Monday, March 28, 2016

Wondering Aloud Toward a "Death with Dignity"

During this legislative season, Iowa lawmakers considered and then abandoned a proposed "Death with Dignity" bill.  It received some attention along the way, punctuated by a lead editorial in the Des Moines Register last week supporting passage.  I was hopeful that an extended conversation would ensue, and toward that end contributed a guest essay for possible publication.  Alas, as I indicated, the bill died in the funneled legislative session -- with or without dignity -- and the news, along with the Register's attentions, have moved onto other subjects. 

Still wishing for a serious and extended conversation, and since the Register passed on my essay, I opt to post it here and invite responsive participation.  You will search in vain for solutions in what follows.  The reason is that I don't know what they are.  What you will find instead (vetted and approved by the subject's family) is my passionate sense that among the unacceptable solutions is the status quo. And so read, reflect, consider and, if you wish, contribute your own wise thoughts.

On a bright but sobered October Friday morning 5 years ago my wife and I drove our beloved Welsh Corgi of twelve years for a final time to the vet.  Several months earlier he had been diagnosed with lymphatic cancer, and through the ensuing weeks had submitted to chemotherapy and acupuncture, along with the discomforting miscellany of deep sickness and constant handling.  Eventually, however, it became obvious even to us who were blinded by our affection for him that continuing on might be in the best interest of our sentimentality, but not to his well-being, comfort and quality of life. He was, to sharpen the point on it, dying whether or not we chose to admit it.

After conferring with the doctors, we scheduled that next day’s heart-heavy final drive to the clinic.  The staff had prepared the room – softened its otherwise clinical appearance and feel with blankets and quietness.  We cried, the doctors cried, the front desk staff cried; we held him, spoke to him, caressed him, until with the medicines’ help he relaxed in that final way and breathed his last.  As miserable and grief-filled as it was, it was beautiful. It was tender, loving, and gently peaceful.

Meanwhile, within days of these precious moments, a dear friend and parishioner mere blocks from that animal clinic was struggling with her own diagnosis.  A physician in her earlier years and later a medical librarian, Barb was coolly and methodically rational.  She had cared attentively for her husband who had gradually declined first through Parkinson’s Disease and then deeper and deeper into dementia before dying a few years earlier.  Now given a similar diagnosis herself, beginning to experience its symptoms and clear that she didn't want her children and grandchildren to go through her own agonizing decline, she put her medical and analytical researcher’s skills to work exploring alternatives.  She studied the laws in those few states that permitted physician assisted suicide and concluded that she could not reasonably qualify.  She broached the subject with physicians nearer at hand, knowing deep down that they could not help her.  Throughout, Barb kept her thinking and her inquiries secret from her kids – contrary to her nature and their usual family patterns -- since both were involved in medical careers that would have obligated them to intervene in ways contrary to her wishes.  She began to advocate for a change in the law.  In the end, however, she calmly and rationally reached an unenviable conclusion:  time was not her friend.  She would not live long enough, with faculties enough, to effect a change in the law.  The laws that did sympathize with her were inaccessible to her.  So, out of options, after writing an extensive letter of explanation  to her children whom she charged with continuing her advocacy , she stepped off the 9th floor balcony of the retirement community apartment where she lived; taking matters into her own hands.

I know, this is a complicated subject.  As a minister I am fully mindful of the moral and spiritual issues that routinely and necessarily trouble such discussions, and I am sympathetic to those tormented by the medical ethics brought into question by considerations of physicians assisting with the death of a patient.  These, and I am not oblivious to the thorny and complicated public policy issues at stake.

But what haunts me is the juxtaposition, by a matter of days, of the tender and lovingly beautiful death of my dog in the hands of those who loved him, and the jarring plunge to her death of a dear and beloved mother and grandmother, carried out in secret isolation, whose options she deemed to be too few and untenable.  I don't know how to resolve the complications; I don't know how to rewrite the laws.  I only know that together we have to figure it out.

Because it's unconscionable that our pets have a better death than our parents, our spouses, our grandparents and our children.


Mary Lou Fitch said...

I totally agree with you Tim....I've been through the exact same thing with 3 of my loving was a beautiful and peaceful thing to see their suffering end as I held them in my arms. My late husband was under the care of Hospice for his last week on earth and they were wonderful to him. I just received a letter 2 days ago that his bone donation (at age 80) was used to help 22 people in 7 states! I feel so very bad about your friend... I have known 3 dear friends who took their own lives....but honestly feel that is even harder on the loved ones. Something must be done to help prevent this like that happening!!!!

Gary Gesaman said...

This is one of the many life issues that seem to call for "situation ethics". Neither the law or legalistic religion seem well suited to help us. It would seem that we need to be open minded, flexible and non-judgmental in approaching this matter. Not easy for us humans. Dogs seem to be better at it. Gary G.

Barbara said...

Last year, our son-in-law was diagnosed with terminal cancer, which had already spread from his lungs to his bones, liver, and lymph glands. Originally, Brian opted for chemotherapy, which made him terribly ill. Along with his misery, the tumors continued to grow. After trying three kinds of medications with negative results, he decided to allow the disease to take its course. At his request, Brian died at home with help from hospice and immediate family. Hospice helped Brian experience comfort and a bit a quality for a few weeks.

More recently, my cousin also died of cancer, which had spread to her brain and spinal cord. Unlike Brian, she and her daughter fought the illness to the end. In addition to the misery from the cancer, the chemotherapy and radiation increased her pain, nausea, and general misery. Laws that force individuals with incurable health situations to continue to suffer seem antiquated and barbaric. Surely, we can learn to treat humans with as much compassion as we have for animals. The question revolves around the quality of life. When quality and pleasure leave, we must find a legal way to help the physical body leave also.

Phil Miller said...

You’re not alone in wrestling with these questions, Tim, even if the squelching of a bill cut off public discussion in the state where the tall corn grows. Though her effort was too late, and with too little time or energy to pursue it fully, your friend Barb was on target in researching laws of states which have given consideration to the issue. We talk about this at home so as to know each other’s wishes, but we haven’t contributed anything to a more public discourse. Hospital ethicists may have devoted themselves to the question, as well as moral theologians and philosophers. It’s time to pull it out of the ivory tower into the public square. Thanks for your voice.