**1. Introduction**

"Can't the doctor just give me a pill to end it all now?" Some patients diagnosed with a terminal illness will feel unwilling to await natural death from their disease, especially if they anticipate that such waiting will lead to suffering, loss of control, loss of dignity, or a burden on loved ones. This chapter explores the options open to those who want to end life on their own schedule in 2022. Is there a pill? Does the doctor have it? How would that work? Is geography a factor? What choices are available to the reader today? This chapter addresses the choices available to cancer patients seeking "release" in 2022. Though the ethical issues involved in suicide and euthanasia generate rich, complex debate [1], this chapter reluctantly leaves that for another discussion, focusing instead on choices that a cancer patient can explore in 2022. Options involving a doctor are severely limited by geography and by the limitations inherent in medical practice, as we will discuss. Some readers may find that they have come here to choose a method of ending their lives, only to discover that choices are not limited to selecting a method of dying. Though we intend complete presentation

of every method of dying reasonably available, the authors confess that we will be pleased every time readers make choices other than dying by their own hands.

## **2. Definitions**

Clear definition facilitates discussion. All humans die. Most will experience *natural death*, death that occurs because of old age, disease, accident, or catastrophe. Though natural death is one of the choices for a cancer patient, this chapter focuses on those deaths hastened by human intervention. We set aside euphemisms increasingly used to obscure human intervention (Medical Assistance in Dying, Death with Dignity, and so forth) in favor of straightforward language and clear meaning. We define as *suicide* any death caused by injuring oneself with the intent to die. *Homicide* is the term used when one human takes the life of another. We examine *assisted suicide*, suicide undertaken with the aid of another person, and focus here primarily on the special circumstance termed *physician-assisted suicide (PAS)*, in which a physician assists a person seeking death, usually by writing a prescription for a lethal dose of drugs that the patient takes without assistance.

*Euthanasia* (literally, good dying) is the circumstance in which an action by one person produces the intentional death of another. In contrast with suicide, in which the person who takes the action is the one who dies, with euthanasia the person who takes the action (usually a doctor) performs this action on another person, who dies. *Passive euthanasia*, which is not our primary concern in this chapter, refers to removal of life-supporting medication or technical support, not often an issue for cancer patients. *Active euthanasia* involves one person taking an action that causes another to die (often by injection of a lethal preparation by a doctor). *Euthanasia* is *voluntary* when the person dying has requested it. Euthanasia on request is legal in some countries under limited conditions and is the only euthanasia to be considered in this chapter. *Involuntary euthanasia*, in which the person who dies has neither requested nor given consent to being killed, is never legal. In most of the world, involuntary euthanasia is considered homicide, or murder. Euthanasia without consent does occur, despite being illegal, and this is a source of intense concern and debate in countries that permit euthanasia.

In summary, *suicide* means I do something, and I die. *Physician assisted suicide* means I ask a doctor to prescribe lethal medication, and I take it by myself and die. *Voluntary euthanasia* means I ask a doctor to administer lethal medication, by drink or by injection, after which I die.
