276 Grief and Loss Across the Lifespan
patients focus on the importance of being present, “just be[ing]there,” as the
most helpful aspect of hospice. Both dying patients and caregivers (when asked
what they would do for a friend in a similar situation) reported that what was
most helpful was being available just to listen (Clukey, 2007). Hospice care is
focused on listening deeply to what the patient wants, fears, and hopes for and
then trying to assure that they can be comfortable and pursue the things that
are still possible.
The website http://www.wisconsinmedicalsociety.org/professional/hcw pro-
vides the viewer with a 10-minute video to engage adults in making their
plans, having the difficult conversations, and preparing medical directives.Death With Dignity—Patients’ Rights at the End of Life
As awareness of choices at the end of life has evolved, interest in advanced
medical directives and the right to hasten death have evolved and brought
changes across the United States. Advanced medical directives are legal docu-
ments that allow individuals to specify what medical care they desire when
they are no longer able to make their wishes known. They can refuse such life-
prolonging efforts as feeding tubes, respiratory ventilation, and cardiac resus-
citation. Many refer to these documents as “living wills” as they allow one
to define what one would wish at the end of life while one is still conscious,
competent, and able to make such decisions for oneself. These documents
allow family members to follow their loved one’s instructions rather than to
feel responsible for withholding medical care. These documents allow medi-
cal providers to withhold treatment rather than make active efforts to end life.
Death with dignity laws were introduced and passed in Oregon
(1994/1997) and Washington state (2008/2009) and introduced and passed
in legislation in Vermont in 2013. Since the very public death of 29-year-old
Brittany Maynard in late 2014 (after a move to Oregon to avail herself of what
some call physician assisted suicide) (www.cnn.com/2014/10/07/opinion/
maynard-assisted-suicide-cancer-dignity), momentum has grown for legisla-
tion that allows competent terminally ill individuals to have physicians help
them end their lives. Compassion and Choices, the nation’s oldest and largest
nonprofit organization working to improve care and expand choice at the end
of life (www.CompassionandChoice.org), has been active in promoting these
legislative changes. Oregon now has extensive experience with a protocol that
allows individuals to access medications that will bring death [called physician
aid in dying (PAD)], within a very precise protocol (www. deathwithdignity
.org/access-acts). They find that people often feel reassured by having the
medication available should they need it and many do not actively take the
medication when their pain, symptoms, and alienation from loved ones and
caregivers are managed with quality hospice care.
Some are resolute that death with dignity laws are harmful. People fear
that insurers will try to coerce patients to make use of this option and they assert
that such laws imply that a compromised life is not worth living (Town Hall,
2015). Some believe that PAD violates the sanctity of life, errs when it moves
to active hastening of death rather than passive avoidance of life-prolonging
treatments, risks promoting euthanasia, and is open to misjudgments on the