Many people and their families begin to notice signs of Alzheimer’s long before the disease fully progresses. Neurologists can now detect indicators of brain deterioration that may begin 10-20 years prior to it becoming a major issue in someone’s life.
The problem with current diagnostic criteria —even if legislation eventually passes
— is that a person may live for several years after diagnosis with little visible change, only to then experience a rapid decline in mood, cognition, and functioning. Common symptoms include “sundowning,” anger toward family members who “just don’t get it,” depression, and anxiety. While many say, “Tomorrow is a new day,” those living through these realities know those “good” days can be few and far between.
Time feels heavier on our shoulders as we juggle work, caregiving, and personal responsibilities. This is especially true in colder climates or during long academic years, when many of us look forward to summer for renewal. Warmer weather often brings improved moods, more outdoor activity, and family time-reminding us how environment and balance affect mental health.
For those of us in the Northeast, “spring fever” is real. When the sun finally shines, it’s harder to stay focused indoors —we’d rather be outside. Students also reflect this seasonal shift: energy levels rise, attention wanes, and the end of the school year brings excitement and distraction. The longer days invite us all to slow down, reconnect socially, and find joy in simple experiences.
DEATH WITH DIGNITY AND THE RIGHT TO CHOOSE
As we continue to wait for legislation allowing the right to choose at the end of life, our emotions fluctuate between sadness and pain as we watch loved ones endure the agony of terminal illnesses. Many doctors, therapists, and families in states like New York-where no Death with Dignity Act currently exists-struggle with the lack of options for patients who wish to maintain autonomy over their lives and deaths.
Legislators often misunderstand how profoundly such laws could improve the quality of life for those facing irreversible decline.
Many individuals have long expressed their wishes to family members—whether or not their spouses are present—to ensure their preferences are honored if a serious illness occurs. I have always believed that no one should be forced to live in a state of severe cognitive, physical, or communicative impairment that strips away the independence and dignity they once had.
While documents such as a Do Not Resuscitate (DNR) order express one’s medical wishes, families or executors can sometimes override these decisions, especially when misinformation or guilt is involved. The result can be prolonged suffering, isolation in care facilities, and the loss of personal choice when it matters most.
In contrast, residents of several U.S. jurisdictions currently have access to medical aid in dying, which allows a terminally ill, mentally competent adult to receive a prescribed, lethal dose of medication from their physician. These include:
- California – End of Life Option Act (2015/2016)
- Colorado – End of Life Options Act (2016)
- District of Columbia – Death with Dignity Act (2016/2017)
- Hawaii – Our Care, Our Choice Act (2018/2019)
- Maine – Maine Death with Dignity Act (2019)
- New Jersey – Medical Aid in Dying for the Terminally Ill Act (2019)
- New Mexico – Elizabeth Whitefield End of Life Options Act (2021)
- Oregon – Death with Dignity Act (1994/1997)
- Vermont – Patient Choice and Control at the End of Life Act (2013)
- Washington – Death with Dignity Act (2008)
Montana has no formal statute but, since a 2009 state Supreme Court ruling, does not prohibit a physician from honoring a terminally ill, mentally competent patient’s request for aid in dying..DeathwithDignity.org, TriageCancer.org
The Right to Self-Actualization
I am of the opinion that the right to self-actualization-the ability to live and die according to one’s values, beliefs, and definition of dignity —is a fundamental human right. When a person faces terminal illness or irreversible decline, allowing them to make informed, autonomous decisions about their care is not an act of despair but of profound self-respect.
True compassion lies in honoring choice. It is about empowering individuals to define what quality of life means to them, to express their final wishes clearly, and to have those wishes respected without shame or legal barriers. As medical science advances, so too should our understanding of dignity-not only in how we live, but in how we choose to leave this world.
Marcy Abramsky, LCSW•2025
