Oct 28

Further Reflections on Death With Dignity

No Man is an Island—

Many readers who commented on my pieces Musings on Death With Dignity (9/1/13) and Part 2 of Musings… (9/17/13) appeared to believe I was contemplating ending my life. Rather, I was stating my philosophy of personal autonomy and discussing a person’s presumed duty to weigh the consequences of taking one’s own life against the feelings of loved ones and friends. I genuinely appreciate the love and caring those readers expressed. However, I have given considerable thought to the issue since then and want to share those thoughts with my readers.

Those who have not read the “Musings” pieces should read them to understand my philosophy and the background for this piece. Basically, my beliefs are based on the high value I place on the intellect and, since my operation, the value I now place on the physical aspects of a person’s being apart from the intellect. The question has been raised by a psychologist friend and others whether the feelings of loved ones who care for me should carry enough weight to prevent me from putting my philosophy into effect should I feel the time has arrived for my departure.

I must add here, by way of clarification, that I am talking about an assisted death with dignity, NOT about a person’s right to commit an unassisted suicide when in the grips of a temporary bout of depression or because, for example, a love affair has gone sour. That can lead to a long-term sense of  guilt that the deceased’s loved ones failed to respond in a timely fashion. For several years I suffered such guilt over the suicide of a co-worker, feeling that had I intervened he would have chosen life.

I recognize that my deliberately planned departure from this vale of tears and pleasures may cause grief. Grief, however, diminishes over time until peace is normally achieved. Grief would also be present in the case of an assisted suicide, and it may well be accompanied by anger that the departed acted selfishly and didn’t think of the loved ones’ feelings. However, any anger, too, would normally diminish over time, and understanding—or at least acceptance—would come to replace it. Refusal to accept what has occurred in such an instance is not normally encountered. Regret may be one of the outcomes but, again, time usually heals the emotional trauma allowing peace to replace it. Life goes on.

What is usually forgotten by acceding to the demand that the feelings of others must take precedence is that, not only is the future unknown, but the one who wants to die may very well be condemned to a worse fate than a quick, painless departure. This was touched on in the earlier pieces.

 Condemnation Considered—

It’s a fact that we are all going to die. Some will die an accidental death. Some will die as a result of violence. Some will die slowly. Some will die quickly. Some will die in pain. Some will die without pain. Some will be frightened. Some will die peacefully in their sleep. Some will choose their own death, but most will not. It’s a fact: All of us will die one way or another. The when and how are largely unknown. Given that fact, let’s look at reality.

Doctors are presumably governed by the admonition to do no harm that originally placed severe restrictions on what a physician could and could not do. Times have changed and the oath sworn by doctors has changed with the times and with advances made by science.  What was reasonable in the Fifth century B.C.E. is no longer reasonable or practical. However, doctors and the hospitals in which they practice their art will nevertheless vary in what they will and will not do.

Many doctors and hospitals in the world—and particularly those with certain religious affiliations—are considerably stricter in what they refuse to do. For example, strict Roman Catholic doctors and Roman Catholic hospitals refuse to perform abortions as a violation of God’s will and their personal consciences. Apropos this article, they also refuse to allow a dying patient to be assisted in dying through the administration of a fast-acting but lethal dose of a painless drug. Pain relievers, whether adequate to the patient’s level of pain or not, can be administered, but in those instances where the medical authorities are restricted by belief or policy, active involvement in assisting the dying person across death’s threshold is not permitted regardless of the dying patient’s wishes.

By insisting that their wishes are paramount, the dying person’s loved ones may be condemning the dying person in such a situation to a lingering and painful death. Are you sure you want to find yourself or a loved one in such a situation?  Well, you say, “I will never be in such a situation where I live.” Do you travel? Do the laws remain static where you live? Is it possible that religious legislators in your area will gain power in the future? Might you or a loved one be the next Terri Schiavo?

Hospital personnel have routine jobs to do. Taking blood samples and setting intravenous drips are quite common tasks they perform every day. I won’t be the first to tell you that those are often painful to the patient even when they are carried out carefully for the right reasons and on the right patient.

On one occasion because of a lack of space in the ward where I should have been located, I was temporarily placed in a ward with patients with assorted sexually transmitted diseases. As a result, despite my emphatic vocal objections, blood samples were taken repeatedly. It hurt. It was unpleasant. To the personnel taking my blood, my protests were understandably ignored and the tests were taken as part of the routine. I doubt that this incident is unusual in a crowded hospital. These may seem like small intrusions, but to the patient they are not small. Might your loved ones be condemning you to such painful indignities?

In case you are not paying attention to what I have been writing about and pondering since the issue was raised by my psychologist friend, this is what I mean when I say one’s loved ones who oppose a death with dignity may be condemning a person to a worse fate than the desired assisted death. Their concerns are what’s important to them, not those of the one directly affected.

To those friends who may think this is my farewell, it is not intended as such. It is a discussion on the pros and cons of what is an important and difficult question. Fortunately in my case, my brain is still functioning even though the rest of my body is not performing as I certainly wish it would despite recent therapy and minor progress. Major deficits remain and age continues to advance. As I have often said, if wishes were horses, beggars would ride. That said, I offer this piece for your consideration. It’s not an easy decision to make, but the question remains: who is most entitled to make the decision in the final analysis? Who is the one who is most involved?

My answer is—however selfish it may seem to some—that, assuming the person wanting death with dignity is mentally sound and thinking rationally, the individual alone must have the final say. When I decide that the nothingness of death is more desirable than uncertain but continued limited  or deteriorating life, I must be the one whose decision counts. As unfortunate and emotionally painful as it may be, my loved ones will have to deal with my departure in whatever way gives them solace. Assuming that nature doesn’t intervene first, that’s the way individual autonomy works.

If you have all your faculties, you will have your own decision to make. If you are unable to make that decision for yourself, someone else will necessarily make the decision for good or ill. Fingers crossed that it will be made with compassion.


    • Kitty Courcier on October 29, 2013 at 17:03

    Dear Don, you have said it very well. I know the suffering my patients endure all too well having been an RN now for almost 25 years. In a hospital setting care is most often crisis driven and at a time when patients and their families are ill-equipped to make life and death decisions. Too often the family is unaware of the patients wishes and even though there is an advanced directive these documents can we very limited and family confused to their loved ones wishes. In the case of death with dignity I would hope that in-depth counseling with family would be part of the plan. I feel strongly that there is a place for this type of intervention if all involved are in the discussion. Ultimately a patient of sound mind and of age should have the finally say in their care in all situation. My hope is that the medical community and the greater world can come to terms with this issue with dignity and compassion.

      • Don Bay on October 29, 2013 at 19:31

      Kitty says it well. She has been in such a situation of stress and knows that the patient’s wishes can be overlooked or ignored. Make your wishes clear to your loved ones and carry a DNR (Do Not Resuscitate) instruction with you at all times if you agree with me and wish to die with dignity. As a patient, you have the right to make your exit on your own terms. Meanwhile, live as fully as you can.

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