Many factors in our political and cultural climate have contributed to an increased interest among mainstream Americans for the Dignity in Dying movement<\/a>.\u00a0 Organizations such as Compassion and Choices,\u00a0 Death with Dignity, and Final Exit Network <\/a>have worked hard to get out their various messages, but so have many citizens who would be unlikely to join any of these organizations, yet wish to clarify their positions on end-of-life issues with their families and physicians.\u00a0 This is a growing movement that is progressive, reasonable, and hopeful, especially considering the capacity of medicine \u00a0to prolong life, even when it can no longer offer patients better quality of life.<\/p>\n Affordable Care Act<\/strong><\/p>\n The Affordable Care Act of 2010 (ACA) has brought some of these end-of-life issues into the cultural landscape.\u00a0 Both the supporters and the detractors of this legislation are concerned that an overwhelming percentage of medical costs occur in the last few weeks and months of a person\u2019s life.\u00a0 President Obama dropped the provision for Medicare coverage of end-of-life consultations, mainly because it threatened passage of the very important ACA.Those who oppose this clause, primarily conservatives who see it as a threat to right-to-life, eventually will have to face the fact \u00a0that a consultation between patient (if possible), the family, and physicians will almost certainly ease the suffering of everyone involved, even if the only outcome is a better understanding of the situation.\u00a0 These discussions take time, and physicians should be compensated for their time and expertise. The provision does not mandate that any family has to have this guided discussion, simply that Medicare will cover certain costs, if they decide to go ahead.\u00a0<\/p>\n Movies and TV<\/strong><\/p>\n Movies and television shows, as well, have explored end-of-life issues and helped us see them in greater perspective. PBS\u2019 Frontline<\/em> has presented several shows on this topic, most recently a skillfully done inquiry with interviews of patients, families, and physicians from intensive care departments in New York City. In 2009, HBO presented a documentary on Dr. Jack Kevorkian called You Don\u2019t Know Jack<\/a><\/em>, featuring Al Pacino. Later this month [May 26, 2011] HBO will feature another documentary, How to Die in Oregon<\/em>, which looks into the history and realities of the first state to pass a Death with Dignity Act.\u00a0 This film has won great acclaim wherever it has been shown, mainly at film festivals.<\/p>\n Terminology<\/strong><\/p>\n This would be a good place to clarify terms that are often misunderstood.\u00a0 For the purposes of this piece, \u201ceuthanasia\u201d means that someone acts in such a way to cause another person\u2019s death, in response to the written or understood request of that person.\u00a0 This is what Jack Kevorkian did when he inserted an IV line into a man who asked for help, a man totally paralyzed by advanced ALS (Lou Gehrig\u2019s disease).\u00a0 Kevorkian deliberately filmed this procedure and allowed 60 Minutes<\/em> to show it, resulting in his conviction and prison term. The Michigan court convicted him of manslaughter for \u201cassisting in suicide,\u201d a felony.\u00a0\u00a0 Even in Switzerland and the Netherlands, a person must drink the potion or swallow the pills in order to end life.\u00a0<\/p>\n Self-deliverance<\/strong><\/p>\n By the way, for the purposes of this article, such an act will be called \u201cself-deliverance\u201d not suicide.\u00a0 Self deliverance is the action of a terminally ill person who has virtually no chance of significant improvement and who wants to maintain control over his death.\u00a0 I would call the death of someone like [well-known St. Louisan] I.E. Millstone self-deliverance, because at 102, but apparently not suffering from a terminal illness as we usually understand it, he jumped from the Daniel Boone Bridge over the Missouri River.\u00a0 At 102, with various ailments and the loss of most family and friends, life is a terminal illness from which there will be no significant improvement.\u00a0<\/p>\n Physician-assisted death<\/strong><\/p>\n Even the words \u201cphysician-assisted death\u201d mean that a suffering person may obtain from a physician the prescription that will bring about death, if the person meets all of the requirements.\u00a0 This kind of death, self administered, is currently legal in the states of Oregon, Washington, and Montana, with legislation pending in Vermont.\u00a0 Only people who can get two physicians to certify that they are within six months of death are eligible.\u00a0 This requirement \u00a0eliminates those who suffer from Alzheimer\u2019s, advanced Multiple Sclerosis, advanced Parkinson\u2019s, Huntington\u2019s, and other horrendous neurological illnesses for which death is certain, but not necessarily within six months.<\/p>\n \u00a0Print media<\/strong><\/p>\n Magazine articles and books, too, have raised our consciousness. \u00a0Dr. Atul Gawande\u2019s piece, \u201cLetting Go,\u201d <\/a>in the August 2, 2010 issue of The New Yorker<\/em> has been widely read and quoted.\u00a0 Additionally, Susan Jacoby recently published Never Say Die: The Myth and Marketing of the New Old Age<\/em>.\u00a0 She employs a quick intelligence and humor to make her main points.\u00a0 Both of these authors urge Americans to be wiser and more informed about old age and end-of-life choices, in order to improve the quality of the time one has left.<\/p>\n