Options For Hastening Death In The Face Of Intractable
Suffering Or A Loss Of Selfhood Through Dementia

There are options for those looking to hasten their death when faced with intractable suffering or progressing cognitive impairment or dementia. Unfortunately, none of them is quick or easy to implement, and we encourage anyone considering hastening their death to start planning early. Planning is not commitment. One can always choose not to exercise an option that one has put in place. However, when people wait to plan until they are close to wanting to end their lives, it is often too late, as they no longer have the time, energy, or strength to make the necessary arrangements and carry them out.

When competent, all of these options are possibilities. If you become incompetent through dementia, head injury, or any other reason, the only options available are 1 and 2, and you must have prepared your appointed healthcare representative and put your wishes in writing when you were competent. Once you become incompetent, it is too late.

1.   Stop Therapeutic Medical Treatment

Those facing declining health or dementia who do not want their lives extended can work with their doctors and healthcare representative to tailor their healthcare choices away from extending life. There is no guarantee that this will hasten death, but competent adults and their legally appointed healthcare representatives can refuse any and all treatment while still being entitled to palliative care to keep them comfortable. The medical establishment is geared toward testing and treating, so making these sorts of changes will be more difficult than it might sound, and one must be forceful in pursuing them. An additional challenge is that many medications and treatments are both therapeutic and palliative; for example, a heart medication might give you more energy, but it does so by improving your heart function, which probably helps you live longer. Many tradeoffs are unlikely to be easy or clear.

2.   Voluntarily Stopping Eating and Drinking

Voluntarily Stopping Eating and Drinking (VSED) is a well-understood and time-tested method of hastening one’s death. With hospice or proper palliative care, it is not painful and can be a very satisfactory way to end one’s life. For information on VSED, see our handout, Preparing for VSED: finalexitnetwork.org/resources/fen-resources/voluntarily-stopping-eating-and-drinking-vsed.

While you are still competent, you may direct your healthcare representative to initiate your VSED choice on your behalf should you become incompetent in the future. One way to do this is to supplement your advance directive with an advance directive for dementia: https://finalexitnetwork.org/advance-directives-for-dementia/

3.   Medical Aid in Dying in the U.S.

Medical aid in dying (MAID, also called “death with dignity”) is available in some U.S. States. For a current list of states where MAID is legal, go to: deathwithdignity.org/states. Each state’s law is slightly different, but they all require that two doctors agree the patient has six months or less to live (in at least one state, hospice enrollment qualifies as one of these determinations). Most states require the patient to express their request twice with a waiting period between. Two states, Oregon and Vermont, will serve patients from other states, but the entire process must take place within either Oregon or Vermont.

The American Clinicians Academy on Medical Aid in Dying has a patient-to-doctor referral service for those seeking a MAID provider: www.acamaid.org.

4.   Medical Aid in Dying in Switzerland

Switzerland allows non-Swiss citizens to visit Switzerland to access medical aid in dying. This is an expensive option; with travel, expect it to cost between $10,000 and $20,000. The following Swiss organizations can give you information on their criteria and what is needed:

Dignitas: www.dignitas.ch/index.php?lang=en

Pegasos: www.pegasos-association.com

5.   Books on Safe, Comfortable Methods of Self-Deliverance

For do-it-yourself types, there are good, publicly available how-to books. Two that we recommend are:

Final Exit 2020: https://www.finalexit.org/ (available only as a digital download). This resource is less expensive, a little less technical, and contains information on using drugs and using inert gas, such as helium and nitrogen.

The Peaceful Pill Handbook: www.peacefulpillhandbook.com (both paper and online versions available; the online edition is updated regularly and includes instructional videos). This resource is more expensive, a bit more technical, and contains information on a number of different self-deliverance methods, rating each for reliability, availability, and peacefulness.

6.   Final Exit Network’s Exit Guide Program

For those who meet our criteria, the Exit Guide Program will provide, free of charge, trained and experienced guides to educate you on safe, comfortable ways to end your life. Our guides do not provide physical assistance or the means, so anyone working with guides must be competent and able to procure, assemble, and operate the equipment without assistance. To learn more about the Exit Guide Program, call us at (866) 654-9156 or contact us through our website: www.finalexitnetwork.org/contact-us.

January 2024