1.14 What messages do the TV, films or other media send about these aspects of D&D?

How painful or otherwise unpleasant dying is?

 How people act when terminally ill or dying?

How you should act when terminally ill, suffering or dying?

The circumstances, if any, under which a person could or should  leave life voluntarily?

 What happens after leaving life?

1.15 What has been your emotional reaction to D&D in dramas or descriptions of real D&D in books, movies or TV?

1.16 How could parents, teachers, ministers or the media do a better job of teaching about D&D?

1.17 If your work or daily life brings you into regular contact with D&D, you can answer these questions:

· What effect does this contact have on your ideas and feelings about your own exit?

· Did your decision to do this work or spend your time this way have anything to do with its involvement with D&D?

1.18 How do you react when others bring up the subject of D&D?

1.19 Do you ever bring it up yourself? What reactions do you get?

1.20 Have you had dreams or fantasies about D&D? Are the images pleasant or unpleasant? (For example: “I was dying on my bed, and  ...”, or “After I was gone, I imagined that I was ...,” or “Afterwards, I imagined that people ...”)?

1.21 Why do you think that contemplating D&D is so difficult for people-in-general?

1.22 What do you think keeps people like you from considering D&D as something to plan for?

1.23 Can you think of any ways that people might become less sensitive to D&D? For example, how do you think it would work to have a group of people discuss their ideas and feelings about leaving life in a group or class. How should the teacher or group leader handle people's discomfort with the topic?

1.24 Should certain aspects of D&D be a part of public school or college education. At what age are children ready to learn about D&D. How should D&D be presented to children of different ages?

2: Your reactions when others leave life

2.1 How did you feel as you responded to the questions in the previous section? How do you feel about proceeding?

2.2 If you are reluctant to proceed, would any of the following help you to feel more like doing so?

2.3 What thoughts and feelings have you sometimes or usually have had during funerals or when you have read obituaries?  

2.4 What ideas or feelings have you had when someone close to you left life?

2.5 Do you sometimes like to be sad? What does being sad do for you?

2.6 Have you ever been with a person during the last stages of his life? What are some of the reactions you observed in that person?

What did you make of these reactions? Were you surprised or concerned?

2.7 Did you notice any of these processes or changes? 

2.8 What did you think or feel about these changes?

2.9 What do you think of the treatment he or she received?

2.10 What help was given to his or her survivors?

2.11 What suggestions do you have for improvements in the treatment of the person leaving or of the person's survivors?

3.3 Could any of the following help to reduce this anxiety?

3.4 Have you been able to take any of the following recommended concrete steps to plan for your exit from life?

3.5 If you have not, what has kept you from doing the above things?

3.6 Some people are collecting medication or setting up other means of leaving life to use to use in case they need to use them. Their plans would include safeguards against impulsive or overly self-centered actions. What do you think of this idea?

3.7 Some other cultures treat D&D more casually, as a natural event, rather than as a catastrophe to be avoided at all costs. What do you think are the reasons for this?

What you have thoughts about leaving life in the past

 3.8 Have there been times when you acted as though you wanted to leave life, but really didn’t want to or at least weren’t sure? If so, were any of the following part of the situation?

3.9 Have there been times when you really did want to have life end? What kept you from carrying out this wish?

3.10 Would it have been a good decision to carry out this wish? If not, why not?

5: Quality of life and suffering

Assessing your own quality of life

5.1 Rate these activities on Pleasure, Sense of Accomplishment, Importance, and Potential for Positive and Negative Change:

• Physical health?

• Emotional or psychological health?

• Work or study?

• Family?

• Social life and friends?

• Physical activity?

•  Artistic or expressive activity?

• Involvement in other realities (reading, TV, computer games, other media)?

• Appetite or physiological satisfaction (sex, eating, drinking, medication, drugs)?

• Standard of living (money, investments, material possessions)?

5.2 Your “self” contributes to your QOL. You live with your self all the time so how you get along with your self is important. How satisfied are you with your self? What is it like for you to live with yourself?

5.3 List anything else that contributes to your current QOL.

5.4 How much of the time do you feel good about the way things are going, because you are accomplishing things, because you are having a good time, or because you making progress towards improving your QOL?

Assessing your level of suffering

5.5 The following question asks about your current levels of discomfort or suffering (Degree, Duration, and Degree of Expected Change in various areas.  

• Painful or uncomfortable physical symptoms? 

• Incapacitating physical problems or handicaps?

• Emotional or psychological problems

• Problems or frustrations with job, finances, or standard of living? 

• Problems, frustrations, or conflicts with family or friends?

• Other interpersonal problems (loneliness, being misunderstood, being a target of prejudice)?

• Threats to survival (war, crime, drought or starvation, frequent flooding or hurricanes, or other natural disasters)?

