Sunday, April 01, 2007

MAKING THE FINAL CHOICES

Somewhere a family is mourning.

For years their 95-year-old mother had been taking multiple daily doses of more than a dozen different prescription medications. Some helped keep her alive, while others mitigated the substantial pain caused by her various ailments. She finally grew tired of waiting to die. After discussing her options with her children, she decided that she would deliberately take an overdose of pain medication.

She let her children know when she planned to take the overdose, to ensure that she would be alone for a number of hours before her death. That way, she figured, no member of her family would be suspected of involvement in ending her life.

Her children accepted her decision. They saw it as her choice. There was no argument.

As their mother had planned, when the EMTs found her and when the coroner examined her, they all came to the same conclusion: She had died in her sleep, which was no surprise, given her age and how many medications she took on a regular basis.

One of the children confided in a friend, however, and that friend subsequently wrote to me. She was, by her own account, struggling to come to terms with the situation and what, if anything, she herself ought to do if she found herself similarly situated.

"I would have no qualms notifying the authorities if someone close to me was suicidal in a situation in which there was no imminence of death," she writes. "What would my ethical obligation be if a family member was contemplating the same decision under the same circumstances?"

In most locations where my column runs, including the place where this incident occurred, suicide is against the law and assisted suicide is legally a form of murder. My reader knows the legalities, however, and that's not what she's asking. She wants to know what would be the ethical thing, the right thing to do.

Frankly, this is a question I cannot answer. It's a question that most of us will never face, but if we do face it we have to answer it for ourselves, drawing on our own ethical and religious backgrounds, and any two people may well come up with different answers. What my reader's answer would be is beyond my capacity to predict, let alone to advise.

In most religions the subject of suicide is fraught with issues, and obviously that would come into play for many people facing this sort of crisis. For the woman in question, and for her family, religious conviction apparently posed no insuperable obstacle, but that wouldn't necessarily be the case for my reader.

What I can tell her is that this family, this mother and her children, made a choice that was not ill-considered.

Once the mother decided that she no longer wanted to live the way she had been living, she had several choices. One would have been simply to stop taking her medication altogether, for example. That decision would surely have brought about her death, but most likely would have resulted in a longer and much more excruciating end than the one she experienced.

Even after she had decided to overdose on pain medication, she might easily -- and, indeed, more surely -- have done so without telling her children of her plans, without letting them know why she planned to do this and without giving them a chance to say goodbye. Such a decision would have prevented any possibility of their interference, but it also might have left her children always wondering what had happened, tormented by the thought that her death had been an accident that could have been avoided if only they had been more attentive. At the very least, it would have left them without the chance for one last conversation with the mother they loved.

But she loved them too -- loved them enough to not want them to be left with any lingering doubt that they might somehow have been responsible for her death. And they in turn loved her enough to honor her wishes.

I don't know if I would have had the strength to do the same thing if I had been in the place of this mother or these children. And, even if I had had the strength, I'm not certain that I would have chosen the same path.

For this family, however, choosing to allow their mother to end a life wracked by pain that showed no sign of easing was clearly the right thing to do.

3 comments:

Anonymous said...

Jeffrey,

Your column reminded me of my experience in 1988 when my 84-year-old father called me in Charlotte and asked me to come down right away to his place in Naples, Florida. He had seemed to cope well during the year since his wife of 59 years had died suddenly, but he was tired - so tired that he couldn’t get out of his chair to greet me at the door of his senior citizen complex when I arrived.

The next morning I got up before Dad did, which was unusual. I heard him snoring - at last, it appeared, he was getting a good night’s sleep. But after a few hours, it seemed extraordinary, so I entered my father’s bedroom, which at age 48 was nearly as unthinkable as it was at age 18. I could not wake him up. As I left the bedroom to consider the next step, I saw the note on his dresser: This is awful. I can’t take it anymore. It was next to an empty bottle of sleeping pills.

I had him rushed to the hospital, where he was put on life support in the intensive care unit. The doctor on the scene said, “If he was my father, I’d let him go,” believing that Dad would not survive, but even if he did, that there would be permanent brain damage. Dad had a living will and strong opinions. He would not want this. The last thing I would ever want to see was an incapacitated father - tubes down his throat - unable to move or speak, glaring at me for allowing this to happen.

I called my sister in Indianapolis who reluctantly agreed I should tell the doctor that life support should be discontinued. However, a younger doctor suddenly appeared on the scene, saying that my father’s life might be saved, but he couldn’t guarantee his quality of life. His job was to save lives, he said. My sister and I talked again. Respecting Dad’s wishes (and empathizing with them), I returned with the same answer. When the doctor resisted, I suggested a 24-hour waiting period while we reconsidered.

The next day I returned and was amazed to find my father out of intensive care and recovering. He went through depression counseling, got back to playing tennis, and he met a woman who brightened his life for a while. A happy ending? Pretty good, it would seem, but the lady friend died suddenly, and my father spent years alone, enjoying only occasional visits from his distant children and grandchildren while going through a lot of medical problems. When he finally had to be moved into a nursing home facility (still mentally sharp at age 100), he was so unhappy that he tried to take his life while he was there. He died a natural death just a few weeks later.

As your column suggests, nobody knows just what is “right” in these situations. Well, maybe that’s not true. Some people would say “Simple. Maintain precious life at all costs, no matter how much suffering is involved for the ‘victim’ and his loved ones.” I would disagree.

Phil Clutts
Harrisburg, N.C.

Anonymous said...

I visit my 94-year-old grandmother once a month, and she tells me every time that she is "ready to go." She says such things as "I'm good for nothing," "I'm no good anymore," and "I can't wait to join Grandpa."

She has a number of meds that she takes dialy, it takes her forever to make herself a meal, she can hardly stand and walk, and a personal care worker helps her bathe and dress.

As I sit with her, I cannot help but think that I don't want to be old and I don't want to be alone. I cannot help but feel that if I was ever old AND alone, no way would I stick around any longer than I have to.

Scott Manas
Miami, Florida

Maggie said...

Jeff, I agree with you and the previous posters on this issue, although if I found that my 89 year old mother or 90 year old father had taken an overdose, I would probably force myself to go back to bed. Both have lived their lives independently and strong, and the only thing I know of that terrifies my father is the thought of lying helplessly in a nursing facility while someone changes his diapers. I have promised him I would never let that happen, although I'm afraid of what such a promise would mean I might have to do. If it just means leaving his medication nearby, I'm fine with that.
The other issue that is germane to this discussion but hasn't arisen is one of faith. People who believe in preserving life no matter what for as long as possible seem to me to be wanting a larger view of humans' place in the order of things. Clinging hopelessly to life shows a terror of death, and how foolish is that? Those who say that pulling the plug is "playing God" have forgotten that putting the plug in was playing God to begin with. The wise person knows that there is "a time to live and a time to die."

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