An act of Love

August 11, 2006 4:09 PM

Why I helped my wife kill herself.When Michael Graham's wife Elizabeth was diagnosed with motor neurone disease, she made up her mind to die before she became completely immobile. Michael knew he would have to help her - even though it could land him in jail. (note: unless you're unlucky, this is quite likely the saddest story you'll read today)
posted by jonson (32 comments total)

I just wanted to thank you for the warning -- I haven't read the story, because frankly, I can't cope with that right now.

The right to die is one of the most horrible things to have to contemplate -- second, in my humble opinion, to dying of some disease that leaves you trapped and suffering in a crumbled husk of a body.

It's a discussion for the strong, and today, I am not one of them.
posted by eriko at 4:20 PM on August 11, 2006

A very powerful, moving article. Thank you.

(though I would argue not too sad, as they lived a long, happy and mostly healthful life together.)
posted by nonmerci at 4:29 PM on August 11, 2006

Dying quickly and painlessly by drugs is much desired by many, and if we made the agents readily available, the incidence of suicide would undoubtedly be greater. Many people who would otherwise kill themselves are kept from it by the thought of the great violence one generally has to do to your own body, to kill yourself by mechanical means.

Whether this is for good, or evil, I don't know, and I have watched a number of people die in hospitals, and a few die by suicide. All the suicides I've personally known have used hanging, guns, or motor vehicles to die, except my grandfather, a heart patient, who used a plastic snow shovel, and 5 inches of wet Kansas snow on his drive.

As to the morality of suicide, I think most people would think the well considered act at the end of a long life, to avoid prolonged suffering and indignity, to be a rational act. The problem is obviously that as one comes back from that obvious limit case, one day at a time, the gray area of moral action is quickly reached, and it stays gray, for years and years back into all possibilities of human life, and soon becomes the moral morass in which whole societies lose their sense of right.
posted by paulsc at 4:41 PM on August 11, 2006

Wow - rough. A fascinating read, thanks.
posted by ORthey at 4:42 PM on August 11, 2006

I wish I was so lucky, to have someone I loved so much, to care for them in this way. I assume the writer knows how fortunate he is.
posted by revonrut at 4:45 PM on August 11, 2006

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posted by dersins at 4:49 PM on August 11, 2006 [1 favorite]

I'd help my wife to commit suicide.
I'd hope that she'd do the same for me.
My big worry would be that the survivor would be able to take care of our little daughter.
I'd hope she'd understand in time.

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posted by Balisong at 4:49 PM on August 11, 2006

jonson: "unless you're unlucky, this is quite likely the saddest story you'll read today"

Ericko: "I just wanted to thank you for the warning..."

Back in high school it was suggested to me on more than one occasion that I never watch Pink Floyd's The Wall, as I was generally known as a depressed kinda guy and they didn't think it was gonna improve my attitude. Guess they thought it might make me a little suicidal. =)

Won't be clicking on this link either, but hey! Thanks for sharing!
posted by ZachsMind at 5:04 PM on August 11, 2006

Hmm, I actually didn't find it all that sad. Rather cheering, actually, that his wife was able to leave on her own terms.
posted by tkolar at 5:21 PM on August 11, 2006

paulsc: The problem is obviously that as one comes back from that obvious limit case, one day at a time, the gray area of moral action is quickly reached, and it stays gray, for years and years back into all possibilities of human life, and soon becomes the moral morass in which whole societies lose their sense of right.

do you have an historical or present-day society in mind here, or is this simply what you think would happen in such a society?
posted by jepler at 5:46 PM on August 11, 2006

I'm don't think that the article is sad either.

I wouldn't want to slowly waste away from cancer or some terminal disease either. I applaud the writer's wife for her guts and determination in ending her life as she saw fit. And hats off to her husband who obviously loved her very much.

The sad thing is that more countries don't make it easier for folks to choose assisted suicide -- at least in cases of terminal illness. It's barbaric to force people to prolong their suffering. And yes, hospice is nice but that still isn't what some folks would like.

Good FPP, jonson. You're on quite a roll these days. :)
posted by bim at 5:49 PM on August 11, 2006

What I think is sad about this, to be clear, is NOT that the woman chose to end her life, but that it had to happen in such a fashion. In a more civilized world, a doctor (upon pronouncing uncurable disease with a very short & painful life remaining) would offer the patient a painless way out, with dignity & comfort.
posted by jonson at 5:52 PM on August 11, 2006

Jonson: The Netherlands; a more civilized world.

