WHAT ARE
MY OPTIONS?
If you have received a diagnosis of a terminal disease, you have an important choice to make around how much control you want over your dying process.
OPTION 1:
Continue aggressive treatment and all clinical trials
By definition, if your disease is terminal, these treatments won't cure you.
They may, however, buy you additional time. Try to get a realistic assessment from your doctor on the severity of the side effects versus the possible gain in time.
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Recognize that a clinical trial, while not likely to provide you with significant improvement, will help researchers determine better treatment options in the future.
OPTION 2:
Palliative care only
This means you have accepted that your medical situation is terminal and you want to focus on being as comfortable as possible in the time left.
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Your doctor might not raise this option out of concern for the impact on you.
So, if you are ready to discuss this option, initiate the discussion with your doctor. Carefully consider their advice, but remember that ultimately the decision is in your hands.
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If you decide to receive palliative care only, ask your doctor about whether you need a specialist in palliative care, and about home care versus in-hospice care.
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If you haven't already done so, it is essential that you let your immediate family know of your decision and how they can best support you.
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At any point in your medical illness you can choose to forego any or all therapeutic treatments and opt for palliative care only. You should inform the medical staff and request to see a palliative care specialist. If you have received a diagnosis of 6 months or less, you might want to consider enrolling in hospice:
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OPTION 3:
Palliative sedation
There are certain terminal illnesses so painful, such as certain cancers or respiratory illnesses, that no amount of conscious sedation will alleviate symptoms associated with dying such as pain, delirium, and/or shortness of breath. In cases like these, you or your loved one may prefer a state of sedated unconsciousness to ease the process of dying. In this case, palliative sedation is a good choice. Palliative sedation provides you or your loved one with high doses of pain-managing medication. The medication induces a state of unconsciousness intended to minimize suffering.
Before you choose palliative sedation to ease your end of life process, your doctors will want to ensure that all therapeutic approaches to symptom management have been exhausted and that your wishes (either expressed at the time or in an Advance Directive) are consistent with this approach. A palliative care specialist will generally be called in to ensure that protocols have been followed and that you, your family, and medical staff all understand the process. Palliative sedation can only occur in a hospital or an inpatient hospice.
If you decide on palliative sedation—either as a care instruction in your advance directive or at your time of need—you and/or your healthcare representative must be very clear about the outcomes: pain and discomfort will be alleviated by sedation but it will leave you unconscious. It is best to have very honest conversations with loved ones about what this care means for you and to say goodbyes before palliative sedation is administered.
OPTION 4:
Hastened death
It is your right to choose to end your life if your condition makes your quality of life unacceptable to you. There are many legal and safe ways to hasten ones death if you feel this is the best option for you. However, we believe that it is very important to make sure this this decision is one that includes your loved ones and that palliative care options have been explored first.
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MAID
Some states have passed Medical Aid in Dying laws. These laws permit terminally ill individuals who meet very specific criteria to obtain a prescription for a lethal combination of medications. For more information on your state's laws and your potential eligibility, visit:
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Switzerland
Switzerland is the only country in the world that allows non-residents who have severe medical issues to legally end their lives.
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The largest organization in Switzerland providing this service is Dignitas.
The application process is lengthy and the services are expensive. But it is an important and dignified option. For more information, visit:
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VSED
Voluntary Stopping of Eating and Drinking is legal in all States.
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If you are interested in learning more about this process or finding expert help, see our About VSED page.
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Alternative Non-Violent Methods
For those who want autonomy in deciding when, where, and how to die, there are a number of resources focusing on painless and non-violent methods:
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Final Exit, a book by Derek Humphry
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The Peaceful Pill Handbook by Phillip Nietschke
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Final Exit Network, a non-profit organization which provides information as well as free Exit Guide services