• Other environmental problems (toxic air or water, crowded living conditions, stressful or depressing weather)?

• Other kinds of suffering?

5.6 When you look over the list, would you say that your overall level of suffering is (various degrees of acceptable and tolerability).

5.7 What would other people say about your of your QOL or level of suffering? Would they wonder how you can stand it? Would they think you are doing OK or as well as anyone could expect? Would they think you were doing well compared to others like yourself? Would they think you were lucky and envy you? Would these opinions make a difference to you?

5.8 What would you say if you were looking over the responses of another person that were the same as yours?

5.9 Is your QOL or the degree of suffering that you are enduring now and that you expect to face in the future enough for you to consider leaving life?

5.10 Which of these additional factors could influence your ideas and feelings about leaving?

5.11 Let's say that you were in physical or psychological pain that was not going to get better. There is no hope of a cure. You have concluded that you could not adapt to the pain, and you could find no meaning in your suffering. You were not doing anyone any good by continuing to live. Would you consider leaving?

5.12 What other conditions you can think of that would make you feel more comfortable about leaving?

5.13 What would you do if you invited into a UFO, with the assurance that you would have a life free from meaningless suffering? How much risk would you be willing to take? What evidence would you need before you decided to go?

Your response to the suffering of others

5.14 Have you ever known a person that you believed would be better off permanently asleep? Have you ever wished that the life of a person who appeared to be suffering terribly would end?

5.15 Is there such a thing as complete hopelessness that is justified by the facts? Is it ever the case that there is nothing that anyone can do to make things better? Is there such a thing as "rational suicide"?

5.16 Which of these groups do you think should be offered the means to leave life?

5.17 Especially if you checked “Anyone who asks”: What safeguards do you think should be put in place?

5.18 Which of the following do you think are good reasons for not offering people the opportunity to leave life voluntarily?

6: The effects of your leaving on others

Your value to family and society

6.1 Perhaps you don’t believe that a person’s worth to society should ever have any bearing on whether or not he leaves life. If this is so, you can indicate the reasons that you think this way, and then you can skip to the next section.

6.2 Think back over your life. What things have you done that have had positive and negative impact on others?

6.3 Which of these describe your value to the world? (I am a Very or Somewhat, Positive or Negative Influence on One other person or animal, Several..., Dozens..., Thousands..., Millions ...).

 6.4 When you try to figure out the value of your contributions to the world, to whom are you comparing yourself when you make this judgment?

6.5 If the earth were going to be destroyed, and there were a spaceship that could allow only a small number of the most useful people to escape, where on the list do you think you would be and why?

6.6 What do you conclude from your responses to the preceding questions?

6.7 Do you think that spending some time with a person who would help you review your life might help you to understand and accept your failures and acknowledge your contributions?

The reactions of people around you to your leaving

6.8 How dependent are others are on you, and for what?

• Family?

•  Friends?

•  Neighbors?

•  Co-workers?

•  The company you work for?

•  Your town or city?

•  Society or your country?

•  The world?

6.9 Who would miss your personal presence (as opposed to what you can accomplish or produce) and how much?

6.10 What would be the responses of those you care about to your leaving voluntarily?

6.11 How would people respond to the manner of your leaving?

6.12 What do you conclude from your responses the questions about your value to society and about the reactions of others to your leaving?

We can now re-visit a slightly different form of an earlier question:

6.13 Is your current or expected QOL in combination with your value to others and the reactions of others to the fact and manner of your exit such that you would consider leaving life voluntarily, now or in the future?

... and this one:

6.14 Which of these additional factors could influence your ideas and feelings about leaving?

7: Other factors affecting the decision to leave: You ideas about the afterlife, decreasing the fear of leaving, providing incentives

After leaving life, what?

7.1 What belief or image do you have of leaving life and of what might happen afterwards?

7.2 If you there were to be life after leaving, what would you want it to be like? (Choose a vision that satisfies important needs that you accept in yourself and that do not clash with your values).

Leaving life without fear?

 7.3 Have there been times when you have been aware that you were not afraid of dying, or that you were acting as though you weren't? If so, what were you doing or experiencing?

7.4 What do you think of the idea of using virtual reality technology to create a pleasant or exciting situation in which a person is not afraid of anything? Could immersion in the simulation help the person to leave without anxiety?

7.5 What if there were a computer chip that could implanted in your body that would contain nanobots who would either treat a suddenly-occurring medical condition on the spot, or, if they determined that you were about to die painfully from something like a heart attack, stroke, or from wounds from a car accident or shooting, they would put you asleep permanently. (If there were any question about whether your condition were terminal, the ‘bots would simply anesthetize you.)  Would you have such a chip implanted:

Controlling the number of people who leave with incentives

7.6 Let’s say that you worked for an advertising agency and you were given the task of making leaving life seem more positive. How would you go about changing the images associated with these experiences?

