On Death With Dignity
August 7, 1972 — Hearing before the US Senate Special Committee on Aging, Washington DC
Dr. Ross. Senator Church, Members of the Senate, I have been asked to share my experiences in the case of the dying patient, with special emphasis on dying with dignity.
I do not like to talk about dying with dignity, but I would like to talk about living with dignity, and I think that makes a difference.
I have interviewed over 500 terminally ill patients and asked them to share with us what it is like to be dying, what kind of needs, fears, and fantasies those patients have, and, perhaps most important, it tells what kind of things an we do, by which I mean family members and members of the helping professions, to be more helpful.
We started this project not as a research projector anything planned, but as a chance happening. I think it became important that I was born and raised in Switzerland. In the old country — and I guess in the old times in this country, also — death was part of life, like birth is. When I was a child, people used to be born at home and often died at home. Dying patients were not very often institutionalized. This did not make dying easier for the dying patient, but I think most important of all, it helped the children and grandchildren to learn that death is part of life.
When I came to this country, I was very impressed that the children are not allowed to visit patients in hospitals or the mental institutions. Very seldom you hear the laughter of children in nursing homes. And I have seen hundreds of people in this country who have never experienced a death in the family. What we have learned from interviewing over 500 dying patients — and I am not talking about dying children, who, by the way, die much easier than grownups — the majority of our patients wanted to die very badly at home. Yet, close to 80 percent of all patients interviewed died in an institution. Patients who can prepare themselves early and in a familiar comfortable environment for their impending death are better able to finish their un finished business, to put their house in order, as they pass through the stages of dying, as I have outlined in my book, “On Death and Dying”.
Family members still now believe that it is better “not to tell” the patient. We found the opposite to be true. If we will listen to the patient and talk with them about their illness, they will proceed much quicker to the stage of acceptance, and not resignation. Eighty percent of our patients in nursing homes wanted to die very badly, but they are not the in the stage of acceptance. They are in a stage of resignation, which is kind of a feeling of defeat,” what’s the use, I am tired of living.”
NEED OF THE PATIENT FOR HOPE
Patients have two basic essential needs when they are informed that they have a potentially fatal illness: The biggest need is always allow for hope. Hope is not the same as hope for cure treatment or prolongation of life. When a patient s dying, this hope will change to something that is not associated with cure treatment or prolongation of life.
To give you a practical example of how hope changes, like hope from the living to the hope of the dying. I visited a young mother with small children who had cancer. Each time I saw her, she said, “I hope those research laboratories work hard and I can get one of their new miracle drugs, and I get well.” Naturally, I shared those hopes with her, though the probability was extremely slim.
One day I visited her, and she looked very different. She said, “Dr. Ross, a miracle happened.” I said, “Did you get the new drugs?” She said, “No, I know now that these miracle drugs are not forthcoming, and I am no longer afraid.” I asked her, “What is your hope now?” She said, “I hope my children are going to make it.”
If we are not afraid to face and talk about dying, we would then say, “Do you feel like talking about it?”
As long as a patient is alive, he needs hope, but not the projection of our hope, which is usually a prolongation of life.
Besides the need for hope, patients need a reassurance that they will not be deserted, yet most of our patients who become beyond medical help feel deserted.
To give you a brief clinical example of what I mean by the loneliness of dying, I had a 28-year-old mother of three small children with liver disease. Because of her liver disease, she was going in and out of hepatic comas, and became frequently confused and psychotic.
Her husband could not take it anymore. He had spent all his savings on doctor and hospital bills. He had these three little children . He had no homemaker, no help whatsoever. He was heavily in debt, and he never knew when he came home from work whether his wife was still functioning.
One day he said, “It would be better if you would live one single day and function as a housewife and mother, rather than to prolong this misery any longer.”
Unfortunately nobody helped this desperate husband and father, who tried unsuccessfully to provide for his family, The patient herself desperately looked for hope, which nobody gave her. She went to the hospital, where a young resident told her, “There is nothing else I can do for you.”
