Decline treatment, and have a DNR clause....it adds up.
To some - there comes a time....
I can tell you that my mother died quickly with a DNR and in a socialized medicine environment.
I suspect there may have been 'help' and see nothing wrong in it.
You're right... personal choices
Having been involved in the HIV/AIDS community in FL in a major capacity, I can assure you that suicide---with a little help from your friends---was a major "therapy" back when HIV diagnosis was a death sentence. Our mixing pharmacies were allowed a minimal amount of morphine and opioid derivatives to be purchased, and each of those purchases was closely monitored, inventoried and audited by the pharmacy boards. The paper trail and chain-of-possession were intense, and if you screwed up even one vial your purchase of *any* pharmaceutical could be shut off immediately, and your pharmacy red tagged.
I went through that process well over a thousand times.
But to the OP's question: home care and hospice in the US sense does not exist in the DR because of cost constraints. And there is not enough wealthy population to support private efforts on any scale of efficiencies.
Morphine is available but difficult to come by for the average person. You have to work through a sympathetic doctor with connections. And then the quantities would be small, not enough for long-term pain management.
DV8 was in the pharmacy bidniz. Perhaps she could offer her opinions.
When we first started MotoCaribe and needed an extensive first aid kit, it was like pulling teeth to get any analgesics for bad road accidents. We ultimately prevailed, but it took lobbying by connected docs to the Minister of Health to get it done, and my personal medical background indeed helped. That was in 2008. That said, renewals have been a little easier. A little.
I like the "one-shot" solution. Frankly, if you've ever seen pain management for terminal illnesses, the patient is pretty much out of it anyway. A nudge over the line would go unnoticed and unfelt. I can't tell you how relieved relatives, friends and significant others are when the "out of it" stage was reached because all the good-byes had already been made.
It sounds crazy, but back then AIDS patients would have suicide parties. Well, they weren't called that. They were called "celebrations." When a patient was ready to give up the fight and the inevitable was in sight, friends and families would gather---sometimes nurses would be "unofficially" present---a warm evening would ensue, life's celebration reviewed, and the patient would retreat to his bedroom with experienced friends for leaving the earth. It wasn't until the residence was cleared of ALL drugs and people (except the s.o.) that the nurse would report for "Hospice duty*" and 911 was called without blaring sirens.
*I say "Hospice duty" because at the time in FL the only people who could pronounce death were physicians, certain EMT's and Hospice nurses. So we had nurses that worked for both our home health agency/infusion pharmacy and our hospice. The same nurse could do both infusion and hospice. If she was acting as a home health nurse a call to 911 requires blaring sirens and "heroic efforts" even if she knew the patient was dead. If she was a hospice nurse, the ambulance would arrive without sirens wailing. That's what the patients wanted.