What is the cultural value of dying in an era of assisted dying?

Abstract

Assisted dying is now a lawful and integral component of many societies 'death system', orienting individual and collective encounters with death and dying. While only a very small number of people living with terminal illness in these societies will opt for an assisted death, the choice nevertheless exists for those who satisfy the legal criteria. Theoretically, in these jurisdictions, this turns dying into an optional part of the human lifecycle; a final phase of life that, until now, seemed a universal feature of life except in instances of sudden death. As anthropologists specialising in death and dying, we pose the question of how the various cultural scripts that have sought to give meaning to dying in post-industrial Western societies since the mid-twentieth century might be affected by the advent of assisted dying. We begin by building on both medical and social science literature to construct a working definition of 'dying'.We then identify four dominant cultural scripts: psychological growth; preparation for death; the suffering experience; and the caring experience. After outlining each script, we discuss how it may (or may not) be affected by the increase in assisted dying legislation. We propose that it is the 'caring' script; the notion of affective, intergenerational bonds created through the experience of caring for people specifically in the last few months or weeks of their life, which are likely to be most affected. However, we find that access to these cultural scripts is already limited because of the widespread reluctance to recognise and name 'dying', and the challenges of doing so. Consequently, the various cultural scripts we identify are negated not by the increase in assisted dying, but rather by a combination of medical advances and institutional orthodoxies which limit opportunity for people to experience themselves, or others, as 'dying'.

Travelling to die: views, attitudes and end-of-life preferences of Israelis considering receiving aid-in-dying in Switzerland

“…Most preparations for executing the plan can be divided into four major activities: [ 1 ] involving the family in the planning, mainly through informing close family members; [ 2 ] reading relevant information on the Internet and media or books that describe techniques for killing oneself (e.g., Final Exit , [ 42 ]); [ 3 ] completing other projects before carrying out the plan, such as traveling to exotic places; and [ 4 ] saying goodbye to loved ones (hoping that they will not dissuade the participant from carrying out their plan.)…”

“…The generating of various categories consists of frequent comparisons between and within incidents and concepts, through a process of theoretical coding that establishes meaning, interpretation, and understanding of the researched phenomenon [ 38 ]. Analysisconducted in four stages: [ 1 ] All interviews were read in full, and initial coding and categorization was performed—resulting in 257 codes; [ 2 ] second coding and categorization resulted in 196 codes; [ 3 ] th code categorization within and between interviews was performed and category titles were amended and unified, while ensuring that the original understanding and meaning were not altered. Review of the categories led to the omission of a number of categories that seemed to be out of the ordinary and had no significant contribution to the research question.…”

“…As additional countries legalize aid-in-dying (also known as assisted dying or assisted suicide) and consider extending the application of existing laws, this practice becomes an integral component of societies’ expectations, rules, motives, and symbols, representing a cultural desire to shorten the dying phase. While this may be a response to (or the antithesis of) medical efforts to prolong life, it impacts the benefits of a recognized and perhaps longer dying period [ 2 ].…”

“…In November 2018, the Swiss Academy of Medical Sciences [ 14 ] issued five requirements for aid-in-dying in Switzerland: [ 1 ] the patient has the capacity to issue such a request—a capacity that must be assessed and documented; [ 2 ] the patient's desire is independent and well-considered; [ 3 ] the symptoms of the patient’s disease or impairment cause the patient intolerable suffering; [ 4 ] the patient has sought other medical treatment options that were ineffective or unacceptable; and [ 5 ] the patient's request is understandable, based on the patient's history and repeated discussions with the physician who agrees that aid-in-dying is suitable in this case [ 14 ].…”

“…A more recent systematic review covering qualitative studies from 2001–2016, on the expression of people's wish to die due to life-threatening conditions, found five major themes [ 15 ]: [ 1 ] Suffering was an overarching theme and a common denominator for understanding the other themes, and included physical suffering as well as psychological, social, or existential suffering; [ 2 ] Reasons for wishing to die, including physical, psychological, emotional, and social reasons; [ 3 ] Meanings attributed to the wish to die, such as a cry for help, a preferable alternative to suffering, sparing others having to care for them, a way of preserving self-determination, and an expression of another form to live; [ 4 ] Functions that are addressed through the wish to die, such as means for communicating feelings, thoughts, and wishes, and means for maintaining control over one's life; and [ 5 ] the feeling that time is running out, death is imminent, and we should be ready for it.…”