Dying Wish: a documentary with an enduring message

^{(photo credit: Scene from the documentary: Dying Wish. Dr. Michael Miller surrounded by family)}

When retired surgeon, Dr. Michael Miller’s health began to seriously decline, he knew he wanted to die in his own bed, at his home in Boulder, Colorado.  His desire was to leave surrounded by family, under the care of a supportive hospice team.  Dr. Miller, who had pancreatic cancer at age 80, had done his homework on end-of-life choices. He had researched the dying process and discovered that patients who stopped eating and drinking had what he deemed an easier exit.

Karen van Vuuren directed Dying Wish in 2007. Now, nearly two decades later, hospices and institutions that offer end-of-life trainings still use it as an educational resource about the dying process and Voluntary Stopping of Eating and Drinking (VSED).

In the research he conducted after receiving his terminal diagnosis, Dr. Miller found few studies specifically addressing VSED. What little evidence he uncovered proved largely anecdotal. He also discerned a lack of understanding about dehydration and the resultant dying process. He found that few patients received information about the effects of terminal dehydration, and professional healthcare workers at the time were largely ignorant of what it looked like. Dying Wish is the gift of a compassionate physician who as a healthcare provider himself, lamented his past lack of knowledge and skill at the bedside of the dying. 

Dr. Miller decided that when his body told him death was impending, he would allow nature to take its course by ceasing his intake of food and fluids. His existential pain around a prolonged dying process, and his belief that dehydration would alleviate some of his more troublesome symptoms, led to that decision.

When filming began, Dr. Miller had not yet embarked upon his fast.  For some time, he had been dealing with pain, nausea, and diarrhea, for which his hospice care team was providing treatment.

Dying Wish follows Dr. Miller for the two weeks of his fast, through to his death on the thirteenth day of not eating and drinking.  We see the physical changes in him, the dizziness associated with hypotension, the muscle loss, cachexia, and the general weakness and withdrawal from the external world. We hear about the methods of comfort care his caregivers use to address the most common adverse symptom of dehydration in the dying, dry mouth. Those who have seen the film often express their surprise at Dr. Miller’s still frequent trips to the bathroom, days into his fast. This is testament to the body’s continued need to eliminate waste, even when food and fluids are no longer entering the system.

Dr. Miller wanted to highlight the common physical benefits of dehydration at the end of a terminal illness; the release of endorphins providing natural analgesia, reduced edema and pain from fluid-filled tumors, fewer secretions, to name but a few.  His goal was to dispel myths of protracted pain and anguish due to thirst.  At no point does Dr. Miller complain of either thirst or hunger.  Indeed, it becomes clear that cancer takes away his hunger and that this occurred months before he signed on to hospice.  Reduced appetite and a disinterest in eating are a natural part of the dying process as the body begins to shut down.

Ultimately, Dying Wish is a window onto a patient experiencing the dying process in a conscious way. The film provides a picture of peaceful death, one in which the dying one exercises control over the circumstances of his death, tainting it neither by chaos nor a sense of tragedy.

Perhaps the most profoundly touching scenes are those in which Dr. Miller takes leave of his family. In these, he reflects on the completeness of his life and the conscious nature of his leaving. His death becomes a rite of passage that allows his family to express their love and to let him go.

Dying Wish addresses far more than what it means to stop eating and drinking at the end of life.  As an educational tool, it invites discussion about existential and psycho-spiritual questions such as the nature of a “good death” and what it means to be “ready to die?”  Director, Karen van Vuuren sought out bioethicists who could comment on these topics. In the film, they share their experiences about patients who have made similar choices.

Dying Wish makes it clear that patients have a right to stop eating and drinking at the end of their life. Dr. Miller’s own advanced directives emphasized the importance of quality of life. He was determined to avoid the indignity his 102-year-old mother who experienced nursing home staff pressuring her to eat against her will. Her advanced directives, completed while she was mentally competent, had specifically stated, “no spoon-feeding.”

Dying Wish is a film about a choice that remains within our control. Doctors are notorious for their desire to control outcomes and are trained to stave off death. As a vascular and thoracic surgeon, Dr. Miller, one could argue, had that same need for some vestige of control when his death became inevitable. But we also witness him in a state of surrender and acceptance, paying attention, with grace, to the messages his failing body is sending him.

Physicians who have seen the film have commented that Dr. Miller made them feel more comfortable about their own death.  End-of-life professionals have used the documentary with patients to broach sensitive end-of-life issues with families via the less personal medium of a film. Patients with terminal diagnoses and their families have also found the film a helpful vehicle for difficult conversations about end-of-life choices.

Upon its release, Dying Wish screened at film festivals around the US, featured at the Colorado Center for Hospice and Palliative Care, and at the national clinical conference of the National Hospice and Palliative Care Organization.

By Karen van Vuuren

Director, Karen van Vuuren, formerly the executive director of non-profit, Natural Transitions, is currently a faculty member of Natural Transitions Institute, and president of its board of directors. She has created three, four-week online end-of-life educational enrichment courses, dealing with how we prepare for death, how we creatively respond to and mark death, and green and natural choices for after-death care. Van Vuuren is also completing her training as a clinical mental health counselor whose focus is on spiritual transformation after loss.

➡️ Consider being a part of a tender exploration of understanding and preparing for death bolstered by greater consciousness, clarity and courage. Karen is offering courses this fall and they are not to be missed. Click here to learn more and register: Natural Transitions Institute | Celebrancy & End-of-Life Training 

🎬 For more information about Dying Wish and to find out how to stream it online, visit dyingwishmedia.com