, trips abroad and time with her close friends.
Vervoort’s continued enthusiasm for living in spite of her suffering was the result of being granted the choice to do what she wanted with her life, Rapaport said.
“The most important central theme of the film is that when a person has control over their personal body, mind, spirit, that it gives them freedom to live. And in this case, having control over decision-making about the end of your life,” Rapaport explained.
“She had incredible highs and really amazing successes that still astonish me and I think astonished her fans and the Belgian public and the royal family. And she also had horrendous lows,” Rapaport said.
Vervoort was named a Grand Officer of the Order of the Crown by Belgium’s King Philippe, whom she met in a ceremony in 2013, along with Queen Mathilde.
By the end of her life, seizures and excruciating pain had become almost daily for Vervoort, which also understandably contributed to a decline in her athletic ability.
The day Rapaport and her husband, Wolfgang Held, who is also a filmmaker, met Vervoort, the athlete experienced a seizure, which at the time led them to believe she was dying in front of them.
“It was grueling to watch. It was very upsetting to watch when Marieke would go into the seizures, and over the three years that we shot with her on and off, it happened more and more frequently,” Rapaport added.
“I didn’t want it to be a film only about this marvelous Paralympic athlete who triumphs in the face of incredible odds. I really wanted the audience to get the sense of what this young woman goes through on a regular basis,” she explained.
An ongoing conversation
In 2019, after a small party with friends and family, Vervoort died through euthanasia at her home in Diest, Belgium, at the age of 40 – and although it has now been some four years since her passing, conversations around euthanasia are still as relevant now as they were then.
Although a few European countries including Belgium, Luxembourg, the Netherlands and, recently, Portugal allow euthanasia under certain conditions, euthanasia and assisted suicide are not legal in most countries, and assisting a suicide, or providing a means to die by suicide, is punishable with jail time in many places.
The Vatican condemned euthanasia in its strongest language yet in 2020, calling it an “act of homicide” that can never be justified.
Meanwhile, debates resurface in Belgium over patients who have died by euthanasia on the grounds of psychiatric reasons.
Last year, the European Court of Human Rights ruled that Belgium didn’t violate the rights of a person with depression when it accepted her decision to go ahead with a euthanasia procedure after her son, with support from Christian advocacy organization ADF International, mounted a court case that was highly publicized in the country.
In Belgium, 2,966 people died by euthanasia in 2022, comprising 2.5% of all deaths in the country that year, according to the country’s Federal Commission for the Control and Evaluation of Euthanasia.
Of euthanasia performed in 2022, nearly 90% of patients were over the age of 60, with almost 60% of the 2,966 who died having cancer, about 20% affected by multiple diseases and about 9% affected by nervous system diseases.
Rapaport told CNN Sport she wanted Vervoort’s experience – shown through shots of the athlete grimacing and crying out in pain, as well as footage of her seizures – to help people to understand why people would decide to die by euthanasia.
“It’s not an advocacy film. It doesn’t have any statistics. There’s no politicking in it. I felt that the more you can enter into this young woman’s experience, the more you will understand the arguments for assisted dying, no matter what country you’re in,” Rapaport added.
“Her story does expand the conversation, and you see what a person goes through and her case: how [the right to die as she wanted] improved her life immeasurably.
“That’s what I thought was so beautiful about her story, that this permission made her life so much better in the meantime, and it really allowed her to live to the maximum. And that was just unbelievably inspiring,” she added.
Rapaport hopes the film will keep conversations around death ongoing.
“It’s something generally people don’t want to talk about until they absolutely have to; even then, they don’t want to talk about it. But having control over that really can transform the rest of a person’s life and that is all we have.
“That’s all we have because we’re all going there,” Rapaport added. “It’s just a matter of when, how and how it will be handled.”
Three decades ago, Dr. Jack Kevorkian became the face of the incredibly contentious debate over medically assisted death. Dubbed “Dr. Death” in the media, he claimed to have helped at least 130 patients die before being convicted of second-degree murder in 1998.
Kevorkian died in 2011, but the argument over whether it should be legal for doctors to aid people in ending their lives is still far from settled. Today, 10 states and Washington, D.C., allow medically assisted suicide — a process in which life-ending drugs are supplied to patients, who administer the dose themselves. The laws differ, but they generally state that individuals must have a terminal illness and a prognosis of less than six months to live to qualify. Only two states, Oregon and Vermont, allow medically assisted suicide for nonresidents.
