I feel uncomfortable with this topic as my drive for survival is overwhelming. Still, I very much identify with the Author's need to choose an exit strategy when the end is inevitable and imminent.
My mother, father in law, and sister chose to die earlier and with DNRs in place. My sister refused treatment that would give her at most three days more of pain filled survival at the cost of quality of life. My mother in law chose DNR but family members intervened and she spent her last days trapped in her own body unable to respond. The other three died more peacefully and very close (within 3 days) to the time they would have expired anyway. They were fortunate as they did not have to deal with travel, stress and red tape to die in a foreign land.
On the other hand, I have had two friends die an untimely death because they "did not want to be a burden" and could not imagine people wanting them alive if they could not be useful. They worried their illness would decimate the family assets. Two other friends felt the same and yet after talking and getting them help, they outlived the prognosis of death by several years.
I have also witnessed family members in total misery as family members were refused water, food and pain medications as they had no hope of recovery. These family members have the suffering etched in their hearts and minds and it is a living hell. Apparently, in some countries, a merciful overdose is murder but leaving them to starve is not.
I see this as a complex conversation that needs to be had early with room for change and openness so not only the patient has the best end of life but also those that will be the bereaved and the health professionals that care for them. For many years I resisted this conversation, it is not comfortable or fun as no one wants to face down the details of their own mortality or that of those they love but having the conversation early reduces barriers, brings comfort, and frames solutions.
Competing interests: No competing interests