Realistic secularists who desire to plan for a likely mismatch between the duration of somatic and mental life urgently need a more elastic legal understanding of “death”.
Death with Dignity laws of any sort are exceptional in this country. Such as they are, they do not help [im-]patients who cannot be medically certified as both ill and terminal. The norms of the legal and medical professions classify rationally life-weary persons as depressed. The most that they can do is to spritz a bit of psychotropic fog (talking or pharmaceutical, makes no matter) to muddle a patient’s welcoming gestures (= suicidal thoughts) toward the Reaper. To such sufferers, he is not Grim, but Dilatory. The ancients died younger and thought harder about these issues, before ethical philosophy became entwined with theological dogma as deeply as it is today.
Until the law accommodates the wishes of today’s Stoics or Epicureans, Five Wishes provide the best control we can exercise in advance of life’s end. This readily available checklist has been vetted by lawyers and doctors. If you download and fill it out as directed, the form is believed to have legal force in about 43 of the 50 United States of America. Now, let us challenge our lawmakers and parsons to make a Sixth Wish enforceable in all 50 jurisdictions. Recognition of the Sixth Wish as a civil right would expand the range of individual autonomy, and vex the seminars of ethicists for a few more decades. Because it departs radically from mainstream funerary rituals, we must expect a fight before we realize a right to round out our brief span according to our own personal values. If we could, many of us might pre-commit to the following directive to cover the worst of final contingencies:
6. If my cognition has deteriorated so far that I cannot name two of my closest family members or friends within two minutes after being asked, and medical intervention has been ineffectual to reverse my dementia (regardless of my diagnosis) after two therapeutic attempts (of no more than  days duration), my designee is directed to organize a Memorial Service, and announce my death. Thereafter, I wish to be regarded as brain dead. My surviving spouse has my encouragement to remarry and to take any necessary steps to ensure recognition of the marriage. I wish my estate to be distributed as provided by my Will or the laws of intestacy. I request the State of ____ to issue Death Certificates, and direct my discharge from any institution in which I am receiving care chargeable to my estate. I demand and consent to judicial determination that this is my governing and last competent expression of my wishes on these points.
After my death as defined above, my representative may donate my tissues and organs for transplant or investigative purposes, even if the donation [causes or] accelerates my body’s [legal/physical] demise, provided that the standard of care for surgical or other forms of harvesting is followed as prescribed for mentally competent donors to the greatest possible extent.
In conformity with his cohort, Parthian has already executed health care proxies, advance directives, and the admirable “Five Wishes” document. Until recently, he thought that his affairs were in reasonable order. However, he has seen too many relatives and friends outlive their minds and memories. Their surrogates and intimates, stymied and nonplussed, are helpless spectators as physical remains slowly arrive at an expensive and medically protracted end. The survivors have already mourned privately. The moment of legal death is valued as a license to go public, to mark liberation from a fantasy: “where there’s life, there’s hope.” Reality teaches that sometimes “life” is only “existence”, worthless to its possessor, who has given up the ghost at some indeterminate and unmarked incremental moment long before the grave opens.