This is a case where it's impossible to reconcile the commandments "thou shalt not kill" with "love thy neighbour". So maybe it's understandable that the preachers in Kansas or wherever choose to let the former prevail and vilify the Netherlands that let's in this case the latter prevail.
But still I think anybody with a heart would find it hard to look that man in the eye and call the police to have him arrested.

Re Paulsc: obviously an expanding morally grey zone is the prime pitfall with respect to euthanasia. If that's your objection you should inspect countries where euthanasia is not illegal under some circumstances and find out wether moral erosion has taken it's toll. Case in point: the Netherlands and apparently Switzerland.
posted by jouke at 6:37 PM on August 11, 2006

"... do you have an historical or present-day society in mind here, or is this simply what you think would happen in such a society? ..."
posted by jepler at 8:46 PM EST on August 1

Classical Athens comes to mind. The American West, where pretty much everybody was armed, opium as lump tar and in oral suspension as paregoric was readily available, and people facing severe injury or illness were often left to themselves with a six shooter in reach, would serve as a more modern example.
posted by paulsc at 6:49 PM on August 11, 2006

"... Re Paulsc: obviously an expanding morally grey zone is the prime pitfall with respect to euthanasia. If that's your objection you should inspect countries where euthanasia is not illegal under some circumstances and find out wether moral erosion has taken it's toll. Case in point: the Netherlands and apparently Switzerland. ..."
posted by jouke at 9:37 PM EST on August 11

It's not necessary to go so far from American soil. euthanasia is practiced every day, in every city in America, in the cancer and chronic medicine wards of most general hospitals. Once a patient is on late stage pain meds and anti-anxiety drugs, and the family is worn out, the medical and nursing staffs are generally willing and able to massively escalate the dosage of morphine and ativan "to keep the patient comfortable" (and manageable), and be very slow with administration of antibiotics when pneumonia presents. Once a family member stops insisting on aggressive treatment of late stage cancer symptoms for a sick person medicated beyond argument themselves, almost anywhere in America, heavily medicated death will follow, under hospital staff supervision, in days. No one has to ask, they just have to quit objecting.
posted by paulsc at 6:58 PM on August 11, 2006

Wow. I can't imagine, during that first attempt, how he left her and went off to bed. Am I the only one who found that strange?
posted by Addlepated at 7:02 PM on August 11, 2006

You say Neurone I say Neuron. Crazy brits.
posted by delmoi at 7:10 PM on August 11, 2006

Once a patient is on late stage pain meds and anti-anxiety drugs, and the family is worn out, the medical and nursing staffs are generally willing and able to massively escalate the dosage of morphine and ativan "to keep the patient comfortable" (and manageable)...

Not all of us want to wait until things get to the late stage. Palliative care isn't good enough.


Wow. I can't imagine, during that first attempt, how he left her and went off to bed. Am I the only one who found that strange?

From the article: "Eventually she said, "Don't you sit up any longer - you go to bed." It was about three-quarters of an hour after she'd taken the drug. I said, "Well, I'll never get to sleep," but I did as she asked. I just wished her goodnight, and that was it. What do you say?"

Yes, what do you say...or do? They were at peace with their decision and it's what the wife asked for (for he family to go to sleep). Plus the author was over 80 years old, as stated in the article.
posted by bim at 7:24 PM on August 11, 2006

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posted by freedryk at 7:59 PM on August 11, 2006

"... Not all of us want to wait until things get to the late stage. Palliative care isn't good enough. ..."
posted by bim at 10:24 PM EST on August 11

I understand. The question becomes one of certainty of means, and ability to execute them.

If you have no qualms about massive injury and mess, a large caliber handgun with a heavy modern load, shot once through the top of the mouth (pointing up to the top of the head, not back in the throat), will reliably do the job. Yet it may not be possible for a person with failing health to keep such means at hand, under pressure of family concerns, or to reliably operate it, when hand coordination and strength are failing, as the lady in the article's condition showed. And even if these disincentives do not govern, the resultant trauma to loved ones that may find the body, and the incidental damage to the area that will result, may be disincentives to use such means.

