End of life – no discussion

Right after I had the encounter I described a few weeks ago, I received an email with terrible news. The email included a scanned hand-written letter – a farewell letter to family and friends. The writer of this letter is someone I have known for most of my life – a vibrant, lively, intelligent person – a university professor. The letter stated that life had become impossible to live fully, due to pain and disability, and the medications to relieve the pain simply resulted in being groggy and bedridden.

And this writer solved the problem of a life not worth living with a gun (a more reliable solution than drugs, in the writer’s view).

The family had discussed it beforehand, and the decision to take this option was a considered one. They were as OK with the decision as any family could be, and saw that it was the only real option. Unfortunately, while life was rendered not worth living, there was not a diagnosis that gave the sufferer eligibility to utilize the benefits of Hospice.

A few years ago, my mother was back in a deep depression. It had been a while since things had been so black and hopeless for her, and she expressed repeatedly how terribly she felt, and that she couldn’t see a way out of that misery. Her only hope was that she now lives in Ofegon, and she was hopeful that a physician could offer her physician-assisted suicide.

Of course, the catch to that hope is that in order to qualify for physician-assisted suicide, you can’t have clinical depression!

But, at the time, talking to her and hearing the deep pain in her voice, I wondered why it shouldn’t be an option to have some control over ending such soul-crushing agony. We talk a lot about destigmatizing mental illness, but we don’t really ever put a diagnosis of depression, or schizophrenia, on a par with heart disease, diabetes, or cancer. They continue to be treated differently, and, yet, is the suffering any different?

A few weeks ago, I listened to the podcast of On Being with Krista Tippett, interviewing Jennifer Michael Hecht – philosopher, historian, and poet. The program is called Hope for Our Future Selves, and she argues very persuasively against committing suicide, with great understanding and sensitivity for the suffering that can lead to suicide. Several times in the interview, she and Krista Tippett make clear that they are not referring to the choice to end life in the context of hospice (but, of course, this option wasn’t on the table for the letter-writer above who died by gunshot, nor for my mother in her deep depression).

I keep thinking, in all of this recent focus I’ve placed on the end-of-life, that we as a society, and as individuals, really need to move towards a more sophisticated and nuanced understanding and acceptance of the reality of death. We all will die. We have invested a lot of attention, in our modern world, to optimizing the beginning of life – prenatal care, birthing centers, Lamaze breathing, yoga for pregnancy – but we give no thought to how we want to die. Shouldn’t the end of life be as significant and meaningful as life’s beginning?

And, we need to start respecting that we all hold values about life, and that, for some of us, life may be not living when the pain is simply too much to bear, and when the activities that make a life worthwhile can no longer be engaged in.

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