On The Ultimate Decision

 

Dr. Jack Kevorkian died this morning, in a Michigan hospital to which he had recently been admitted for treatment of pneumonia and a liver condition.  His work as an advocate of assisted suicide is well-known, and for many years his views and actions have fuelled a polarized debate about euthanasia, pitting those who consider him a murderer against others who champion his belief that we all have a right to determine how and when we die.  

To put a very human face on this issue, I would suggest you go to Vision and Verb, where Ginnie wrote earlier this week about her wife’s cousin, a Dutch woman who chose to be euthanized rather than face an slow, agonizing death.  The question of whether euthanasia should be allowed and under what circumstances continues to preoccupy lawmakers, philosophers, writers, religious figures and most importantly, many who suffer from acutely painful or limiting medical conditions -and the people who love them.    

Because this is a topic which will never go away, and which, as more of us grow older, may even become personally relevant, I would like to share the story – first posted in September 2009 – of a woman who became a great friend of mine after I moved to France, and who, in life and death, provoked me to examine my own views on many subjects, and especially this one.  

~~~~~~~~~~~~~  

Last week, an old friend finally got what she wanted most. Death was her wish, and it arrived in the way she had hoped it would—in her own bed in the apartment where she had lived for more than fifty years, with the person she loved most by her side.

A year ago she had tried to end her life, and the intervention that saved her was not welcomed. She had always been a fiercely independent person and the thought of becoming increasingly reliant on the small community in which she lived was untenable to her. Her vision of her situation was realistic and pragmatic. She had no living children to care for her, and was adamant that she would not become a burden to her only relative, the grandson she had helped to raise after the breakup of his parents’ marriage. Her home was a walk-up apartment in central Nice where she had lived in with her lover of 40 years –they married only shortly before his death – and she would not consider any other, under any circumstances. She gauged her ability to cope with her advancing age by the frequency with which she was willing to go down and up four flights of stairs – over the last few years it had dropped from four times a day, to once, then to only a few times a week, until finally she had only enough energy to leave the building when absolutely necessary.

The first time she spoke to me of suicide was several years ago, when she revealed that she had accumulated enough prescription medication to deliver herself a fatal overdose if and when she reached the point where life was no longer liveable on her terms. My first reaction was shocked rejection of her intention. In remarkably good health for someone in her late eighties, she walked to the shops every day, went to the cinema regularly and had ‘her’ table at a favourite local restaurant. She was keenly interested in politics, changing societal mores and the influence of the internet, and her plan to choreograph the end of her life seemed completely incompatible with her engagement in the world.

But over many discussions with her, I began to see how suicide could be considered the reasonable act of a rational person who refuses to be taken hostage by diminishing physical capacity and declining health. She was clear-eyed about the future and would frequently remark that, at the age of ninety, there were no miracles left.

After she failed in her first attempt a year ago, suicide became a frequent, almost obsessive reference in her conversations. She still went to the hairdresser once a week, still watched the evening news, still took an interest in what went on around her – but she had started down a path from which she would not be diverted.

A few months ago her eyesight began to fail rapidly and although she was willing to undergo treatment to try and save what was left, the effort so exhausted her that she stopped following the treatment after the first session. We had lunch together a few weeks later and she talked about her distress at no longer being able to read a newspaper, a bank statement or watch television. It was difficult not to protest her single-minded intention, or to offer her empty reassurances, but I had no basis from which to argue that her life could be improved or would even be bearable.  As much as I could try to put myself in her shoes, it was impossible for me, at my age and in good health, to imagine how hostile her future had become and how untenable was the prospect of needing help to function in her daily life.

Obliquely, she asked for my help.  She knew of all kinds of ways to put an end to her life but was afraid of suffering pain, or of not succeeding.  I was extremely uncomfortable but told her I could take her to Switzerland, where under rigorous scrutiny, there is a medical clinic with the legal and practical means to accommodate a person who wishes to commit suicide.  There is, however, a residence requirement of several months, and it’s an expensive process.  She already knew all about it, and said she couldn’t afford it, in terms of money or time.    

And so she tried again, alone. She didn’t succeed immediately, but during the brief period of hospitalization that followed her second deliberate overdose a cancerous tumour was discovered. She refused both treatment and nourishment; her grandson acceded to her wishes and took her home, where she died a few days later. I don’t really know if I—or others—failed her, but I doubt she would think so.

I came to believe she had the right to do whatever she chose with her life and that it was no one else’s place to judge her circumstances liveable, or not. I only wish she had been felled by a heart attack in her sleep and been spared her terrible decision.

~~~~~~~~~

Note:  My friend could have availed herself of free, state-subsidized services, including in-home care, assistance with shopping, accompaniment to medical appointments and daily cooked-meal delivery.  She did have some housekeeping help, but the presence of others – strangers – in her home bothered her.  For a time she accepted the meal service, but ultimately decided that her quality of life depended on doing things herself, her way.