With Death with Dignity, my dad’s last days were a celebration.
BY ELIZABETH SHIER
My dad died on May 16, 2024. He had emphysema and the (undiagnosed) beginnings of dementia, but neither was the direct cause of his death. Due to the agency granted him through the Death with Dignity laws in Washington state, he was able to orchestrate his own death and last day of his life as a victory lap—a celebration of life filled with gratitude and dignity. It was one of the best weeks of his life. I couldn’t have imagined it, but his last week was one of my favorite weeks, too.
Eleven months before, my dad, John Shier, decided to move from his longtime home in Green Bay, Wis., to the Seattle assisted living community where I work as a director. He was on hospice and wanted to be closer to me, his only child, and to my mom’s family in the Pacific Northwest. He’d lost my mom in 2022 after her long battle with a rotten neurological disease, and his emphysema had robbed him of the ability to do many of the things that gave his life meaning and purpose. In light of these losses, and facing further decline, he felt that the full circle of his life was complete. Always an avid reader, educator, and activist, he was hell-bent on being back in the driver’s seat of his own life and that meant pursuing Death with Dignity.
My dad was uniquely qualified to pursue a groundbreaking and unconventional death. Those who knew and loved him would say that this was the perfect death for him. He had a PhD in philosophy of religion from the University of Wisconsin, Madison. From teaching, he went into advocacy work for seniors. Losing his best friend to cancer at 40 motivated him to spend almost 20 years as a hospice volunteer. Then rather than retire, at 60 he went back to school to become a hospice nurse and later wrote the book, Choose Today, Live Tomorrow—Notes from That Guy Nurse. He was keenly aware of the ways our health care system fails people at end of life. He preached loudly that our system prolongs life at the expense of well-being, therefore, he was committed to honoring his hospice patients and to preserving their quality of life as much as possible until the end. As an avowed atheist, he was not a typical church member, yet he remained active and engaged all his life, bringing philosophy to hard Christian conversations. It is difficult to imagine anyone with a richer or informed perspective on end-of-life issues.
My dad inspired me in many ways. I chose a career that places me at the center of aging and in close proximity to death. I deeply appreciate my elders and my days are filled with laughter, great conversation, and purpose. Aging and death are part of living. Most people who live in the community where I work are nearing the end of their lives, which creates a heightened appreciation of the time we have together.
I have lost friends, role models, amazing family members, and my own mom. Yet, in all the passings I have known, none could be described as joyful leave-takings. Death often arrives after a long, slow, and painful decline. And all the while we guiltily wonder, “How long will this go on?”
Over an 18-month period my conversations with dad were peppered with talk of his death, discussions about his life feeling complete, and his frustration over just waiting to die. He viewed Death with Dignity as a path toward ending the feeling of being in limbo.
My love for my dad is intense and complex, and respecting his decision did not come easily in the beginning. I would have loved for him to find enough joy in our Sunday outings to want to stay around for a few more years. I wanted more of chasing Thomas Dambo’s trolls, more ferry rides, and more gelato. In early April, his signature impatience kicked in and I got serious about finding him a doctor willing to prescribe the necessary medication. Dr. Darrell Owens at the University of Washington Medical Center turned out to be the right man for the job. He spent a full hour talking with my dad to assess his candidacy and prognosis. It took another week and some help from the good volunteers at End of Life Washington to find a second doctor we needed by law to agree. A week later I walked out of the pharmacy with his prescription labeled “WARNING: Contents fatal if ingested.” It felt surreal. I’m not sure how to express it, but it felt like a big win for my dad. And a win for me, too, the daughter making this dream a reality.
I have been learning more about ambiguous loss and grief since dad’s death. Ambiguous loss is a term coined by Dr. Pauline Boss in the 1970s. She used it to describe grief that has no definitive boundary or closure. My dad experienced ambiguous loss over the decline of his health and well-being and the uncertainty of when his life would end. I experienced ambiguous loss as I watched him go through that process.
My dad was a powerful and impassioned activist, opinionated, and constantly in motion my entire life. As soon as he chose a date for the end of his life, he reclaimed his identity and was back to the man I’d always known and loved. His thinking grew clearer by the day and I watched him have thoughtful conversations and make plans for a living eulogy party, complete with vodka martinis. Crazy, but true, this process gave me back the Dr. John Shier I knew and loved.
As a gifted keynote speaker, during his last week we recorded an interview for StoryCorps, which is now available and cataloged at the U.S. Library of Congress. We treated ourselves to a Seattle opera, threw a beautiful backyard birthday party, had a fantastic dinner with family at Ray’s Boathouse, and fulfilled his dream of riding in a Tesla. The grand finale was a living eulogy party. His oldest and dearest friends and family from across the country Zoomed in and his neighbors and caregivers gathered, while dad and I regaled everyone with stories from his lifetime of activism and adventure. The day before he died, his best friends roasted him and he was riddled with laughter. As we hugged goodbye that night he said, “I never knew it could be like this.”
On the day of his death, he played cribbage with his favorite bath aid, our chef made him a fantastic lunch and someone from our culinary team baked him a cake on her day off and brought it to him. Another team member wrote him a song and performed it. One by one his care team sought him out for hugs, conversation, prayers, and well wishes. The experience of saying goodbye to someone who is present and able to truly be with us at the end is unique. We say too many goodbyes and most are nothing like this. I was moved beyond words to see the grace, beauty, love, and humor so many brought to my dad’s last days.
As the afternoon waned, we gathered our favorite people in my dad’s apartment, and he toasted all of us with gratitude for a wonderful life and for everyone he loved and who had loved him so well. He gifted his ring to my husband. There was ceremony and joy. He swallowed his medication with his favorite cocktail. He was laughing right up until the moment he closed his eyes and took his last breath.
Death with Dignity is Not a Right Everywhere
Because Death with Dignity is a legal option in Washington state, my dad was able to be fully present for every remarkable moment that we got to enjoy together that last week. He charged me to share his story because we both believe it fundamentally changes the narrative about end-of-life. He would love knowing that you are reading this right now. He would be over the moon to think that he inspired a conversation on end-of-life options at your dinner table. He would be elated to think his death might provide inspiration to others to embrace their own best last weeks and to advocate for Death with Dignity where it is not currently available.
Eight states have enacted Death with Dignity legislation: California, Oregon, Washington, Montana, Colorado, New Mexico, Maine, and Vermont.
Six states have Death with Dignity legislation pending: Michigan, New York, North Carolina, Delaware, Pennsylvania, and Massachusetts.
To learn more about end-of-life planning and Death with Dignity laws in your state, go to deathwithdignity.org
With Deepest Gratitude
My eternal gratitude for the incredible care provided by the team at Aegis Madison. In all of my years working with remarkable teams, I was still blown away by the support and love you gave my family. And to Dr. Darrell Owens for the time you gave my dad. Your willingness to write his script changed everything. The entire team at Continuum Hospice was stellar: You listened, you counselled, you leaned in, and you held our hands. Our thanks as well to Aegis Queen Anne at Rogers Park and a shout out to Katterman’s Pharmacy on Sand Point Way—not all pharmacies will fill this special prescription. Most of all, thank you dad. You showed me, once again, what is possible with determination and an open heart and mind.
Elizabeth Shier was born and raised in DePere, Wis., graduated from Macalester College in St. Paul, and has split her career between grant writing in San Diego, heavy-equipment operation in Antarctica, and senior living in Seattle. She is married and parents two cats. Weekends are spent hiking and making art.