“Death with dignity” has long been a slogan of the “right to die” movement. Proponents of legalizing physician-assisted suicide and/or voluntary active euthanasia (in which mentally competent patients with terminal illnesses can request to end their lives and suffering) adopted this rallying cry as a means of speaking to the concern of the general public about the dehumanizing aspects of dying in increasingly technologically sophisticated health care settings. In contrast, opposition to “mercy killing” has arisen in some religious and ethnic communities who oppose the medical termination of life under any condition, either for moral reasons or because of historically conditioned distrust toward the health care system. Recently, proponents of palliative care as an alternative to assisted suicide and euthanasia have attempted to demonstrate that dignified deaths are possible when the dying person’s needs are attended to in sincere and caring ways. Thus, the concept of a “dignified death” is subject to varying interpretations, ranging from endorsement of the patient’s right to request physician assistance in dying, to the less ethically contested principles that a person can refuse futile treatment that only prolongs suffering and that systematic attention to pain management along with the patient’s (and family’s) psychological, social, and spiritual needs is essential to permit an appropriate death.
Interest in assisted suicide and euthanasia in the United States dates back to the early 20th century, with the first euthanasia bill drafted in Ohio in 1906 and the first euthanasia society in the United States being founded in New York in 1938. However, it was not until the 1970s that the movement gained significant traction, possibly as a result of the development and use of medical technology that could prolong life and, perhaps secondarily, increase perceived suffering. Although there had been widespread efforts to distribute “living wills” to permit patients to declare their end-of-life treatment preferences, the first state statute legalizing the use of living wills was not passed until 1976 in California, coinciding with the New Jersey Supreme Court’s decision to allow the parents of Karen Ann Quinlan to disconnect the ventilator that was keeping her alive in an unconscious vegetative state.
The Hemlock Society (recently renamed “End-of Life Choices”) was founded in 1980 with a charter principle to publish a book “about methods and strategies of planned death with dignity.” Final Exit, which provided explicit information, appeared in 1991, written by society founder Derek Humphry. “Death with dignity” was widely adopted as a catchphrase for the movement to indicate the desire to die in a way that did not sacrifice quality of life for quantity. Many subsequent legislative efforts were referred to as “death with dignity” acts or bills, such as an unsuccessful bill in Oregon in 1991, an unsuccessful act on the 1992 California ballot, and the successful 1994 Oregon Death with Dignity Act (which was passed again and implemented in late 1997).
This idea of “death with dignity” tapped into a core concern of the general public, because the possibility of losing one’s dignity near the end of life is one of the greatest fears of people in general and dying individuals in particular. Perhaps for this reason, numerous surveys of public and professional attitudes concerning end-of-life treatment decisions indicate widespread, but not universal, support for the principle of patient self-determination as a means of ensuring death without unnecessary suffering, at least in many Western countries. Partly as a result of this growing awareness of the problem, more attention is being given to the idea that a person can die with her or his dignity intact without having to resort to assisted suicide or euthanasia. Although this has been a core aspect of hospice care, it is likely that a diversity of efforts to enhance dignity near the end of life will be undertaken in medical settings and other long-term care institutions in the future.
- Chochinov, H. M. (2002). Dignity-conserving care—A new model for palliative Journal of the American Medical Association, 287, 2253–2260.
- Death with Dignity National Center, http://www.deathwithdignity.org/
- Field, M. J., & Cassel, C. K. (1997). Approaching death: Improving care at the end of life. Washington, DC: National Academy
- Hillyard, , & Dombrink, J. (2001). Dying right: The death with dignity movement. New York: Routledge.
- Humphry, D. (1991). Final exit. Eugene, OR: Hemlock Society. Last Acts, http://www.lastacts.org/
- Webb, (1997). The good death: The new American search to reshape the end of life. New York: Bantam.