Calling the right-to-die movement "the 21st century human right," Jerry Metz, M.D. spoke to a group gathered at on Tuesday afternoon about his organization, Final Exit. Metz discussed the work Final Exit does to help terminally and chronically ill adults choose when they want to die.
According to Metz, the reasons for a person wanting to end his or her life are varied and often complicated. Ninety-one percent of patients cite the loss of autonomy as a main concern when making end-of-life decisions. Eighty-eight percent cite the loss of engagement in activities they previously enjoyed. Only 21% cite pain as a motivating factor.
Even though the right to die is technically considered suicide, Metz made a point to differentiate between the actions of a Final Exit patient's choice and a traditional suicide. He defined suicide as "the cutting short of an otherwise productive life" and noted that "suicide is a loaded word. It has an image of mental illness." While Final Exit helps the sick "self-deliver," as the organization's pamphlet states, the organization does not encourage people to commit suicide, does not directly provide the means of death and does not actively engage in the admission of the means of death.
In order to be aided by Final Exit, the seriously ill must submit to a high level of scrutiny and a number of steps are carefully followed. There are five categories used to differentiate the type of terminal or chronic illness of each potential patient:
Category 1 includes what Metz describes as "a hard diagnosis." This includes illnesses that can be determined through a physical exam, such as terminal cancer or Lou Gehrig's disease.
Category 2 includes "soft diagnoses," for which there is no clear medical test. This may include Chronic Fatigue Syndrome or multiple chemical sensitivities. According to Metz, Final Exit does not deal with those in this category.
Category 3 includes mental illness and "situational distress." While it is technically possible for someone in this category to be accepted by Final Exit, the standards set by the Final Exit doctors are so strict (chronic depression, multiple hospitalizations, ECT treatment) that no one has yet met the criteria to be considered for further aid.
Two new categories were recently included: Category P and Category D. Category P consists of those who have "severe, poorly controlled, chronic pain." Metz noted that while pain may not indicate terminal illness, these potential patients "are often so medicated that they are essentially zombies."
The newest category, Category D, consists of patients with progressive dementia. This is a difficult category to assess, because the patient must be lucid enough to understand what the consequences of his or her decision are and ensure that they can themselves operate the equipment which would lead to their death.
Besides being placed into one of the categories of illness, the patients must undergo a series of steps to determine whether or not Final Exit is appropriate for them.
First, the patient gets in touch with a case coordinator, who becomes the first point of contact. The case coordinator asks the person to read the book Final Exit before any further decisions are made. Second, he or she must submit a letter of intent, which demonstrates that the patient is of sound mind and understands his or her impending choice and also describes the person's illness. Third, the patient will then submit medical records to the Final Exit board of doctors to demonstrate that they are either terminally ill or have permanently lost their quality of life. After these steps are followed, the board of doctors will determine whether or not they can receive a provisional acceptance.
After meeting with two Final Exit guides, the senior guide makes the final decision as to whether or not the patient can go ahead with their end-of-life plans. It is at that time that the patient is told how to procure the method of death. Metz would not discuss what these methods entail, however. This information is only divulged to those who meet the criteria to continue with their "self-delivery." The guides and the patient then make sure that the body will be discovered within an acceptable time period if there are no witnesses.
In the final step, after the patient has "self-delivered," the organization helps protect the guides from prosecution, which occasionally happens. Charges are pending in Georgia against Final Exit guides who have been charged with assisting in suicide, tampering with evidence (removing the method of death) and, interestingly, RICO statutes, which ensures that the state can freeze Final Exit assets within the state of Georgia.
Allowing one to choose the method of his or her own death is a controversial subject in the United States. Metz discussed the case of Terri Schiavo, whose husband and parents battled in the courts over whether or not to remove life support from the brain-dead Florida woman. Still, according to a Harris poll cited by Metz, 70% of Americans believe that a person should be able to choose their method of death.
Because of the possibility of the window of opportunity passing, leading a patient to become unable to make his or her own end-of-life decisions through Final Exit and operate the method of death his or her self, Metz told the listeners to get a living will and a durable power of attorney to ensure their wishes are followed.
It is doubtful that the United States will soon follow in the steps of the Netherlands, where right-to-die has been decriminalized. However, it remains a serious topic for thought. If you are interested in learning more about Final Exit, check out their website at: www.finalexitnetwork.org.