People find me, people who are tired of suffering, people who look ahead and only see more suffering. It’s not only physical aches and pains, though there is plenty of that. The suffering is also aching hearts, minds, and spirits. They are exhausted. When I mention the double effect of not wanting to die, but of being unable to live with the way they feel, heads nod, often tears arise, and people feel understood.
As an End-of-Life Doula, I listen. My job is listening, holding space, being present, and it’s also educating and advocating. They ask me about options. Some have heard there are legal means to hasten death and ask directly about them. Some feel there has to be a way out of suffering without the violence, secrecy, and loved one’s grief at a death by suicide.
So, we talk. I first talk about Palliative Care to make sure that all the ways to relieve suffering have been explored, that physical pain has been addressed and alleviated as much as possible by the medical team and complementary medicine practitioners, that emotional pain has been addressed and alleviated as much as possible by therapists or other mental health professionals, and that spiritual pain has been addressed and alleviated as much as possible by chaplains, ministers, and other spiritual counselors, teachers, and guides.
Then I ask about their support network, how family and friends might feel about a decision to hasten death. Whether or not their closest people could and would be supportive. Whether any of their closest people would interfere in their decision to hasten death.
And then we talk some more. We talk about their lives, their journey with illness, and their hopes and fears about the end of their life. Not one has taken this lightly. Not one has had absolutely no deep feelings about a choice to hasten death.
I answer their questions.
My job is listening, holding space, being present, and it’s also educating and advocating.
I share the experiences of clients who have chosen to voluntarily stop eating and drinking (VSED). Most have an affinity for that method. They understand that they have the right not to eat and drink and want to know more. They begin to feel some control over their life and death. They see an end to suffering along with the bittersweet knowledge of leaving what they know and love about this life. They make a plan, gather the support needed, set a date, and say their goodbyes. Within about two weeks death comes on their terms.
Those who don’t resonate with VSED ask about other methods. We discuss their diagnosis and whether it is considered terminal or not.
I live in North Carolina, where Medical Aid in Dying (MAID) is not yet legal. If the client's illness is terminal, we talk about the process of Medical Aid in Dying and the need to establish residency in another state where it is legal or the need to travel to a state without residency requirements. Some decide to pursue the process and undertake the necessary travel and expense. Others may not have the energy or resources to travel to a state without residency requirements or don’t have an affinity for that method.
Next, I tell them about traveling to countries where Medical Aid in Dying doesn’t require a terminal diagnosis. I outline that there are requirements and a process to complete before acceptance to a program such as Dignitas, Pegasos, and Athanasios. I currently know one person, most of the way through that process, who feels in control and is waiting to intuit when the time is right for setting a date and making the trip for a voluntary assisted death. The family is supportive at this time, but they are wishing and hoping for a long time together.
Those who do not have the financial means for a trip abroad or do not have the time or energy for the acceptance process of that method of a death with dignity ask, “what else?” I then tell them about the process of death by inert gas and refer them to Final Exit Network.
These methods are all legal. They all allow for a thoughtful, intentional end to suffering. There is no impulsivity, secrecy, or violence. People exploring these methods experience agency and control, and many choose to allow a natural death in the end.
I am an End-of-Life Doula; I listen, I educate, and I support the decisions of my clients.