The State of Maryland legislature recently declined for the second consecutive year to bring to the floor a bill allowing terminally ill people to legally end their lives. Like other similar bills in Oregon, Washington, California, and Vermont, the initial bill was titled “Death With Dignity.” The 2016 version was titled “End of Life Options,” and addressed some of the greatest objections that some major constituencies have, and reflects the evolution of thinking about the issue.
The phrase “Assisted Suicide” conjures a slippery slope to enabling depressed people to “end it all,” or convincing elderly relatives to avoid being a burden to families, or even helping the process along in order to cash in on the patriarch’s last will and testament before he changes it. Ultimately, it applies to the ancient Greeks who presented Socrates with the hemlock because of his teaching methods, which aroused skepticism and impiety in his students. The implications for horrifying adherence to “political correctness” is obvious – but this is not what is meant by advocates of “death with dignity.”
The phrase “Death with dignity” confirms what humanity has known from the beginning: that death in the midst of debilitating pain or terminal illness is undignified – whether death is the result of deliberate infliction of pain through torture, or the result of illness accompanied by pain that is beyond any intervention. The phrase indicts the often lonely deaths of neglected patients in nursing homes. Hospice providers object – and rightly so – that death while in Hospice care is far from that kind of “bad death.” In fact, the slogan of Hospice of the Panhandle in West Virginia is, “It’s about life,” meaningful life achieved through pain management, support of caregivers, and accompaniment throughout the process of what Hospice calls “active dying.” No one under Hospice care dies alone.
My personal story in this regard is like many others. My mother was in terminal stages in a nursing home in Kansas City. The attending physician urged my brother & sister and me to sign our mother into Hospice care. As soon as we did that, she was moved from a noisy, tile-floored, smoke-filled ward in a crank-up bed left over from the 1930s, to a quiet, semi-private room, with pictures on the walls, flowers on the bedside table, and a modern hospital bed that was designed to prevent bedsores. She did indeed die in quiet dignity, as have others I have accompanied both as a partner and friend, and in my years as an “11th hour” hospice volunteer. We are the ones who make sure everyone in our care dies with dignity, and no one dies alone.
The third stage in the evolution of how to define laws that will allow terminally ill people to choose to die on their own terms is “End of Life Options.” California is the first state to pass a law under that title. The phrase “End of life options” removes some of the negative associations of names like “assisted suicide” or “death with dignity.” Most obviously, having options for the end of life means people can chose the whole range from hospital-based palliative care, to home-based Hospice care, to medically prescribed and supervised use of drugs by mentally competent, terminally ill patients to safely end their lives before their condition or disease runs its full course.
Despite some of the more strident voices in the debate (“So much money can be saved if the patients kill themselves!” Frederick News-Post letter to the editor, March 3, 2016), I am not word-smithing murder here. How we define the issue goes beyond life-or-death to the meaning of the quality of human life. We have long acknowledged that the humane treatment of animals includes putting them down when they become too old, too ill, or too injured. We “put them out of their misery” with the assistance of compassionate veterinarians. If we can treat our cats and dogs and horses that way, why not allow our loved ones and ourselves the choice when life ceases to have any meaning outside of the day-to-day slog through terminal disability and pain?
In a recent interview with PBS NewsHour reporter Jeffrey Brown, Diane Rehm talked about the understanding that she and her terminally ill husband shared. “He wanted to relinquish life. He didn’t commit suicide. He wanted to let go of life and be on to the next journey….Even after he said, I’m ready, I’m ready to die, I said to him, sweetheart, are you sure? Is this really what you want? And he said, absolutely. I can no longer use my hands. I cannot walk. I cannot feed myself. I cannot do anything for myself. I am ready to die.” John Rehm did not have the luxury of legal options for ending his life quickly and painlessly. Instead, he chose to deliberately stop eating and drinking – which took 10 days. “I so resented that John was having to go through this long 10-day process to die. He had said 10 days earlier he was ready to die, and it took him that long. It shouldn’t have, I don’t believe, taken him that long.”**
Death is no longer perceived as being part of life. Until the late 19th century, children often died before they reached the age of 5; women routinely died in child birth; plagues came and went on their own mysterious schedules, killing rich and poor alike. Modern western society has been very successful at denying the reality of death. Our scientific and medical knowledge has allowed us to keep death largely under our own control – or so it seems. We seldom think about our own mortality until some accident or sudden onset of illness confronts us. But, as illustrated by Brittany Maynard and John Rehm, when we choose the manner, time, and place of our own death – when we relinquish life – we actually reclaim life – lived to the end on our own terms.
Webster’s New World College Dictionary notes that “relinquish implies a giving up of something desirable and connotes compulsion, or the force of necessity.” That undeniable force is life itself.
**[Diane Rehm’s memoir, On My Own, tells the story of her husband’s death and her own struggle to reconstruct her life without him. http://tinyurl.com/zs52o5r]