This week, Dr. Peter Goodwin died. He was, coincidentally, like half my family, a South African who eventually settled in Oregon. What the world knew him for, though, was being a champion of what is variously called “Death with Dignity,” “Right to Die,” or “assisted suicide.” He was a medical doctor who helped push through Oregon’s Death with Dignity Act in 1994.
Since then, a handful of other states, including my own, Montana, have passed similar laws. Basically, these laws allow a terminally ill person to ask a doctor for a prescription for lethal drugs. Of course, this is the sort of thing Montana would allow. Our state constitution enshrines both the right to privacy and the right to human dignity. What happens in a doctor’s office belongs between you and your doctor. Hmm. Where have I heard that before?
Anyway, Goodwin’s death gives me an excuse, a news hook, as it were, to talk about assisted suicide. I’ve wanted to talk about it here for a while, but I didn’t want to upset or worry folks unnecessarily, so I didn’t. The one time I tried to have the discussion in person with someone, he got pretty angry and we didn’t get very far. Back then, I was quite sick, and I was thinking about assisted suicide in terms of my own self, if it came to that. Well, now I am in remission, and I am doing great. Assisted suicide is far from my daily personal thoughts. So I thought while everything is calm and peaceful here, it might be a good time to explain my thinking on the subject.
My position was, and pretty much still is, that I am going to do everything I possibly can to stay alive. But, if the doctors ever tell me my situation is hopeless, my illness is terminal and that I am going irretrievably downhill, I would reserve the right to choose the time and manner of my own death.
Our society is so bad at discussing this sort of thing! Not only does the subject make us grossly uncomfortable, but we don’t even have the terminology for it. I sort of object to the term, “assisted suicide.” I think that if you are already unavoidably dying, and you kill yourself, you aren’t committing suicide. The word “suicide” implies that you want to die. And in this case, it’s not that you want to die; it’s that if you have to die, you want to do it a certain way. I don’t like the phrase “Right to Die” either, because I don’t believe in a right to suicide by just anyone at any time. “Death with Dignity” is too vague; I believe with the great advances made in hospice and palliative care in recent years, it can be possible in many cases to have a dignified death without taking the step we refer to as “assisted suicide.”
Here is a link to Goodwin’s obituary in The Oregonian newspaper:
And here is a link to the editorial by The Oregonian newspaper on his passing:
This guy does not sound to me like a wack job. He does not seem creepy in a Dr. Kevorkian-kind-of-way. Kevorkian seemed a little icky; he almost seemed to be too into his work, you know? But Dr. Goodwin seems to have come to a similar conclusion from a place more grounded and sane.
Here’s what I bring to the subject: My father died of brain cancer in 1971, when I was eight years old. This was before the hospice movement. His death was long and drawn-out. He went into the hospital in August, and never came home. He did not die until April. (Eventually, not long before his death, he was transferred to a nursing home.) As he became sicker, he was unable to walk or talk or go to the bathroom. He still understood a lot, which made him crazy with frustration because he couldn’t respond properly. He would try to say something, but nonsense would come out. My brother, who was 10 years old, and I, were not allowed to visit him, because in those days children were not allowed to visit that hospital. (My dad’s doctor allowed us to be smuggled in once, toward the end, to say goodbye.) My mom ran herself absolutely ragged trying to take care of everybody’s needs.
Of course, nowadays we have hospice care. I hope that a case like his would be handled very, very differently now. But that experience gives me a baseline gut instinct to operate from: if I ever am in a situation where I am severely and terminally ill, I do not plan to take seven months over dying. I hope to never put my loved ones through the wringer like that, exhausting them emotionally, physically, financially, and spiritually at exactly the time they need to be strongest.
I belong to the United Methodist church. I looked up our denomination’s official position on assisted suicide. The church is against it, for two reasons. First, they say it demonstrates a lack of faith. Who is to say a miracle might not happen at the last minute? And second, they say it usurps the power of God over human life and death. Only God can choose a time for a person to die.
I guess I just disagree.
If you are a soldier in Afghanistan, and you throw yourself on a grenade so it doesn’t blow up your friends, but it does kill you, they don’t call you a suicide. They call you a hero.
I think it’s more like that.
Then there are all the slippery-slope arguments. If you think assisted suicide is okay, what’s wrong with garden-variety suicide? Or euthanasia? Or mercy killing?
Well, as experience in Oregon since the passage of the Death with Dignity Act has shown, legalizing assisted suicide there did not cause everyone to start killing themselves or each other willy-nilly.
And I am talking about acting within very clear parameters, here. We’re talking about a theoretical person who is clearly dying and in pain, making the decision for herself about when everybody has had enough.
I would not make this decision for someone else.