She then went home, and in her desperation went to a faith healer, who told her that she was cured. She believed this, and stopped taking her medication, stopped taking the diet, and she again slipped into a coma.
Nobody helped this family. She was again admitted to the hospital. By then, the family had it. They just could not cope with it anymore.
In the hospital, the same tragedy: The medical ward wanted to transfer her to the psychiatric ward and the latter did not want a dying patient and insisted that she be kept on a medical floor. They could not tolerate this woman who walked up and down the hallway talking about God’s miracles, of the faith healer who cured her.
It become like a ping-pong game, and this is the tragedy of hospitalized patients who cause all these anxieties in us. We don’t know what to say or do with them.
I told this woman that I would never talk with her about her illness or dying, and I would not desert her.“ Let’s only talk about the present. She became the best patient I ever had, but she was put in the last room at the end of a long hallway, farthest away from the nursing station.
Not one door closed, but two doors. She never had a visitor.
This woman, when I visited with her one day, sat on the edge of the bed with the telephone off the hook in her hands. I said, “What in the world are you doing?” She said, “Oh just to hear a sound.” This is the loneliness of the dying patients that I am talking about.
Another time, she was lying on her bed smiling, with her arms stiff down the side of her body and I asked her, “What in the world are you smiling about?” She looked at me and said, “Don’t you see these beautiful flowers that my husband surrounded me with?” Needless to say, there were no flowers.
It took me a while to appreciate that this woman realized that she just could not live without some expression of love and care, hopefully coming from her husband. In order to live, this woman had to develop a delusion of flowers, sent to her by her husband after her death.
SUPPORTIVE HOME AIDS
This is the loneliness I am talking about. And these things would be preventable if we would not hospitalize all these patients, but if we could give the family some help at the beginning, if we could occasionally relieve them with homemakers, if we could send physicians and caseworkers to their homes, so that this last hospitalization can be prevented, and the dying patient can at least die in his own home, surrounded by the children, and also in the familiar environment that they have lived, and where they have been loved. But in order to do this, we have to give help not only to the dying patient but to such desperate husbands who try to make ends meet and just cannot make it alone.
A DEATH-DEFYING SOCIETY
We live in a very peculiar, death-denying society. We isolate both the dying and the old, and it serves a purpose, I guess. They are reminders of our own mortality.
If I am allowed, I would like to read Joseph Matthews’ description of the death of his own father, a classical description of a death-denying society:
My father, I say, was 92. In his latter years he had wonderfully chiseled wrinkles. I had helped to put them there. His cheeks were deeply sunken; his lips pale. He was an old man. There is a kind of glory in the face of an old man. Not so with the stranger laying there. They had my Papa looking like he was 52. Cotton stuffed in his cheeks had erased the best wrinkles. Makeup powder and rouge plastered his face way up into his hair and around his neck and ears. His lips were painted. He looked ready to step before the footlights of the matinee performance.
I fiercely wanted to pluck out the cotton but was afraid. At least the makeup could come off. I called for alcohol and linens .A very reluctant mortician brought them to me. And I began the restoration. As the powder, the rouge, the lipstick disappeared the stranger grew older. He never recovered the look of his 92 years but in the end the man in the coffin became my Papa.
Not only the needly lonely old people are isolated, not only the dying patients are getting lipstick on their lips in order to make them look younger, the young dying patient suffers perhaps the most because he is rarely allowed to die without heroic efforts to prolong his life — which often results in a prolongation of suffering.
And I thought as an example I would use this patient that some of you will remember, she was a 21-year-old girl with acute leukemia. She was young and full of life. When we interviewed her in our hospital, she said very loud and clear that although her chances were one in a million that her big dream was still that should could graduate in June from college, that she could get married in July.
Her bargain was that she would not have any children for 5 years, and if she would still be alive, she would then have lots of children and live happily ever after. But she also said she knew that her chances were one in a million.
