I have been involved with several conversations about death and dying in the last year, specifically in relation to assisted suicide and palliative care. In Switzerland assisted suicide is legal and comes out of the Swiss protection of an individual’s right to decide for oneself what is right at the end of life. So, assisted suicide is one of the elements of such conversations in Switzerland. Some people from countries where this is not legal find it an important part of the death and dying options.
The Swiss cultural perspective about the right to decide for oneself is reflected in the number of non-assisted suicides or choices to end life in Switzerland, something I experienced in my own neighbourhood. The first year and a half after I moved to Switzerland from the US I experienced five older adults who decided to end their life by not eating, hanging themselves, jumping in front of the train or shooting themselves in the head. I lived within 500 meters of 3 of these cases and so was quite deeply shocked by the number of people who chose to die on my street plus the way 3 of these people chose to die. I asked the questions, why did these people not use the legal assisted suicide services for a less violent death and what led them to feel they needed to end their lives? I found no real answers but these realisations/ideas: Only one situation was connected with depression - the others were all clear-headed choices. I also wondered if the legality of assisted suicide encouraged more people to take their lives but not to deeply reflect upon their choice or discuss the options with someone.
The top concerns I heard the discussions of which I was a part:
- The desire to have control over when the right time is to go, especially in regards to physical suffering.
- The motivation to become a member of one of the Swiss organisations – it is a form of “insurance” in the case that one gets a terminal illness, which might cause great physical suffering.
- A concern that there are many “Suicide tourists” who come to Switzerland to die.
- The shock to those who are not informed that their loved one, neighbour or friend has engaged assisted suicide.
- The lack of support and understanding for those around the person who has chosen to use assisted suicide. The organisations or “businesses” are serving their “customers” not the others. During and after the death of the person who has chosen to use assisted suicide loved ones are not supported. The are also not prepared for the situation.
- Concern that the cost of being old and the most expensive last two years of life (research shows that the last two years are most expensive) “forces” older people to consider and follow through with ending their lives to save the inheritance that their offspring / family would otherwise not receive.
How can we better support and prepare for the dying process so that when someone who decides that they are really ready to end their life they do so without it being a question of money/inheritance and they do so having been able to reflect upon their fear of loss of control. How can we do better at supporting those who are left behind, especially when they are in the room where the person is dying or has died.
My idea is to provide end-of-life coaching especially as part of the investigation of and application for assisted suicide. Based upon the themes raised in the conversations of which I was a part such coaching should at least include responses to the questions of inheritance, our culture of control and the accompanying loved ones.
Inheritance:End-of-life coaching can help people identify their life values: as Parker Palmer says, let your life tell you what your values are vs tell your life what your values are. Our values are the basis for understanding the role and form and method of inheritance that we want. Identifying a person’s values as a basis for defining inheritance – so that inheritance can be gestalted to match a person’s values vs being determined by money as the highest value.
End-of-life coaching can help people identify non-financial forms of inheritance which they have provided and can provide.
Control:End-of-life coaching can help people reflect upon their concern about loss of control. This to include reflecting upon times that the lack of control, ie. Serendipity or accident or failure created new, valuable and positive life changing opportunities. Using real stories of people who found meaning in their dying process even through pain, loss of control and facing the unknown.
Support of Loved Ones: End-of-life coaching can help people reflect upon how they can create support for those who would accompany them in the actual assisted suicide process. This includes being informed about what actually happens right after you have died. Further, although many people say they are not religious, they are spiritual or they are human and thus need something to help make sense of and ritually recognise the actual death moment. Thus, helping people reflect upon the role of death, dying or closure rituals in different traditions as a basis for discussion with those who will be left behind and accompany the person choosing to end their life. Helping to gestalt and performing end-of-life assisted suicide death rituals that are custom made for the accompanying loved ones and the person who has chosen to die.