While the U.S. is one of just a handful of countries to legalize what is often called medical assistance in dying (MAID), our laws are significantly more restrictive than those in some of our peer nations. For example, America is the only country to require a terminal diagnosis. All others allow people living with incurable illnesses that cause them “unbearable pain” to choose a medically administered death. Most permit both assisted suicide and euthanasia, in which doctors administer life-ending drugs directly. Several also permit MAID for people with severe mental illness and let individuals make “advance requests” in cases in which they’re expected to lose their capacity to make their own decisions in the future, such as from dementia.
Over the past few years, Canada has become the site of the highest number of medically assisted deaths in the world. There were more than 10,000 MAID cases in Canada in 2021. That’s more than the total number of assisted suicides estimated to have occurred in the U.S. since Oregon became the first state to legalize the practice in 1997.
Why there’s debate
At the most basic level, the debate over medically assisted death comes down to morality. Either you believe it’s categorically wrong for a doctor to help someone end their life or, like nearly three-quarters of Americans, you believe there are cases where people should be granted the “right to die” on their own terms.
The issue gets much more complicated when it comes to defining what those cases should be and what criteria people should have to meet before they’re allowed to choose a medically assisted death.
Advocates for expanding opportunities for MAID say that limiting access exclusively to terminally ill patients leaves countless people to suffer unnecessarily and denies them the ability to opt for a peaceful, pain-free death. They argue that a truly compassionate society would trust individuals to make their own choices, rather than insist that they die in a way that satisfies others’ sense of right and wrong.
But critics worry that more permissive assisted death laws could lead to a “death on demand” system or create circumstances in which people are pushed toward making the choice to die when that may not be necessary. There’s also concern that MAID could warp into a way for society to avoid the effort and expense of caring for its most vulnerable members, including the disabled, mentally ill and even the poor. Many critics point to troubling reports out of Canada — including one case in which a patient’s family claims he was “basically put to death” — as a sign of the slippery slope that can happen when there aren’t sufficient guardrails in place.
What’s next
Supporters of medically assisted death are hoping to expand the practice into more areas of the country. Bills that would legalize assisted suicide have been proposed in at least 10 states over the past year, though it’s unclear whether any of them will become law.
Perspectives
It’s inhumane to force people to suffer when they want to take a different path
“It is nothing less than cruel to prevent anyone from having some control in their most difficult hours as life comes to an end. Of course, there must be safeguards. … But for those who choose to end their suffering and for the families that support their decision, the death with dignity option should be available.” — Judy Kugel, Boston Globe
Assisted death should be available only in very limited circumstances
“Is it really more humane to deny a miserable person a clean assisted suicide than to grant it? Authorities should say yes: We won’t help you die because of your depression, poverty or unfit living conditions for the same reason we won’t take out your appendix if you have a broken leg, or prescribe lithium for a nasty case of psoriasis.” — Chris Selley, Wall Street Journal
Freedom to die should be treated as basic human right
“The ability to end one’s life is an important freedom. Our bodies belong to us, not the government. We should have the power to decide whether we wish to continue living, particularly if we are in constant pain or suffering debilitating or fatal illnesses.” — Scott Shackleford, Reason
The foundations of our humanity begin to crumble when life loses its value
“The idea that human rights encompass a right to self-destruction, the conceit that people in a state of terrible suffering and vulnerability are really ‘free’ to make a choice that ends all choices, the idea that a healing profession should include death in its battery of treatments — these are inherently destructive ideas.” — Ross Douthat, New York Times
Canada has shown how dangerous MAID can be for vulnerable people
“The introduction of euthanasia in Canada has become the slipperiest of all slippery slopes. Of course, the expansion of assisted suicide laws in the U.S. will produce the same troubling problems. … Canadians have the right to die, but do they have the right to live in the face of medical challenges?” — Valerie Hudson, Deseret News
We don’t have to choose between protecting the vulnerable and giving people the right to die with dignity
“Let’s be clear: It was always going to be complicated to find the proper balance between protecting patients and helping them die. Complicated but achievable. It should absolutely be possible to write laws that protect elderly, sick, disabled and otherwise vulnerable people from manipulation or coercion while still providing competent adults with options for relief from intolerable suffering or irremediable illness.” — Nicholas Goldberg, Los Angeles Times
The worst case scenario is a world where people can choose to die at any time for any reason
“The ultimate goal — or, at least, the consequence — of allowing assisted suicide/euthanasia is death on demand.” — Wesley J. Smith, National Review
Banning MAID leaves people to face, and often choose, death entirely on their own
“People facing the grim, painful finality of their lives are committing suicide right now, many without a physician present to ease their suffering — or to talk them out of it. Patients can’t be the primary decision maker on end-of-life options if the government refuses to permit the existence of a decision. Patients can’t consult with doctors or loved ones about their end-of-life preferences if the consultation itself is illegal.” — David Colborne, Nevada Independent
Current limits are so restrictive, the “right to die” largely exists only on paper
“The few places in the United States where assisted suicide is allowed impose restrictions so exacting they are difficult for people in state, and often nearly impossible for anyone out of state, to meet.” — Pamela Paul, New York Times
Sometimes life isn’t better than death
“The idea that any life is better than no life at all is largely unexamined and unchallenged, especially by the young and healthy. … But isn’t the principle itself — life at all costs — due for a reevaluation that pays more attention to the wishes of the individual? Wouldn’t more control of the time, place and circumstances of our deaths alleviate some of our fear of dying, if not of death itself?” — John M. Crisp, Tribune News Service
In January, just a few days after the start of 2023, a woman walked into the Daytona Beach, Florida, hospital where her terminally ill husband was a patient and shot him. She said she intended to kill herself as well, but hospital staff stopped her before she could carry out the second part of her plan.