She came back into the hospital 5 weeks later, again because the family could not get enough home care for her. Her biggest dream was to live at home, and possibly to die at home.
She was put into an intensive care unit. When I visited her on New Year’s Eve, she was a picture of utter isolation, loneliness, and anguish. I came into the intensive care unit. She was lying there with tubes hanging out of her mouth, her lips cut, the infusion bottles going, a tracheostomy and the respirator, and she was desperately holding my hand.
I covered her with a bed sheet. (She was not even covered.) A nurse came and says, “Don’t bother. She is going to push it off anyway.” I walked toward her, and she grabbed my hands pointing her fingers to the ceiling. I looked up and said, “Susie, I think this light bothers you. You are lying on your back and must stare into this light.” She grabbed my hands and kissed the obviously conveying “You are understanding me”. I went to ask if these lights could be turned down, only to get a nice lecture about the rules and regulations of the intensive care unit.
I also asked for two chairs for the mother and father to sit down when they visit, because I cannot comprehend why patients have to die alone in an intensive care unit and their families sit alone outside in a waiting room. I was told the mother cannot get a chair because she stayed more than 5 minutes last time.”
This happened in my own institution, where I have been teaching the care of the dying patient for four and a half years. The reason I am using these examples, not to be judgmental, but because we have to face this together and do something about it! Nurses who work on cancer wards or intensive care units, have an extremely depleting and exhausting kind of work if they dare to get involved.
I am supposed to be a specialist, but I cannot do this work more than 4 hours at any given time. Then I need to switch gears or recharge my battery. But the nurses are supposed to do this 8 or 9 hours every day. This is inhuman and emotionally impossible.
If I could change the administration, I would ask these people to work 4 hours a day, so that they can look at a patient as a human being and don’t have to depersonalize him, so that they can get in volved. You can only do this a limited amount of time. If you are asking too much of them, they have to depersonalize, mechanize the care and in the process of it, the care must become dehumanized.
The physicians looked at this specific girl and called both parents at 7 p.m., telling them that it was a question of hours. Then they went home. They informed them, not in the hallway, not over the telephone, but in a private room. But then they went home. This is the tragedy. They accepted academically that this girl was dying, but inside there was no degree of acceptance.
If they had really accepted that there is a time to live, and a time to die, they would have taken this young girl out of intensive care unit at 7 p.m., put her in a private room, and had two chairs for the mother and father to sit with their child during the last hours of her life.
This is a question of reeducation of the public, not only physicians and nurses and social workers, but also families, who sooner or later have to be faced with a dying patient.
EDUCATION THROUGH EXPERIENCE
Why do I bring up all these specific examples? I think we can do something about it. I think we have to put much more emphasis on education, on teaching even small children that death is part of life, or inviting old people who perhaps don’t have a family any more in our homes, to take them in as grandmothers and grandfathers, not only to give them the final care, but to allow our children to have experience of having old and sick people in our house.
We should not institutionalize people. We can give the families much more help with home care, visiting nurses, giving the families and the patient spiritual, emotional, and financial help in order to facilitate the final care at home.
We very badly need alternative living situations like smaller housing units in hometowns which are financially accessible, and I am not going to talk only about the dying patient. We need retirement villages, not isolated from the center of life, in a community for the healthy old people.
We need much more homemaker services, shopping services, delivery services, and much better medical services. Indeed, transportation to physicians, and encourage more physicians who make house calls.
Nursing homes should be part of other facilities, not dead ends. Every nursing home in my opinion, should have a day care center on the premises, where the elderly, lonely person can become a grand parent to a lonely, needy child. It would take much less staff, it would cost less money, and it would also teach the young child that old age can be a source of wisdom and love, even when the eyesight fails and the steps slow down.
Children should be allowed and encouraged to visit mental institutions, old age homes, and hospitals, so that they grow up knowing that old age and death is part of life, just like birth is. Thank you.
