Thursday, February 26, 2015

Rant — The Right To Die

For many this is a subject to avoid.  Some may also ask why a blog mostly dedicated to crime fiction and film would interject something that is political, possibly religious and probably controversial in nature in this space. I’ve been unwise before in this regard. If I considered the blog merely a marketing tool for my books, I should remain neutral.  But I promised myself and my readers that I would, from time to time, give voice to what I believe, completely divorced from savvy marketing.  As I write this, there is legislation in several sates that would allow physician assisted suicide in cases involving terminal illness and corresponding pain and suffering. I hope this movement, also called "death with dignity," will gain support and allow each of us to make these critical choices for ourselves when we can, while we can.

Gertrude Stein; What was the question?
As a mystery writer, death is rarely far from my thoughts. At my age and with my DNA letting various demons out of the bag, death is a regular companion. I am paying greater personal attention to the inevitable.    Some of those thoughts are dedicated to practical questions, and the solutions to those are relatively common sense. (1.) What happens to my belongings when I go? Some of the concerns are spiritually speculative. (2,) Is there an ego, an identity that exists afterward and, if so, what might that be? Some are spiritual and practical at the same time. (3.) If death becomes imminent, what do I do? How hard do I or others fight against it?

All right.  Belongings are relatively easy.  That’s what wills and trusts are for. Some of the decisions might be difficult. But the chances are you’ve thought about it long before death became this real. Some things don’t get resolved. Old photos and letters, for example, and other items of mostly sentimental value may prove impossible n less a younger family member has developed an interest in family history. I’ve never thrown away a letter and it’s equally difficult to part with photographs. I also have all my old news clippings, those about me as a novelist and those by me during my media days. Who would want them? Fortunately that wind-up cable car that played a tinny version of “I left My Heart In San Francisco” got lost during one of my moves. The truth is I probably will leave my heart here and not much else.  I’ve already begun sorting and tossing.  It’s not going well.

The ego/identity question is metaphysical and not answerable in this realm. Those who have chosen a religion may be guided by its tenets and might get some help from the appropriate spiritual leader. Some religions believe they have it all figured out. Personally, I doubt that, but I certainly have thoughts on the subject.  It is, at times, fascinating to consider the endless possibilities of the meaning of life and what happens, if anything, when it comes to an end. It’s similar to the solving of a mystery.  We have clues, suspicions, and crackpot theories.  The thing is:  When the finally the end comes, we are rarely any closer to solving the mystery than we were when the question first presented itself.

There is a story about author Gertrude Stein and her long-time companion, Alice B. Toklas. It is said they had an agreement that when the first to die was passing through death’s door, she would reveal the secret with her last breath. Alice lingered by Gertrude’ bedside when the day came.  And when the legendary Stein appeared to be shuffling of the mortal coil, Alice pleaded:  “What is the answer?  What is the answer? Gertrude had just enough life to respond.

“What was the question?”

The really important question is what do you do about death when you can still do something about how you die. If we are hit by a truck or suffer a massive heart attack, no amount of preparation will make a difference.  But given modern medicine and the nature of some deadly diseases, we may have warning.  And we may understand what to expect as we travel consciously on the path to death.  Also, we may have choices.

In some cases, palliative care specialists may be able to provide a calm, peaceful and pain free journey to the final moment.  Sometimes family and friends are there providing comfort and company until the person slips away. I think this is ideal. I’m game to let nature take its course when I have a choice and when the process is as serene and respectful as this suggests.

Many deaths do not allow for a civilized, dignified departure. Sometimes we are stuck in between. The treatment for some cancers, for example, create horrible moral dilemmas as the cancer advances and conditions worsen.

Chemotherapy may very well be the way to go. In some cases, after months of discomfort, often severe, the cancer is nonetheless beaten and the patient has a full recovery and has many more productive and enjoyable years ahead. There are times, no doubt, when the suffering is worth it.  

Sometimes it’s not.   There are times when chemo is given simply because it is the only alternative to imminent death and we’re not allowed to let people die. But sometimes, such treatment only causes suffering. No healing.  Just suffering. The pain is prolonged in exchange for a short gain of a few painful, unhappy extra months. I would question its value.  Similarly, if staying alive is simply staying alive in a state where one can no longer communicate or enjoy a book, where one is simply trapped in a body, I don’t see the point. I want out as quickly as possible.  I accept the notion that few get through life without suffering, but it seems to me most intelligent beings avoid it when they can.

When my father was eventually placed in the Alzheimers unit in a nursing home, I visited and was able to observe several patients over time.  Some sat dazed and confused. Some seemed withdrawn in fear.  Others seemed to be in constant distress. Still others showed no outward signs of anxiety.  It’s quite possible they were in a benign other world.  My father, fortunately, seemed to keep himself occupied in harmless fascination with his surrounings, examining them in a way that seemed to provide some meaning or purpose for him.  He passed away before we were faced with any notion that his existence brought him more pain than pleasure.   However if I were the woman who appeared to be in a constant state of terror, I would surely want someone to help me move on or out, whatever the appropriate word is.  There is an obvious need for more compassion in such cases.

I have, as I’m sure many of you have, a healthcare directive that indicates my wishes for no extraordinary effort to keep me alive. If I’m not really going to live a conscious life, pull the plug.  But I live in California.  As forward as the state is, I am not permitted to have a physician-assisted suicide even if doctors determine that I face a long, slow and painful death. To perform the act on my own, without professional help, could make matters even worse. A botched suicide could lead to a worse hell.

In the end, shouldn’t we have the right to arrange our own deaths while we still have the mind and the means to do so and have professional guidance to do it right? But it is against the law here, as it is in most states. 

Who wouldn’t prefer a quick death or one with pain control as we depart? But if that’s not going to be possible, then planning our own deaths is preferable to a season of suffering, mental or physical. Certainly there are ethical questions. We don’t want someone nudging us to an early end because health care costs are diminishing the inheritable estate, for example. Or someone suggesting our condition is worse than it is to get out from under the burden of providing care.  But from what I’ve seen of Oregon’s law, which has set the bar for new legislation, and the research from such serious organizations as Compassion and Choices, there are ways to build safeguards into laws that will protect the ill, the elderly and the disabled from exploitation while enabling people to make decisions about their own lives, especially the quality of those lives as they near an end.


Teri-on-the-sandbar said...

Quite a can of worms you have opened here, although you're not the first or last to let these particular worms into the light. I am reminded, of course, of our mutual friend who left us in July last year, going out more-or-less on her own terms, refusing chemotherapy and surgery, only to meet an ignoble and lonely end at the greedy hands of Christian Science practitioners who were neither very scientific or Christian. That was a horrible way to go and not, I am sure, what she had in mind when she elected to take matters into her own hands. Compassion really ought to start at home. And if ethically aided suicide can do that, perhaps it is not such a bad thing.

Ronald Tierney said...

I understand and agree. All the more reason to have a civilized law that might provide an alternative to that situation. Having the option might allow for serious evaluation and counseling. Just because it's available doesn't mean it's desirable and certainly not mandatory. Selfishly, I want the choice if going gently is not an option otherwise.