You can live with dignity...

"Our bodies break down, sometimes when we're ninety, sometimes before we're even born, but it always happens and there's never any dignity in it. I don't care if you can walk, see, wipe your own ass. It's always ugly. Always. You can live with dignity, we can't die with it." - House


I swear, the next person who uses the phrase 'dying with dignity' in a discussion on the Advanced Medical Directive (AMD) is going to get an earful from me.

Seriously.

Just what exactly is so undignified about dying with 'tubes' running in and out of your body?

How does having an endotracheal tube down your throat or an intravenous access or an intra-arterial line make your exit from this world less glamourous?

Or, how is choking on your own secretions and gasping for air *without* any tubes inserted into your body a 'dignified' way to go?

'Dignity' is in itself a social construct. We, as a society and as individuals, choose what to call 'dignified' and what to call 'undignified'. The fact is there is nothing inherently undignified in receiving life-support measures and treatment. People receive it all the time - from preterm babies, young people who suffered trauma, old people with serious infections, to people who are dying.

Dozens of SARS patients received extraordinary life-sustaining measures during the outbreak. Nobody called them 'undignified'. They were called 'heroes', as were the people who put them on these measures and treatment.

So what exactly is so different about dying from SARS as opposed to dying from cancer or heart failure that makes it acceptable for one group of patients to receive such treatment till the time their bodies fail despite all efforts, and 'undignified' for another group?

angry doc suspects that this 'dying with dignity' talk comes from a fundamental fear of our own mortality and a desire to have some sense of control over the manner and timing of our death.

Unfortunately an AMD doesn't really give you those choices.

You can't choose how or when you want to die by just signing an AMD.

You are allowed to state in advance that you do not want extraordinary life-sustaining treatment when your death is imminent, but don't pretend that you have a real choice over how you got there to begin with, or when it's going to happen. Chances are, if you need your AMD to be activated, you are not going to be looking your best or in a very sound state of mind. In other words, you are still going to look pretty undignified.

angry doc has no problems with people who decide that they do want an AMD signed, for whatever reasons they might have, but anyone who wants me to witness their AMD so they can 'die with dignity' is going to get some tough questioning.

The problem with not questioning the oft-quoted statement that signing an AMD means 'dying with dignity' is that people will let themselves believe that they have thought the whole issue through when all they have done is to parrot someone else's assumptions.

By all means sign the AMD if you want to reduce your final hospitalisation bill, sign the AMD if you want to spare your family from taking the decision on whether to initiate or continue extraordinary life-sustaining treatment, sign the AMD if it makes you feel better about your own mortality.

But don't pretend that signing one will guarantee that you will die with dignity, or that people who do not sign one will die without dignity.