suicide at life’s end …

“What must be made very clear here, is that patients who are suffering during the dying process, and contemplate PAS because they feel they have lost all meaning, dignity and purpose in life, are asking physicians, “Do you agree that my life is worthless because I am dying? They are searching in our responses for a way to resolve the ambivalence. A response affirming the value of one’s life even during the dying process is as powerful and influential as our agreeing that “yes, your life no longer has value and I agree with your decision to die”. Our participation in PAS as physicians chooses a side of the patients’ ambivalence and moves them towards death, when in fact there are very valid reasons to take the other side of the ambivalence towards death and support the meaning, value and dignity of the patient even during the dying process. To assuage concerns of burden, loss of meaning, hopelessness, worthlessness, and loss of dignity. We need to understand this intense complexity of the request for PAS and not feel content to have it go relatively unexplored and feel satisfied that we have a nice set of guidelines for its performance (guidelines that do not require psychiatric assessment or expert palliative care assessment, but rather suggest them). We are a culture that sees things in black and white rather than shades of grey complexity, and we are pacified by guidelines and algorithms. This is a terrible mistake and an injustice to the very vulnerable population of the dying terminally ill.” Breitbart ‘Pall Supp Care’ 2010:1-6.