There was a time when Dr. Jack Kevorkian shocked America by helping terminally ill patients end their lives. The media often referred to him as “Doctor Death” and described what he did as “assisted suicide.” Not unlike many other leaders dedicated to societal change initiatives, he was jailed for his activism.
We’ve come a long way since Kevorkian assisted his first terminal patient with dying in 1990. Oregon voters passed the Death with Dignity Act in 1994 followed by 9 other states and the District of Columbia that legalized the right to die since then. Several other states have or are now considering allowing voters to decide if and how terminally ill patients may end life early.
When it comes to death, there are now two separate and distinct categories that did not exist before 1990. There is the term ‘suicide’, which is too often a sudden, violent act with harmful aftermath; and a more rational decision to end life early due to a terminal illness with dignity and medical support. Unfortunately, due to the coronavirus pandemic, our 2020 news cycle constantly dealt with the idea of death – whether through rising numbers or a grim look into overburdened ICU wards.
We also heard a great deal about suicide. The number of suicides was predicted to increase in 2020 due to the rising rate of depression associated with stress, loneliness, and financial hardship; however, we saw just the opposite. Following an annual upward trend in suicides from 1999 to 2019, there was a 5.6% decrease last year according to The National Center for Health Statistics. Death by suicide dropped out of the top ten causes of death for the first time in more than 10 years.
The same report showed increases in deaths from heart disease, stroke, Alzheimer’s, and diabetes which may have been linked to the lack of availability of medical care due to the demands of COVID treatment. The most recent report by the Centers for Disease Control and Prevention showed more than 89,000 deaths – a 29 percent increase – due to overdose after a decline the previous year.
This begs the question: Is there a possible relationship between these two opposing trends?
While correlation does not beget causation, the increasing number of “Unintentional Overdose Deaths” demands our attention. It was the fourth leading cause of death following COVID in 2020. While the term “unintentional” is used by the National Center for Health Statistics, many medical researchers are not in agreement with the phrase since there is no way to determine intent from the deceased. Still, the medical community can’t help but wonder how many of those overdose deaths are intentional and could be connected to the ripple effects of COVID.
Medical researchers must now dig deeper into the data to answer the elephant-in-the-room question: did more Americans choose to end their lives by overdose during the year of COVID?
In my opinion, the most significant takeaway may be more Americans are making choices about the end of life. With the rise in more ‘right-to-die’ legislation and increased access to palliative medical assistance, it would not be a stretch to assume that more Americans are opting to die with dignity. That does not suggest that Americans are anywhere near united in acceptance. Just as we are divided about so many of today’s issues, the right to die is no exception.
When I talk to community members and other American citizens, many confide in their faith in God and say that their deaths are in the hands of the Divine. Some even go as far as to say that if there is extended suffering in death, it could serve a holy purpose. But there many other faithful believers who struggle with the holy nature of extended pain and suffering when there is no chance for recovery.
Many doctors and nurses I talk to support the concept of honoring end-of-life wishes but often convey frustration with the absence of pre-planning by terminal patients. They also described conflicts between patients’ desires and what family members believe best. Advanced directives are mandatory for medical compliance, but worthless when they are only verbal, unavailable, or overridden by family members. Our nations’ divisiveness is also apparent in the narrow margins of passage or rejection by legislatures and voters in states that have considered right-to-die laws.
Still, there is increasing evidence – both statistically and anecdotally – that Americans want the option to be able to die with dignity. Furthermore, the numbers would suggest that over the past year, a proportion of ‘Unintentional Overdose Deaths’ were attempts by the terminally ill to take their lives on their own terms.
Confronting end-of-life realities can easily be delayed or avoided but doing so is unwise. Decisions are very personal with “no one size fits all” and deserves a common-sense approach. We are all one bad death away from supporting personal choices about the end-of-life. Unfortunately, experiencing that one bad death is often too late.