Elyse Ona Singer

ELYSE O. SINGER, Universisty of Oklahoma, Norman, Oklahoma, was awarded funding in October 2018 to aid research on “Remaking Mexican Death: The Quest for Dignity at the Ends of Life.” In 2008 Mexico City legalized “passive euthanasia” — the right of the terminally ill to refuse or withdraw life-sustaining treatment — in a historic vote. As part of the pioneering “Advance Directive Law,” all Mexico City residents can now register their end-of-life wishes by filing advance directives at a hospital or public notary. Moreover, comprehensive outpatient palliative care services have been made available to terminally ill patients for the first time through public health institutions and at home. Mexico City residents can now opt out of so-called “heroic” biomedical interventions that suspend them on the cusp of death and protract suffering, and many people are taking steps to do so. More than 10,000 capital residents have filed advance directives, publicly declaring their end-of-life wishes in case they fall ill and are unable to communicate their desires to a doctor. Until now, however, little has been known about whether those who have made use of the Advance Directive Law were able to mitigate physical and psychic suffering at the end of life, and whether their survivors understand them to have achieved a dignified death. Initial findings suggest that dignified death is elusive for many terminally ill patients in Mexico City, but there is consensus among patients, family members, and palliative care clinicians that when present, a “dignified death” entails respect for the choices of the dying person, the control of symptoms such as physical pain, the ability to attend to unfinished interpersonal business, being accompanied by loved ones, and being able to choose the place of death.