Tag: end of life

Dr. Death’s Final Decision

June 4th, 2011 — 9:59pm

After championing the rights of the sick and suffering to get help ending their lives — and providing that “help” to scores of terminally ill patients — Dr. Jack Kevorkian died of natural causes on Friday at the age of 83.

According to Geoffrey Fieger, the lawyer who represented Kevorkian in several of his trials in the 1990s, Kevorkian was too weak to take advantage of the option he had offered others and had long wished for himself. “If he had enough strength to do something about it,” Fieger told a news conference in Southfield, Michigan, “he would have.”

If that is true, there is something almost epically tragic about the fact that a man who fought so long and hard for patients’ right to die on their own terms, wasn’t able to take advantage of this option in the end. But then who is to say “Dr. Death” didn’t simply change his mind? He’d apparently been suffering from kidney failure and pneumonia for over a month, long enough to plan his own death if he’d wanted to. He was a doctor and entirely familiar with how to end a life quickly and painlessly. And given his well-known penchant for drama and attention, you’d think he’d want to make himself exhibit A for what he believed in. (At the start of his third trial, he showed up in court wearing Colonial-era clothing to show how antiquated he thought the charges were and, after videotaping himself helping to kill a patient, he voluntarily handed the tape over to “60 Minutes.”)

The fact that Kevorkian didn’t end his own life is, to me, a potent reminder that our political beliefs are not always in the driver’s seat when it comes to death. Just as one can imagine even the staunchest anti-assisted suicide crusader wavering in the face of extreme pain and disability, I have found that certain pro-assisted suicide people seem to believe that killing oneself is actually a better option than dying naturally. Often, when I mention that I wrote a book about my mother’s decision to end her life after a long illness, people say, “Oh, well I definitely plan to do that. I’ve already made it clear that that the minute I get a disease, I want someone to take me out back and shoot me!”

I get the humor but there is a glib — even fashionable — assumption that suicide, assisted or not, is a good way to go. I want to ask: How would your kids feel if you do that? Your spouse? And how would you feel if it was them making that choice? I’m a big supporter of the Death with Dignity Laws in this country, but frankly, as long as I’m not in pain and have some quality of life, I’m planning to “go naturally,” just like Kevorkian did in the end.

The idea that ending your life is going to be easier and more straightforward than letting nature take its course is something of a happy illusion. Having witnessed both my parents dying in very different ways, I know that even the best laid plans for death can go awry. It reminds me of the “birth plan” I drafted when I was pregnant. Somehow, between planning the perfect play list and specifying that I didn’t want an episiotomy, I forgot to factor in throwing up, forgetting to breathe, and the uncontrollable urge to yell obscenities at the nurse. So much for my beautiful birthing experience.

It may be a cliche, but there really are some things we can’t control and even for strong-minded people like my mother, who was determined to plot the details of her “end,” you simply cannot know how you will feel when the day comes. In fact, my mother set and changed her “death dates” several times, discovering on the chosen day that she wasn’t quite ready to go after all.

In Bill Moyers’ PBS special on assisted suicide a few years ago (“On Our Own Terms: Moyers on Dying”), not one of the people Moyers followed actually ended up killing themselves. There was always one more event they wanted to stay alive for: a birthday, or a grandchild’s graduation. Every one of his subjects waited until it was too late and no longer had the physical capability to manage it. All, except for one woman who died from natural causes before she had a chance to take the pills she’d stockpiled. Pulling the plug turns out to not always be so easy.

Adding to the vagaries of the psyche is the unpredictability of the body. Unless you live in one of the three states where physician assisted suicide is legal (Oregon, Washington and Montana) and have access to a group like Compassion & Choices who will help make sure you are taking the right dose of drugs, chances are you will not know how to calibrate the means of death. In my mother’s case, stopping eating and drinking took far longer than she’d expected, and an attempted morphine overdose failed. Although she did ultimately manage to end her life, it was not the controlled, predictable event she’d hoped for.

I read recently that the issue of assisted suicide splits this country almost completely in half, making it an especially divisive and contentious issue. I would respectfully suggest that both sides may have lost sight of the fact that death can – and will — make a mockery of even the most carefully laid plans, the most passionately held beliefs.