Ellen Gilland told police the shooting was by mutual consent, that she and her husband agreed that it was the best way for them to handle his decline in health. He was too weak to take his own life.
A 2020 Gallup poll showed 74% of Americans surveyed said doctors should be allowed to end the life of a patient with an incurable disease “by some painless means” if the patient and the patient’s family requests it.
Medically assisted deaths are illegal in all other states and U.S. territories, including Florida. No jurisdiction permits the use of firearms to end a human life.
Words Matter
Medical aid in dying is not euthanasia. The latter term includes the act of one person killing another who is terminally ill or hopelessly injured and suffering great pain. Euthanasia is illegal throughout the United States. However, if the person who is dying self-administers, the act is not considered euthanasia.
Only 10 states and the District of Columbia have laws that allow medical assistance in dying by making a lethal dose of medication available to adult patients who request one.
In the U.S., terminology has evolved. The current acceptable wording is “medical aid in dying” or “medical assistance in dying” indicating that a medical professional will make a lethal dose of one or more drugs available to the patient but leave it to the patient to decide whether to take it. The terms are abbreviated as MAID.
The word “suicide” is not accurate, although is it sometimes incorrectly applied. Death certificates state a patient’s underlying illness as cause of death.
Although 22% of Americans have access to medical aid in dying, fewer than 1% of people in the 10 states and Washington, DC, where this option is legal actually obtain the medication, and only two-thirds of them ultimately decide to take it, according to Compassion and Choices, a nonprofit group that advocates for end-of-life options including, but not limited to, medical aid in dying.
Where It Is Legal in the U.S.
In addition to reaching a consensus on the language describing medical aid in dying, the 11 jurisdictions that authorize the practice are consistent in their intent, said Kim Callinan, president and CEO of Compassion and Choices.
“Most of the laws across the states are very similar,” she said. “The eligibility criteria are the same. And the safeguards are the same.”
Geoff Sugerman, who served as campaign manager for Oregon’s Death with Dignity law, which was enacted in 2012, and works closely with the national organization called Death with Dignity, laid out the four cornerstones of the laws in in the 11 jurisdictions:
Patients must be adults with a terminal illness and a prognosis of six months or less to live.
Attending physicians must verify patients are acting voluntarily.
Patients must be able to make and communicate their decision to health care providers.
Patients must be able to self-administer (ingest) the medication.
Differences Among Laws
There are some differences in the laws. Where it is legal, a common waiting period for approval of medical assistance in dying is 15 days. Hawaii mandates 20 days. New Mexico and Oregon are less than 15 days. In California, a 2022 adjustment to the law reduced the time from 15 days to 48 hours.
Kim Callinan, Compassion & Choices
Most medically assisted deaths are limited to residents of states that have legalized the procedure. However, the Vermont legislature in April passed a bill that would eliminate the residency requirement; Gov. Phil Scott has said he would sign it into law. Meanwhile, Oregon officials have said the state will not prosecute non-resident cases.
The number of states considering medically assisted death continues to grow. Minnesota and Florida have bills in their legislatures.
Fine-Tuning Legislation
While some states debate new MAID laws, others are weighing changes to existing laws. As public opinion adjusts and data is collected, legislators in several states are considering amendments. Some details in the original laws may have “served as barriers to the patient,” Sugerman explained.
Changes to legislation may include the length of the waiting period and expanding the definition of “medical professional” to include Physician Assistants and Nurse Practitioners. Some states may remove their residency requirements so that patients can travel from other jurisdictions for the process.
