End of Life Care: The Death with Dignity Debate

Society & Public Health

Discussing death is not a taboo, but a essential standard of care that preserves patient dignity and autonomy

By Shravan Nosib

“Place me in that immortal, imperishable world, where light is unceasing, and heaven itself is set.”  — Rig Veda, 9.113.7

The loss of a loved one is always painful, but particularly so when there is a sense that more could have been done to ease their suffering in their final hours. On a recent trip to Mauritius, I learnt about the painful death of a relative with advanced metastatic cancer; she was being treated in a private clinic until one doctor finally told her to go home, as nothing more could be done. She promptly did so for a few hours until she became delirious and very agitated with severe pain and discomfort. She died a few days later in a hospital bed. A former colleague with terminal cancer died recently and had his surgical drains removed without prior analgesia. Distressing scenarios dominated by pain and suffering in a setting with practically non-existent palliative care. There are many more.

End of Life Care. Pic – Theos Think-Tank

Few questions in modern medicine are as intimate, morally difficult and politically consequential as the question of how we should care for a human being who is approaching death. This article focuses on “death with dignity” and its medical, social, religious, and, of course, political ramifications. The Swiss and Canadian models of medical assistance in dying (MAiD), as well as palliative care outside the MAiD framework will be discussed.

Death

For many patients, death is not a gentle passage from the physical to the metaphysical. It can be a terrifying experience dominated by severe pain that outpaces every analgesic dose, visual hallucinations that crowd the room with figures no one else can see, and breathlessness so severe that each breath feels like drowning in air. The body betrays its owner while the mind, still lucid enough to be afraid, watches it happen. Medical intervention then becomes a necessity, offering a dignified end to a dying that has become a torment.

Death with Dignity Act

“Death with dignity” as a legal term originated in Oregon, and voters passed the Act on November 8, 1994. It was the first law anywhere to use that name and the first in the US (and the world) to legalise physician-assisted death for the terminally ill. It took effect in 1997 after a legal injunction was lifted and voters rejected a repeal attempt. The bill traces back to Oregon state senator Frank Roberts, who introduced physician-assisted dying bills in the late 1980s/early 1990s while dying of prostate cancer himself.

Advocates chose “Death with Dignity” specifically to distinguish the model from “euthanasia” — the Oregon law requires self-administration by the patient, not a doctor, as in the Canadian model of MAiD.

MAiD: Medical Assistance in Dying

Just over a decade ago, MAiD was confined to a handful of small, wealthy democracies. Today it is spreading across Europe and North America even as pioneer countries grapple with unsettling questions about who ends up using it. Within a single month this summer, France’s parliament approved a national right to assisted dying and the UK’s House of Commons returned to debate its own version for a second time. Both moves have reopened a decades-old argument: is medically assisted death a compassionate expansion of patient autonomy, or a policy whose “strict safeguards” quietly erode over time, merging into euthanasia?

Switzerland got there first and is now well established in “suicide-tourism”, offering MAiD to terminally ill patients from all over the world, at a price. Through a loophole in Swiss jurisprudence, two non-profit organisations, Exit and Dignitas, have built MAiD into a durable practice: doctors confirm a patient’s capacity to consent and an incurable illness or unbearable disability, but the patient takes the final, fatal action themselves. Euthanasia — a physician-administered lethal cocktail — remains illegal.

Canada’s law did not arrive by accident. In 2015, the Supreme Court struck down the blanket ban on assisted dying in Carter v Canada, reasoning that prohibition forcing some suffering people to endure their illness violated their Charter rights to life, liberty and security of the person. Parliament responded in 2016 with legislation limited to people whose deaths were reasonably foreseeable. In 2021, after a Quebec court ruled that limit unconstitutional, Parliament removed it, creating a second track for people who are suffering but not near death. Thus, a “narrow exception” widens once courts and legislators apply the logic of equality and autonomy consistently. Supporters call it principled, while critics call it a gradual slide towards euthanasia. A UN human rights committee said this year it was “extremely concerned” by the 2021 expansion to non-terminal conditions, citing poverty, inadequate housing and lack of disability supports as factors pushing people toward MAiD rather than treatment.

The next legal frontier is approaching rapidly. Under current law, patients with a mental disorder as their sole underlying diagnosis become eligible on March 17, 2027, unless Parliament intervenes. Politico-legal debates around this statute are bound to be intense. In 2024, MAiD deaths accounted for 5.1% of all deaths in Canada — a non-negligible figure. Patients must be cognitively intact to consent to MAiD; proxies cannot do so on their behalf. Only Canadian citizens can access MAiD, and the lethal cocktail must be administered by a physician.