• What techniques would you use?

•  What media?

•  What symbols or images would you present?

•  What types of people would you use for testimonials?

•  Whom might you chose to be the poster boy or family?

7.7 Which of the following do you think would make leaving life easier?

7.8 Having an escape route from an unpleasant situation can give a person the motivation to risk trying to make things better where he is because he knows he can leave if his attempts fail. Do you think that knowing that the above things are available to you if you need them would make you less likely to want to leave at the time that you began to suffer?

7.9 Which of these safeguards should be put into place to prevent people from making – or being pressured to make -- an irreversible decision to leave that would do more harm than good?

7.10 Which of the above should be applied to everyone, including yourself, and which should be applied only to those people who are not so capable of making the right decision as you are?

7.11 What do you think of the idea of making empathy or “Golden Rule” training part of everyone’s education, as an antidote to the abuses mentioned above?

8: An example of social and political consequences: the "slippery slope"

You and the slippery slope

8.1  How strong are the selfish needs for the money, time and energy that are being used up by elderly or handicapped people?

 8.2 How strong and durable are the self-controls against selfish actions coming from these needs – controls such as: empathy, The Golden Rule, the Ten Commandments (“You shall not kill”, “You shall not covet thy neighbor’s goods...” “Honor thy father and thy mother...”)?

8.3 How strong are the social and legal proscriptions against forcing, tricking, or pressuring a person to leave life?

8.4 Imagine that your bed-ridden, Very Old parent has a couple of million dollars. You will inherit this money if it isn’t used up by his very expensive nursing care. You are drained by the problems of dealing with him and his caregivers. So far as you can tell, he is getting nothing out of life. You feel helpless, saddened and frustrated. Other aspects of your life are suffering from neglect. The law allows people in his position access to a painless exit. He depends on you to help him to make decisions. How do you think you would feel and act?

8.5 Now imagine that the bed-ridden, Very Old person is you. Could you trust your beneficiaries or care-givers not to pressure you to leave?

8.6 Let’s say that your bedridden, Very Old, terminally ill parent asks for your help in leaving life. What would you say or do?

8.7 Do you believe that leaving life voluntarily yourself or helping others to do so might encourage others to act who might not be as enlightened, principled or responsible as you are? Would this belief help keep you from carrying out an action which you have decided is a good one for you or for someone you care about? Would you try to keep it a secret? 

8.8 What do you think are the dangers of making easier access to leaving life public policy instead of leaving it outside the law, with prosecution of physicians or of others who help someone to leave would be at the discretion of the local police and prosecuting attorney?

8.9 Imagine that you are with a group of people on a desert island. There is not enough food and water to last the group for more than a few days, but there is a sustainable supply for two people. There is no possibility of rescue anytime soon. Everyone agrees with the principle that the group should be whittled down. What do you do?

8.10 Now assume that the desert island is a world that is becoming overcrowded. What should we do? What will we do?

8.11 At present, everyone, regardless of their worth to society, is supposed to have an equal right to life. What will happen if the population of the world continues to increase towards unsustainable levels?

9: The decision to leave

9.1 Here are some things that a person who is thinking about leaving might consider:

•  Whether your QOL is acceptable and how long you think it will remain that way.

•  How well you think you will  adapt (or how well you are adapting) to Very Old Age.

•  The value of the contributions to family and society that would be lost if you left.

•  The positive and negative emotional reactions of those around you to your absence and to the circumstances of your leaving, and how long these emotions would last.

•  The possibility of leaving without fear or pain.

•  The accessibility of a method:  that is painless and effective (which means having someone to help you), and that leaves you looking as though you were asleep :

•  The possibility of payoffs there are in addition to relief from suffering, such as: money,  a sense of accomplishment, a feeling of that you are about to do the right thing.

•  Your image of the afterlife. 

•  The social consequences of  leaving voluntarily, including: the challenge posed to those who believe your action is wrong, the fact that you are setting an example that might influence others to take this way out, the furthering of a cause if your leaving is a political act.

  9.2 Can you imagine that your QOL or level of suffering would ever be such that you would consider leaving life voluntarily:

10: Things to do before voluntarily or involuntarily leaving life

10.1 Think about saying "Thank you", "I'm sorry", "I forgive you", and "Good-bye" to the significant people in your life. Who are the people who would feel better about your leaving if you would say those things to them?

10.2 Are there loose ends or “unfinished business” with friends or family? Are there conflicts to be resolved or debts to be repaid? Are there feelings that should be expressed so that you and others could feel that things are settled or resolved?

10.3 How would you feel about spending a few hours reviewing your life with family member or friend or with a professional?