And who knows, when it came down to it, maybe Jack Kevorkian simply wanted to stay alive and was hoping he might recover. Or maybe his lawyer is right and he wished someone had been there to help him speed things along. We will never know and that is as it should be. Because as politicized as it has become in this county, death is ultimately a private experience, fraught with unknowns. And Dr. Kevorkian, like all of us who support assisted suicide as a legal and moral principle, had the right to change his mind.

This piece was published in Salon on June 4th, 2011.

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The Bullies Won… Again

January 10th, 2011 — 2:05pm

In a hugely disappointing move, the Obama administration has abruptly backed away from supporting a frank and open discussion about end-of-life planning between doctors and their elderly patients.

Only three days after implementing a new regulation that provided Medicare coverage for doctors to talk to their patients about what kind of care they wanted at the end of their lives, the White House announced on Wednesday that they were reversing it.

Why the short order flip-flop? Why disappoint the thousands of hospice workers, geriatricians, doctors, caregivers and seniors who had been working towards and supporting this kind of coverage, some of them for years?

Simple: Obama buckled to the bullies. As soon as the loud and vociferous opponents of end-of-life choice began their usual scare mongering and name-calling, he stood down. Instead of sticking to his principles, he chose the politically expedient response and caved…. again.

Yep, because these are the exact same folks who hijacked the healthcare reform debate in 2009 by telling us that Obamacare would result in “death panels” and that Big Government would decide whether or not your granny got to live or die. The same rabid conservatives and “Got you in our crosshairs” Palin supporters who managed to wrest our president’s lunch money away from him two years ago — only this time they just had to yell a little and he handed it right over.

The news is a devastating blow to anyone whose work involves helping people make decisions about end-of-life care. And it will mean millions of the sick and elderly will enter the final chapter of their lives woefully unprepared.

Only 20 or 30 percent of patients at the most have an advance directive in place in this country. The new regulation would have increased that number substantially. It would also have empowered dying patients to think about and choose the kind of death they wanted in advance. Instead, most of us will find ourselves at the mercy of a healthcare system that knows how to keep throwing drugs and procedures at us — insisting on unnecessary “heroic measures” right up to our final painful breath — but isn’t very good at helping us find comfort and peace at the end.

The implications of this cowardly backing down for our healthcare system and our aging population are devastating. It also reveals a most disappointing truth: our political system is being taken over by bullies and the leaders we elected with such high hopes to stand up to them are letting them do it.

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Readers Write Back

March 23rd, 2010 — 9:55pm

Imperfect Endings has been on the stands for exactly three weeks today and it’s been a whirlwind of media coverage — a feature in The Washington Post, an hour on WBUR, interviews and reviews — but the most gratifying response has come from the many people who have contacted me through my website to tell me their stories of losing parents, many of them from Parkinson’s disease.

In addition to the eloquence of these emails, what has amazed me is that EVERY SINGLE ONE OF THEM wrote to say that they supported my mother’s choice! Not one person questioned her decision to die on her own terms — or mine to support her.

I feel so grateful for this positive response. I have to say that in the months leading up to publication, I worried I was going to get attacked for supporting my mother’s decision to end her life (although I did, for a time, argue against it) and for speaking out in favor of legalized assisted suicide. It’s actually been the opposite. So many people, especially those who have lost parents to Parkinson’s, have expressed gratitude for my writing frankly about her choice, and have told me that — in their experience — my mother spared herself a very tough ending. (Obviously, Parkinson’s varies greatly from person to person and I don’t want to frighten anyone. My mother’s Parkinson’s was actually quite slow to progress and highly manageable for many years; it was only the last year or so that it got difficult for her.)

Of course, a few critics did pop up in the blogosphere. I’ve shown up on a few Catholic blogs (understandable — as, for them, suicide in all its forms is a sin). But how to explain the conservative blogger who blamed my mother’s death on the Democrats and the new healthcare reform bill? (Do I hear the sound of a knee jerking?) This was especially ludicrous as my mother died almost nine years ago!

But today is not about the critics. It’s a day to celebrate  this amazing opportunity to engage in conversation about end of life issues with a wider audience, and to express my gratitude to those of you who took the time out of your busy lives to write to me. Your willingness to share your stories was both illuminating and moving. These first three weeks are dedicated to you!

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