SENATOR CHURCH. Thank you very much for your very moving testimony, Dr. Ross.
I understand you are a psychiatrist, and that your observations are based upon interviews with 500 or more dying patients. Is that correct ?
Dr. Ross. Right.
SENATOR CHURCH. As I understand your testimony, would it be accurate to say that your theme really is that we live today in a death denying society?
Dr. Ross. Yes.
SENATOR CHURCH. And we pay heavily forth is in nearly every way. There has been so much criticism, much of it self-criticism ,of our contemporary society on the grounds that it is becoming increasingly dehumanized. Many young people have felt this. And surely it is in the way that we approach death and deal with death that this particular weakness in our society is most dramatically revealed.
I was interested in your observation that whereas in earlier generations families tended to live together, and several generations some times in the same home — in fact, that was typical, so that even young children became familiar with death as a part of life, but this increasingly has disappeared in America.
Your recommendations deal mainly with ways for changing the method of dealing with dying patients in institutions, do they not?
Dr. Ross. Yes.
CHANGING BASIC ATTITUDES
SENATOR CHURCH. What can be done about changing basic attitudes that living people have, who, faced with the imminence of death within the family, will insist that the dying person is not dying, and doctors who will refuse to disclose to the patient, or who are reluctant to dis close to the patient that death is inevitable, or sometimes even to the family? How do we reach and change these attitudes that in their accumulative effect really only make it all more agonizing for everyone concerned?
Dr. Ross. You can change these attitudes, and some of this is al ready beginning to happen .If you try not to be judgmental, if you would try to understand why these things are happening, then I think you can change something about it.
We train physicians basically in the science of medicine, that is, the cure, to treat, to prolong life. I think we should also add a few lectures on the art of medicine, and that is how to take care of the dying patient, and some old people who are not living and not dying.
If we can reach the medical students — we have been teaching medical students for the last 7 years — if you get to them as students, you have a 95-percent batting average. If you get to them as externs it is easier than interns. Interns can be taught better than residents and after about 2 years of residency it becomes almost hopeless.
What I am trying to say is that we have to reeducate, and the earlier we start, the better we can help them.
The same thing goes for children. We have to include children in this experience. If a person dies at home, you should give the children a choice, if they want to come to the funeral. Don’t send them away to relatives and exclude them Those children will then grow up and learn to regard death as part of life. They will remember these shared experiences and hopefully not view death as such a horrible happening.
It is a question of reeducating the whole public. Nursing schools, social work schools, and medical schools have now started to include the care of the dying patient in their curriculum. Seven years ago, I was totally alone, and now there are about 75 institutions in the United States and Canada who have included the care of the dying patients in the curriculum. So as far as I am concerned, there is a lot of hope.
All of these young people will go out to teach other people the same thing.
SENATOR CHURCH. Do you know of any hospitals that follow your recommendations and have made special provisions for dying patients to better enable at least the closest members of the family to be present?
Dr. Ross. Yale University has now applied for grants to start such a hospital. It is similar to the to the St. Christopher’s Hospital in London, which is exclusively for terminally il patients.
SENATOR CHURCH. But this is just really in the beginning stages, is it not, as far as hospitals are concerned?
Dr. Ross. I think you cannot bring about real, meaningful change by revolution. It requires a slow-moving evolution and education.
SENATOR CHURCH. What, in your opinion, has been the effect of Medicare and Medicaid upon the problems that you have discussed this morning?
Dr. Ross I am not very good in money matters, but I know that both Medicare and Medicaid tend to enhance institutionalization. The very first response is, “Let’s hospitalize the patient.”
I think many of these patients could be taken care of on an outpatient basis, if the financial and other necessary help would be forthcoming.
Medicare and Medicaid is, to me, not the total answer. I think if half of the money could be spent in helping to do preliminary work ups and final care away from the hospital, preferably on an outpatient basis, we would not only help the patient to cope with it better but also help the family to come to grips with it and go through the stages which is best done in the home, not in an institution.