Religious Doctrine of Dissent

Religious traditions supply much of the moral vocabulary on both sides, and the lines rarely fall where political tribes expect. The Catholic Church, the most organised opponent worldwide, teaches that life is a gift from God that humans have no authority to end it deliberately, though it permits refusing futile care that only prolongs dying. Hindu teaching is divided over whether the principle of ahimsa, or non-violence, bars assisted death or instead condemns prolonging suffering artificially. Islamic scholars treat deliberate hastening of death as forbidden regardless of suffering. Orthodox Judaism holds a similarly strict line. Anglican and mainline Protestant bodies are the most internally split, some synods opposing legalisation and others declaring neutrality or support — a divide that shaped recent votes in Westminster and Paris.

Compassionate Terminal Care outside MAiD Framework

What about countries where MAiD does not exist? There is an important misconception that countries without assisted dying simply leave terminally ill people to suffer to death. That is not necessarily true, as many countries do provide hospice and palliative care to such patients. The crucial problem is access. The WHO estimates that approximately 57 million people worldwide require palliative care each year, while only around 14% receive it.

The disparity is particularly severe in low- and middle-income countries. The imbalance is starkest in pain relief: a fifth of the world’s population consumes the vast majority of the global morphine supply, and Human Rights Watch has documented countries across Sub-Saharan Africa, South Asia, the Middle East and Central America where fewer than one in a hundred severe-pain patients can obtain needed medication. This creates one of the great inequalities of global medicine.

Thus, wealthy patients may have access to specialist palliative medicine, hospice beds, home nursing, modern analgesics, psychological care and spiritual support, while poor patients in other parts of the world may die from the same disease without adequate analgesia. In such scenarios, critics have warned against MAiD becoming the only available option rather than an informed and free decision.

Death Conference

Open conversations about death are not an optional extra in palliative care; they are central to it. When patients and families are given honest, compassionate space to discuss prognosis, fears, and what matters most, they can make informed choices about treatment, set realistic goals, and ensure their final wishes are known and respected. Avoiding the subject rarely protects anyone and may cause deep distress and unresolved grief. I am aware of one case where a terminally ill patient chose not to tell his partner about his impending death but did inform his children.

Since palliative care aims to relieve suffering in all its forms (physical, emotional, social, and spiritual), it cannot fulfill that purpose without addressing mortality directly. Talking about death honours the patient’s dignity and autonomy, and it must be a standard, skillfully delivered component of care rather than an afterthought. The subject can no longer be taboo.

Mauritian Context

Palliative care and compassionate terminal care are practically non-existent in Mauritius, even though the Ministry of Health boasts of a robust network of primary health care centred around primary care physicians, nurses, community workers and social workers. I was pleasantly surprised to learn that community physicians regularly visit elderly family members for at-home check-ups to address ongoing health issues. But I was equally surprised when I could not buy a very common medication used to dry secretions in terminally ill patients, and I had to plan to get it from Mumbai for a loved one who was dying.

With an ageing population, higher life expectancy and lower birth rates, local demographics resemble that of developed countries and the incidence of all cancers and other killers is expected to rise. The need for palliative care/ compassionate terminal care will become more pressing, and hopefully all stakeholders will join hands to deliver the goods.

Until we become a mature citizenry able to discuss MAiD freely and dispassionately, I believe there is significant room for improvement in palliative care — particularly given how distressing sub-optimal pain control is for terminally ill patients and their loved ones. Effective palliative care is simple to implement at the community level, especially for patients who wish to die at home surrounded by family. Alternatively, patients can receive care in a formal hospital setting within a dedicated private room. Both approaches focus on compassionate end-of-life care: maintaining comfort, managing pain, reducing secretions, and providing spiritual support.

A minimum of freely available drugs, including oxygen, narcotics and non-narcotic painkillers, sedatives and anti-secretory agents, form the backbone of this strategy and go a long way to keeping patients and relatives comfortable. Care should not end when cure ends.

Conclusion

An ancient French folk saying dating back to the 15th century: “Guérir quelquefois, soulager souvent, consoler toujours” captures the essence if not the quintessence of medicine. It is widely attributed in spirit to Hippocrates and ancient Greek medicine for its ethicality and patient-centred care. “Soulager” and “consoler” form two important components of this triad, and sadly it is lacking in modern medicine with its dehumanising technologies.

Being human and humane should be spontaneous and effortless.                 

Mauritius Times ePaper Friday 23 October 2026