I would never do it without a lot of prayer and without checking against the gold standard, which is to compare it to the love and kindness of Jesus. Would Jesus do this thing? That would preclude doing it, ever, out of anger, despondence, exhaustion, or fear.
But if it ever feels right, the loving thing to do, it’s an option.
Before I undertook any assisted suicide for myself, I would rather try hospice care first. If this were a viable option, it would be preferable. It would make loved ones less uncomfortable and it would honor the sanctity of life. But I can imagine scenarios where even ongoing hospice care would not be my choice. If I knew I were losing my mental faculties completely and irrevocably, for example, or if physical pain became uncontrollable, or if the care were bankrupting my family financially or emotionally, I would reserve the right to make a different choice.
Another case study from my own life: several years ago, my grandmother, Julia Person, died in Missoula, Montana, and I was the one who was there with her at the time. She was 101 years old. She was an extremely feisty person, the person after whom we named our daughter. She was quite healthy up until about a week before she died. She had congestive heart failure, but basically all her other systems were working great.
She had made it very clear, verbally and in writing, to more than one person, including her doctor, what medical interventions she did and did not want. In the event of a severe illness, she wanted to be made comfortable, no more. No feeding tubes or anything else. Her clarity on that point relieved us of agonizing decisions when the time came; we knew exactly what she wanted, and even those of us who would have wanted something else for her had to concede the point. (By the way, this is one of the reasons I want to talk about this stuff now, while we are all clear-headed.)
She was obviously dying, but she was so strong that it took her more than a week. I had time to fly out there from Maryland. They had time to get her situated in what was basically a hospice ward at the hospital, although it was called something else at the time. For a week, people came and went saying their goodbyes. Grandma eventually lost consciousness. By the time I got there, she was in what I guess you would call a coma. They said it was possible she was still hearing us but she wasn’t speaking. At least one of us was stayed with her around the clock.
Her main nurse was a guy, whose name I wish I remembered. He was a blessing. He made us feel like we belonged there with her. He made sure there was a comfortable Barcalounger for me to sleep in. He showed me where he kept the coffee, and where he kept the ice cream, and told me help myself at any time.
On Grandma’s last morning, her breathing was really raspy and terrible. It sounded more like drowning. You wanted to help her, but you didn’t know how. It was early on a Sunday morning, maybe five or six o’clock. I had had the night shift, as it were. My mom and sister weren’t there yet.
The nurse said I had a choice to make: he could turn up her morphine, which would ease her breathing and make her a lot more comfortable, which is what she had said she wanted. But it might also push her right over the edge and she might die, right then.
To me, it wasn’t even a hard question. It was a no-brainer. She was miserable.
I told him to crank it up.
He did, and her breathing became much more normal. And then it just stopped. Technically, she died a few minutes before my mom and sister walked in the door. The nurse was there with me. It was beautiful in a way, which maybe only makes sense if you've been there while an old person who was ready to go died a peaceful death.
So, back to our discussion of the morality of life-and-death decisions: Did that nurse and I murder my grandmother?
I sure don’t think so.
Did we hasten her death?
Yeah, we sure did. Maybe by a day, maybe by five minutes, we will never know.
Did we do the right thing? I still think so. We did what Grandma wanted. The only part of that morning I have ever felt guilty about—and I am a grand master at feeling guilty about stuff--is that my mom and sister didn’t have time to get there.
When I apologized to my mother for that, she told me I had totally done the right thing.
And if that decision was okay, and we didn’t commit “murder,” then similarly, a decision to take some lethal drugs if you were horribly, terminally ill wouldn’t be “suicide.”
Modern Americans like us like to think in terms of black and white. One minute you are alive; the next you are dead. We assume there is one point of time when life begins, and we question whether that is at “conception” or “birth.” Well, I think maybe there’s a little gray area at both end of life. An in-between. A really sacred place.
So then, you might ask, Katie, if your mind is made up already then why are you dragging us through all this stuff nobody wants to think about?
Well, for a start, I want my friends to know what I believe in this area, now, while I am healthy and unimpaired and in my right mind.
My biggest worry about ever actually doing such a thing would be being misunderstood in it. Specifically, I would not want any of my friends, especially my young friends or any of my Sunday school students or my children or any of my friends who suffer from chronic illness or depression, to think that I think suicide is okay.
I don’t think suicide is okay. I don’t think it’s romantic. I don’t think it’s beautiful. I think there’s almost always a better way to handle things.
But if, God forbid, things got awful and I was dying anyway and not going to get better, I would be willing to go there. I am grateful for the work of people like Dr. Goodwin. I am glad the laws in Montana are what they are. And I can’t help it, but I think like a Montanan.
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