SENATOR CHURCH. In other words, if the program were modified in such a way that the financial help that is now given to pay for the hospitalization, or the nursing care and the treatment, if in the alternative money could be available to promote care in the home, that this would be a great step forward?
Dr. Ross. A tremendous step ,not only to the patient but also to the family. You see, the patient and the family have to go through the stages of denial: The “No, not me” stage; the anger; the “Why me?” stage; the “bargaining, Yes me but” stage; and finally the depression and final acceptance. The family also has to go through those stages, and it is very hard to go through these stages when a patient is in the hospital, and separated from the family.
If the patient and family can reach the stage of acceptance, the patient dies very peaceful, and the family who is left has no griefwork to do afterwards. You can only do this if you have time to come to grips with it together.
FACILITIES FOR THE TERMINALLY ILL?
SENATOR CHURCH: There is one suggestion here, and I will ask it for the record. I have strong misgivings about this kind of approach, myself, but perhaps you have a different view.
Do you think a brick-and-mortar program should be launched to provide entirely any kind of facility for the terminally ill, or should we adapt our hospitals, nursing homes, and other institutions in conjunction with other kinds of care given at those facilities?
I think perhaps you have already answered that question, but what about the notion of setting up separate facilities for the terminally ill?
Dr. ROSS: I would be very leery if the care of the dying patient would become another subspecialty. I would be opposed if we have some modern death houses which are institutions just for the dying.
SENATOR CHURCH: In other words, this would make a bad situation worse, would it not?
Dr. ROSS: Yes, there is this danger.
It depends, naturally, on the atmosphere of the institution. Basically, St. Christopher’s Hospice in London is a hospital for dying patients exclusively, but the atmosphere there is one of love, care, and acceptance, so it is a beautiful place to be, and I think if I would be dying, I would love to be in a place like this.
But this is something we really cannot duplicate in the United States. In England, it does not cost the patient a penny, because of the British system, and they can give them drugs (like heroin) so that they are totally awake and without pain to the very last moment before they die.
Those things are not duplicable in this country. I would be much more in favor that we train nurses, physicians, and social workers here who love to work with old and dying patients. Then you will not need special institutions for the care of the dying patient, and the majority would be allowed, at least for the final care, to be at home.
SENATOR CHURCH. How much of this education you have spoken of, education for nurses and for doctors to change the present practices in our institutions and to make some better provisions for dying patients — what about reaching out to the general public?
What I mean by that is that there is presently a feeling in this country that if a member of the family is stricken patient, there is a feeling of compulsion because of the mores of our society, that there is a feeling of compulsion because of he more so four society that the family should place that person in an institution, in a hospital, for example, where every facility is available to prolong the life as long as possible, and where, inevitably, we will see in the progression of events the very kind of indignity about which you have testified.
Yet the typical family would feel constrained by the general compulsion, the general attitude ta prevails in this country to do just this. It might not even occur to them ,or they might think that there was something morally wrong or sinful in keeping that person at home, where the latest devices of science were not available to prolong life, so it seems to me it is an educational problem, if it is a problem, one that is not limited to the physician and the nurses in the institutions, but maybe one that extends to the entire country, the whole population.
Dr. Ross. When you talk to these families, it is sometimes very little things that prevent them from even considering taking the patient home. I have, every day, requests to help with making such a decision.
If these families had somebody they could talk to and consider the alternatives, if you can teach a wife how to give injections for pain for her husband,then she might consider taking him home, but some body has to bring up the issue, “What is the problem? Why can’t you
takehim home, if that is his biggest need?” And she may say, “Well, he is in somuch pain and needs injections around the clock.”
All it takes is to teach somebody to give injections. If you can teach it to diabetics, you can teach it to members of the dying person’s family, too.
COUNSELING BY THE CLERGY
SENATOR CHURCH. And, now, at the present time, that kind of counseling is almost unavailable, is it not?
