As we listen to the debate about Medically Assisted Dying, and hear the appeal for Physician Assisted Dying, let’s step back a few years and learn from what once was.
What would the picture look like if we allowed people to die when their bodies were dying, if we did not prevent death, and if we do not push medical extremes to the extremes?
Dying is a natural experience. We have become so good at preventing death that we have forgotten to allow dying to occur when a person stands on deaths doorstep and the door opens.
Years ago an older friend was dying. She lay in ICU after a heart attack and following resuscitation. She struggled to breathe. She struggled to talk. She was able to request no further attempts at CPR. I am not sure if she was aware that within the ICU there was a buffet of possible interventions. Knowing how unhappy she was living with very compromised respiratory function prior to her heart attack, I did not want her to have to live life even more compromised without offering her that decision. I wanted so badly to advocate for excellent symptom management to settle her breathing struggle. I wanted her to know that she had the option to die naturally and comfortably. I wanted her to know that if she stabilized and survived this episode that it might be months or years of rehab followed by a very possible reduction in functioning, before she would have another oppotunity to die naturally. I wanted to say to the health care professionals “DON’T BLOCK HER EXIT“.
More recently I talked with an older family member to help him identify his goals of care, and help his children understand the type of care and interventions he wanted. I participated in a brainstorm session, and provided some phrases and ideas that I hoped would help him clarify his preferences of what acute interventions he might like if his condition declined and he was unable to voice his opinion. I used the same phrase “Dont’ block the exit”. He really liked that phrase. He has quoted it dozens of times in the past months. “Don’t block my exit!”
Yesterday a colleague and I discussed our Advance Care Plans. She said “If I have a stroke, and am unable to eat, I would like to be allowed to die. I do not want rehabilitation, I do not want a feeding tube.” “Don’t block my exit.”
After my mother was diagnosed with a terminal cancer she said, “I am glad that they can not offer me any surgery! I am 81 years old. I have had a good life. There are not enough public funds to use scarce resources to extend my life by a few weeks, months or years. I have had my turn”. She was glad that there was no attempt to “block the exit!”
I remember a man in his late 70s. His wife had recently died. He said he would be happy to follow her in death. He fell, had a brain hemorage, called 911, was admitted to hospital and had brain surgery before his family was even aware of his admission. He was in the ICU for several weeks. Technology, medications, feeding tubes all helped to prolong his life.
His children gathered, requested that life supports and any measures preventing death, be removed. However his surgeon felt that because he had called 911 he had requested and given permission for acute measures to be followed. It was more dificult to stop the acute interventions than it was to start them.
This man stabilized, was discharged from hospital to long term care. Interesting, the health care team and the system that prolonged his life are not there to visit him and provide the intensive loving care that they initially provided that stabilized him and extended his life. It may be many months or even years before another “EXIT” occurs.
My question: If we were allow death to occur naturally, (with the support of hospice palliative comfort measures) would we have the same need to hasten death at a later time?
It is crazy making to block the exit when death presents itself, and when a person is willing or wanting to die, only to need to legalize and hasten death at a later time.
It is time to education the public and health care proferssionals:
“DON’T BLOCK the EXIT” 
7 Responses
I couldn’t agree more. I watched as medical professionals kept both my parents alive long after they would have died naturally. I was grateful for the initial treatment for the types of cancer they had, but at the end “they blocked the exit” and I watched both of them suffer needlessly.
It made me determined that no one will “block my exit” . Thank you for your insight.
Hi Kathy,
Thanks for you thoughts on this topic. I too believe that we need more education and public awareness regarding “the EXIT” Seing death as a natural event is very healing and helpful for others. Great to hear your take on this topic.
Lots of love and peace to you
Ruth
Hi Kath
What particularly catches me about the phrase “Don’t block the exit” is that it goes farther than a DNR/noCPR order — which, as you know, I have tattooed on my right wrist and left chest (as well as the more common ‘form on the frig door’ and in my wallet). I would assume that it includes not just feeding tubes/etc., but things like antibiotics for pneumonia (if already at ‘end of life’) — the old ‘old man’s friend’.
Most templates for Advance Directives — in my opinion — are too generalized; and/or unrealistically expect the person to have enough medical knowledge to make comprehensive decisions, and word them clearly. ‘Don’t block the exit’ is perhaps as generalized a directive as would be possible; and perhaps wouldn’t work for people who have very particular, and (perhaps) uncommon ‘lines in the sand’ to draw about where ‘quality of living’ stops for them.
However, it might work well for those who are
a) already terminal
b)’ready to go — no matter what the particular new medical condition that arises
c)have progressive life-limiting illnesses (including later-stage dementia),
without an extensive Advance Directive — clarifying essential the same thing, but without a long list of possible medical acute or chronic situations. And what a clear, simple and pretty recognizable way of saying that — love it!!!!
And of course, if the person is still capable of speaking for themselves (physically or mentally), they are also able to state whether this particular incident is the time to ‘block the exit’ — or NOT.
That said, personally I feel that ‘don’t block the exit’ directives needs to be addressed AT THE SAME TIME as assisted-dying and pre-chosen (i.e. before any later mental/physical incapacity) euthanasia. Both are options of dignity and choice — once one has reached their personal threshold beyond ‘quality of living’. Unfortunately, ‘don’t block the exit’ (i.e. withhold treatment)doesn’t address the cases where it is not possible to relieve the suffering and/or one has a slowly-progressing life-limiting illness.
And as we talk about ‘natural death’, I think that we do need to keep in mind that very few people, in our modern first-world cultures, will die without having been treated with some degree of non-natural medical intervention. So, for me, the ‘bottom line’ question is ‘who gets to decide how much, and what KIND, of medical intervention?’ — noting, of course, that assisted-dying and pre-chosen euthanasia are types of a very short medical intervention that specifically avoids more/longer-term medical intervention (i.e. all of the treatment that would be necessary to medically assist that person through a longer dying).
Hi again Kath and friends,
I have been looking for a new saying (similar to ‘don’t block the exit’) that I can’t quite remember. It is something like ‘no way without my say’, but that isn’t quite it. If anyone has come across it, please let me know — and thanks!
By the way, Kath, I have added ‘don’t block the exit’ to the comprehensive Advance Directive I work with and keep updating — in the initial ‘quick check’ section (along with the old VIHA “Comfort, Limited, Surgical or Intensive” options). Although I strongly believe in comprehensive AD templates, that include all of the major ‘choices to be made’ worded clearly, I do believe that this phrase is one that both lay and medical people can identify with; and that there are situations — in an emergency, and when the Representative is not available to advocate for the specifics of AD — where this term, quickly accessible, could ‘save’ a chosen death.
Thanks very much for it. Everyone that I have shared it with ‘got it’ right away!!!
I love this! What a great contribution. I’d love to see you present on this Kath.
Yes its great to see it written about Kath, thank you.