10.4 Here are some questions about what you would want your own exit from life to be like if it were not natural or involuntary. You can try answering them first as if there were no practical, financial, or other constraints. Then, you can modify your responses to take practical considerations and other people’s needs into account:

• What means would you use to leave life? What would be the ideal method be like?

• What rituals, celebrations or other ceremonies would you want to be performed before and afterwards?

• Where would the leaving take place?

• Who would be present?

• Other things you would want to happen?

10.5 Before you leave, which of the following do you think you should do?

      >Make a will which specifies what you will leave to your survivors, perhaps with conditions attached,

      >Make a living will in which you specify the conditions under which you want a medical condition to be treated, and when you want “Comfort Care Only”, or to be allowed to leave if you have already done the work of dying (“Do Not Resuscitate

     >Appoint people to make decisions about your medical care in case you are unable to

     >Discuss your regular will with family or other beneficiaries.

     >Discuss your living will with doctors and family. (Any reluctance on the part of doctors or family to carry out your wishes should be discussed ahead-of-time; otherwise, you risk being kept alive by a last-minute veto.)

      >Give copies of your living will and power of attorneys for health care to your doctor, to the hospital where you are likely to be treated and to the relatives or others who might be involved in making decisions for you.

      >Write down the locations of all important documents and keys. Write down instruction for when you are not there.

      >Plan your funeral and burial to reflect both your wishes and the needs of others.

      >Find out about the current laws and actual practices of euthanasia and physician-assisted suicide as they apply to yourself and those you care about.

      >Make plans for the possibility of wanting to leave voluntarily and gather the necessary resources, including the names of people or organizations that might help.

      >If you are going to leave life voluntarily, discuss your decision with survivors in a way that will help them to understand and accept your decision.

      >Write down your “Thank-you’s” and other feelings to be given to people you care about if you are unable to speak to them directly.

      >Write down apologies, feelings of forgiveness or other things that will resolve conflicts, correct misunderstandings or other clear up other unfinished business.

      >Get some advice or help in carrying out any of the preceding actions.

10.6 What keeps you from doing the things listed above?

10.7 Do you know how to do the things listed above? How could you find out? What is the first small step you could take to get started?

11:What to do after going through the LLQ

Here are a few things you might do. (You can use the To Do section in the Notepad to write these down.):

·   Getting information or advice.  

·   Working on the ideas or feelings that might be keeping you from acting in a way that is best for you, your survivors, and society as a whole.

For example, you might want relieve your own or someone else’s suffering by leaving life or helping someone else to do so. You could begin by asking: “Why do I feel or think this way?”, “What are the assumptions on which my idea or feeling is based?”, “How would someone who thinks or feels differently express his point of view?”, “What about my instinctual fear of leaving and fear of disapproval?”.    

·   Doing some things to reduce the suffering of the world in general. Of course, there are many ways to do this. The question implied by this Guide is what the benefits and costs would be of offering a painless exit from life that is socially approved and rewarded to more people than is the case now.

·   Doing what you can to ensure that you or those you care about do not suffer during Very Old Age or at the end of life, including such things as helping them to make plans for these life stages and making sure that both physical and emotional pain are aggressively treated – if the person wants them to be.   

Another thing you can do is to visit the Guide more than once. The topics covered and the images that are evoked take time to get used to.   

Here are some ways you can help others, based on your work on the LLQ:

• You can be willing to listen to others talk about leaving life when they bring it up. You now have a better understanding of how they feel. You know lots of questions to ask.
• You could give a blank version of this guide to others to look over or fill out – that is, if you believe the benefits of doing so outweigh the anxiety and other costs, of which you are now aware.
• You keep your ears open for reports on new approaches to end-of-life issues. Having explored your own ideas and feelings, you are in a much better position to evaluate how changes will affect you and others you care about, and society.

Here are some ways to keep up with developments in the area:

• You can check out some of the many websites which deal with this area.

 Try these search key words: “death and dying”, “euthanasia”, “hospice care”, “pain medication”, “suffering” or “quality of life”. To refine your search, you can add “new developments (in)”.

• You can keep exploring the ideas introduced in this Guide by reading more about them in books. 

 Another way you can contribute is to let me know what it was like for you to respond to this questionnaire and to make suggestions for changes in Your Reactions to this Guide by filling out the brief form that follows immediately. (This feedback form is included in the other versions)

12: Moving away from D&D: Returning to life as usual

12.1 What do you do when you want proceed from your world of work to being with family or to other activities? Do you usually engage in a transition activity* to help you leave the world of work behind? Can you think of one that would work for you?

*...an activity which serves to blot out a previous part of the day, freeing you to proceed on to the next activity with a clean emotional slate... examples are exercise, meditation, the cocktail hour... 

12.2 Are there other ways that you have learned to deal with obsessive thoughts or with fears that you know are out-of-proportion?

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