Dr. Ross. Yes, except from the clergy. The clergy have been the only ones, but until recently they have not been trained in the needs of the dying patient.
SENATOR CHURCH. That was going to be my next question. Why have the churches so refrained from entering into this area, which seems to be the most natural one for them, and seems to be central to their whole purpose? Why, in your opinion, have churches and clergy men really failed to concern themselves about this problem, as much as one would think they would ?
Dr. Ross. I don’t know if they have really failed. I think they have been the only ones who at least face death once in a while. You appreciate that it is very hard to admit that people are so petrified to die, because if you are really a true Christian, for example, you are not supposed to be afraid to die. You are supposed to look forward to a better life after death, and it is very hard, then, for a normal human being to admit that he is scared, does not want to die, or might even have some doubts about the hereafter, so there is also a lot of conflict from what the church is teaching.
SENATOR CHURCH. You would think if our society as a whole is a death-denying society, at least he churches are not; and,therefore, is there not a larger role that the churches could play in adding greater dignity and comfort to the process of dying in this country?
Dr. Ross. I think they have made probably one of the greatest contributions in the last few years. I have seminaries of all denominations to teach these seminarians how to be more effective with a dying person, and that is true of priests, Protestant ministers, and rabbis.
SENATOR CHURCH. Senator Fong.
SENATOR FONG. Dr. Ross, how do you go about counseling people to accept dying? Should there be a person in each institution that is knowledgeable about this subject? Should there be somebody in the community, some agency whose sole purpose is to see that people are educated to accept dying? Should there be something like that?
Dr. Ross. It is very hard to tell. I don’t think you can have one specialist in an institution who does all the counseling. That would again lead to a subspecialty of the sciences, the “thanatologist,”so the physician would not get involved with a dying patient. The physician would take care of a patient as long as he could help him medically, and there is a chance of recovery. He would desert that patient when he becomes “beyond medical help” and call in the thanatologist like a priest is called now — in the last moment to give the last rites.
SENATOR FONG. So we cannot look to the physicians?
Dr. Ross. Not exclusively. I think we have to include the needs and the care of the dying patient in social work schools, seminary schools, and medical schools, and there will always be a few who love to work with either old people or dying patients, and those are, then, the ones who will visit these people.
It is like in medical school — you always find a handful of medical students w h o are absolutely great for research. They make terrible clinicians, but they do well in research .
SENATOR FONG. Is there a movement now to have such a subject in the social work schools —
Dr. Ross. Yes.
SENATOR FONG: To counsel people to accept dying?
Dr. Ross. Yes.
SENATOR FONG. There is?
Dr. Ross. Yes. I have been teaching many, many schools of social work every year.
SENATOR FONG. And are the social workers equipped now to handle the subject ?
Dr. Ross. More and more. It is still a tiny drop.
SENATOR FONG. Now, how do you approach the dying patient? Who makes the move to tell him, or to try to educate him? How does it come about ?
Dr. Ross. You see, it is not that you go into the room of a terminal patient and say, “You are dying. Let’s talk about it.”
I think if he can go visit these patients, and if they look miserable or grouchy or bitter, somebody, whoever feels comfortable doing this kind of work, simply sits with them and says, “Do you feel like talking ?” It is like opening floodgates.
SENATOR FONG. I come to that next subject.
DYING PATIENTS NEGLECTED
You feel that many of these people who are dying are being neglected?
Dr. Ross. Yes.
SENATOR FONG. Nobody comes to see them, or if somebody comes to see them , then certain things are not being done for them . You mentioned this girl. She was looking into the light, and the light was very, very bright.
Now, how do we get nurses to show a little more solicitude? How do we get hospital aides and the people who are paramedical to help in this field, and how can we get the community to help?
For example, to get more people to do visiting; to visit the hospital? I know there are certain groups of people, ladies who volunteer to go to hospitals, but they sit at the desk and tell you what room a patient is in, but do you have a group that goes out and visits older people, people who are dying, people who need to be comforted? Can we increase that group of people to get into that act?
