Betsy's Assisted Suicide

I just read this provocative post by a local author who helped her sister die using California's new end-of-life option. It had big photos of her sister, in a wheelchair, with a big smile on her face. 

She looked about my age. She's my demographic: white female in her 30s or 40s. In fact she didn't look too different from me. Maybe this is what made the article so powerful. I could not stop thinking about how her diagnosis - ALS - which she received in 2013, could just as easily have come to me. She looks like a beautiful, healthy, young women. Why should she be afflicted with this cruel, degenerative disease?

From the article I learned that she was very clear about her desire to end her own life before allowing the disease to run its course, saying, "I don't want to live out my life paralyzed, eating through a tube in my stomach and communicating through a machine. I'd rather be free than entombed in my body." That certainly seems reasonable to me. 

She chose to drink the lethal dosage of drugs and go to sleep on a bed of white linens on her favorite hillside at sunset. Just before, she hosted 30 of her friends and family members who helped celebrate her life with music, booze, photos, pizza, tamales and laughter. She gave away her personal items, calling them "Besty souvenirs." It seemed like a celebration of her life and a quick, peaceful end, rather than a long, drawn-out death with lots of sadness and wear-and-tear on the family and friends. They could remember her in her final lucid moments, laughing and talking with loved ones, instead of hooked up to machines, captive to a merciless disease. 

This story punched me in my gut. I cannot shake the feeling that Betsy could as easily have been me and that I agree with her decision and if I were in her place, I would make a similar call. 

I'm also cognizant of my own charges: two patients who are in their 80s, simply waiting to die. They have no hope of recovery from their terminal illnesses. Doctors have given them 12 months or less to live. One of them is DNR (do not resuscitate) but the other is full code (she wants every lifesaving measure to be used in case of emergency). I do not understand these points of view. My role is to be a supportive, nonanxious presence, and not to judge. I would never reveal my thoughts about this issue to the family members I am serving, but I do witness a sliver of their pain and exhaustion. Every day is full of caregiving -- feeding, bathing, toileting, cleaning up bodily messes of all kinds. It's like having a newborn, except an adult's body and bodily secretions are more potent, and the elderly generally are not as cute. So each day is a trial, from start to finish. 

I suppose that there is wisdom in this long, drawn-out process. The adult children of my two hospice patients will be relieved when their parents die. They will regain their own lives, able to go where they want whenever they want. 

But if I were in Betsy's situation, I can definitely see why she would want to take control of her destiny and end on a high note. Illnesses can drain a family of resources, energy and goodwill, while reducing the patient to a helpless dependent, unable to function without round-the-clock care. By ending her own life, Betsy released herself from her failing body and she released her family from months or years of suffering and medical bills. Even though it must have been hard, her suicide seems to me the better choice. 

Theologically, I think suicide could be considered an act of martyrdom. We are responsible to God and to neighbor. We are not isolated beings; we are made for community. We are relational. A terminal patient consumes thousands of dollars per day - money that could be used to treat patients with better prognoses, or to feed hungry children. So one could reasonably end one's life on behalf of one's neighbor.

Furthermore, the technology age brought the ability to extend life indefinitely. Prolonging a life with machines, especially a life that has no hope of recovery, is a new phenomenon that exists outside of all concepts of life and death as expressed in scripture. Physician assisted suicide is an outgrowth of people not wanting to be caught up in a futile extension of life. It is an appropriate, humane response to our technology-crazed medical culture that views an acquiescence to death as losing a competition. In reality, assisted suicide is the reasonable answer to a culture obsessed with prolonging life at all costs. 

While the Episcopal church has issued a formal statement against assisted suicide, I think it is high time for the church to reconsider. Perhaps this is a resolution for the 2018 General Convention in Austin.

Seeing Death

In modern American society, we hardly ever see death or dying people. They're kept tucked away in hospitals, nursing homes or private homes, out of public view. So we hardly ever think about the end of our lives, which is strange really because it's the one thing we are all guaranteed to have. 

Contrast that with people living in a less industrialized/developed country. There may not be the financial capabilities, nor the desire, to place a dying family member in a nursing home. And so the family adjusts its schedules, finances and daily living practices to care for the dying person. While this is difficult, and not something I would readily sign myself up for, it is certainly instructive. It means that the whole family -- adults and children alike -- are exposed to the process of dying, 24/7. They witness the body gradually shutting down. They see their loved one sleeping more, resting more, having less energy and less alertness. They witness the arms and legs growing mottled as the body shunts energy and blood away from the extremities and toward the vital organs. They are present for the whole dying process.

What a gift! Not to downplay the difficulty of watching a loved one leave this earth, or the daily work of caregiving, but it is a gift nonetheless to witness a human body naturally moving through its autumn toward its final winter. It is instructive. It gives one a different frame of reference from what we see on TV, which usually shows an intense, quick, painful experience of dying. It seems as though in reality death is a long, slow, drawn-out process that can take over a year! 

It also gives one an opportunity to grieve. It helps one let go of the dying person because one is in tune with the body's natural dying process. Perhaps a long, slow process helps us to more easily accept the end of a life.

And yet we continue to postpone death through extreme medical interventions, and every means possible. We even try to erase signs of aging with hair dyes and plastic surgery. As a culture, we are so uncomfortable with aging and death and we glorify youth and life. 

Because we do not ponder our own death, and because we hardly see or experience death, we do not fully live. We get distracted by advertising that tells us we need to worry about possessions, looks, sports teams, celebrities and clothes. We do not really live our lives. We forget to explore the depth of our soul, or that of others. We rush through meals instead of savoring each bite and reflecting on the miracle of a plant becoming a seed that then becomes a plant that nourishes our bodies. If you stop to think about it, it really is amazing!