Dr. Ross. We have had the seminar on death and dying, where we interviewed hundreds of terminal patients in a screened room which was observed by social workers, nurses, hospital volunteers, medical and theology students.
These dying patients shared with us the most beautiful human doctrines of faith, hope, love, their anguish, and their needs.
You can have classes like this, and you don’t stand up behind a desk and lecture to them. That is where the people who work with these patients can listen to what the dying patient himself has to teach; it is one of the most moving human experiences. I have seen very few of the hundreds and hundreds of members of the helping profession who have not become much more humanly involved with those patients, and this is something we have to include in the curriculum, and it is happening now .
There are many volunteers who sit with dying children whose parents live 3, maybe 4 hours away from the hospital. Their mothers may be pregnant or they have other children or they just have to be home with the children, so we ask volunteers to become substitute parents. They sit in the recovery room with them, they listen to their needs and help these children tremendously.
Those volunteers are marvelous, and we have many, many volunteers to do this work, and there will be more every year.
SENATOR FONG. Dr. Ross, do I understand that you are in favor of prolonging life as long as there is life? Would that be interpreting your thoughts correctly?
Dr. Ross. Our basic role should be to relieve suffering and not to prolong life.
I am against any form or shape of mercy killing. I want to make this very clear.
But I am very, very much in favor of allowing patients to die with dignity; the patient’s own death. I am very opposed to artificial prolongation of life when it becomes meaningless.
I would first wait and discuss who is going to be put on a respirator. I would not put the patient on a respirator and then afterward decide who shall pull the plug.
To me, this is again a question of education. Resuscitation is another example. I have seen patients full of cancer who were hoping that they could die soon, and when they die, the resuscitation machine goes on, and they are brought back to life for a few more hours, a few more days. To me, this is inhuman. This is a prolongation of suffering and not even prolongation of life.
SENATOR FONG. While the patient is living, you feel that we should give them every care and make them comfortable, to make them feel relieved of pain?
Dr. Ross. Yes; loving nursing care, and a human being who can sit with them and love them and care for them. If you have a patient who has no chance to live on any level of real functioning, I would not use those machines.
I hope you appreciate the difference. For example, if he has any chance to make it again, I would use all the treatment available, but if the patient is full of cancer, is hoping to die, and in the stage of acceptance, and wants to die, I think you should let him. That, to me, means he dies with dignity.
SENATOR FONG. Thank you.
SENATOR CHURCH. I think that is a very important distinction to make, and that is why I emphasize in these hearings these are not hearings on euthanasia.
The distinction between any form of so-called mercy killing and a refusal in cases of terminal, hopeless terminal illness to simply pro long life a little longer when it prolongs the misery and agony, and when it really is not conducive to the patient himself or the family, this is the question, and I think you have made that distinction very clear.
Dr. Ross. The tragedy is a tragedy of words. You see, the word “euthanasia” means “a good death” and I am very much in favor of euthanasia, of a good death for the patient’s own death, hopefully at home, surrounded with good care and love, but euthanasia tragically Is also used for mercy killing, and I am opposed to that.
I think we have to find different words. Otherwise, people are confused.
SENATOR CHURCH. Yes; In the latter sense that the term has come to be understood.
Dr .Ross. This is why I said living with dignity, and not dying with dignity.
SENATOR CHURCH. Yes.
Senator Percy, do you have any questions?
SENATOR PERCY. No; I have not.
I would just simply like to welcome my distinguished constituent and say that I am sorry I could not get down earlier to hear you, but I will very carefully go over the record, and I appreciate your being with us this morning.
SENATOR CHURCH. Thank you very much, Doctor.
Source: Death With Dignity: An Inquiry into Related Public Issues. Hearings Before the Special Committee on Aging, United States Senate, Ninety-Second Congress, Second Session, Part 1 — Washington DC (Washington DC: US Government Printing Office) 1972, pp. 10-22.