But in such circumstances, all other means of self-regulated demise will be still less reliable than a gun, as the main FPP story clearly indicates. Dying by medication is not nearly so certain as it seems it should be, and in the Hemlock Society's book Final Exit, the necessity for backing any self-administered medication attempt with a proven secondary method of suffocation, such as plastic bag over the head, is routinely emphasized. Failures of self-administered medication overdose are common, and self-administered poison is not a sufficiently reliable method for most people to consider, if they wish the end made truly under their own control.

So the fact of the matter is, that many, many people wanting release from a terminal illness will require the assistance of professionals. In the U.S. you get that, not by asking for it directly, which may be the lump of hypocrisy troubling the gullets of so many, but by doing a proscribed procedural dance, which involves preparing a valid advanced directive, filing DNR orders if also required, having a sentient discussion of options with the treating physician and nursing staff, and refusing active treatment and antibiotics, while reporting significant discomfort and anxiety. Stay out of hospitals, and go, if necessary, to hospice, and continue to refuse active treatment and complain of pain. Do this consistently, and with any luck at all, you will pass without pain or trauma, typically within days, with the least effect to loved ones and professionals possible.
posted by paulsc at 8:14 PM on August 11, 2006

Thank you for the article, jonson. It was powerful and moving. I've read several articles like this and each one makes me long for the day when folks like this man's wife are able to end their lives on their own terms without having to worry that their own family will face legal troubles. It's a shame that this woman had to go to another country to die with dignity, that she had to sit in a strange flat, surrounded by people she did not know.
posted by LeeJay at 8:15 PM on August 11, 2006

So the fact of the matter is, that many, many people wanting release from a terminal illness will require the assistance of professionals. In the U.S. you get that, not by asking for it directly, which may be the lump of hypocrisy troubling the gullets of so many, but by doing a proscribed procedural dance, which involves preparing a valid advanced directive, filing DNR orders if also required, having a sentient discussion of options with the treating physician and nursing staff, and refusing active treatment and antibiotics, while reporting significant discomfort and anxiety. Stay out of hospitals, and go, if necessary, to hospice, and continue to refuse active treatment and complain of pain. Do this consistently, and with any luck at all, you will pass without pain or trauma, typically within days, with the least effect to loved ones and professionals possible.

But this still doesn't address the issue in the article or that I'm referring to. Some of us would prefer to end it before DNR's and refusing treatment in a hospice or hospital are relevant. And much of the problem with allowing people to die with dignity in the U.S. is the result of religious fanatics trying to impose their beliefs on others -- much the same as in the abortion issue.

Is your point that you are against such a thing?
posted by bim at 8:48 PM on August 11, 2006

"... Is your point that you are against such a thing?"
posted by bim at 11:48 PM EST on August 11

Personally, I am not opposed to a limited right to rational suicide (for the terminally ill, the severely and permanently disabled, etc.) with assistance from third parties, bim. In America, for all practical purposes, anyone with the means to obtain and use a large caliber handgun has an absolute right of suicide, rational or not, already.

I do think that making reliable means for unassisted rational suicide available to the terminally ill, while screening such from the mentally unstable is practically problematic, for a number of reasons. Yet once we introduce professional third parties into systems based on drug administration, such systems tend toward the existing U.S. model, as much as they do the Swiss, Dutch or German systems, if you take into account the difference in firearms laws between the cultures. In the U.S., an adult person without a felony conviction can obtain reliable means of self-deliverance at any gun store within 3 days, and needs thereafter only the capability to use it, and less than one minute of time, which makes our access to reliable, unfettered means, on average, probably better than those of any European system. Thus, I suspect any disagreements we have, bim, are based more on methods acceptable within cultures, and the fact that any drug based system inherently brings into the situation third parties, because of reliability issues of the method, and it is with those third parties that the big ethical issues come. Although statistics are hard to come by, studies cited in Final Exit suggest that half or more of the deaths initiated by drugs actually occur as a result of aspiration of the stomach contents into the trachea, as by direct action of the drugs on the central nervous system. Taking drugs is a tough, unreliable way of trying to take yourself out, so many people need help to push fatal doses on them, and prevent failure due to regurgitation and aspiration.

But, once we've gotten doctors and experienced third party "helpers" involved to improve the "reliability" of drug based methods, there is not that much practical difference in the Swiss approach detailed in the article, and what happens in the U.S. in terminal situations, as far as I can see. Certainly, the woman in the linked article was asked as many questions, and put through as much pre- and postmortem medical examination as any terminal patient in the U.S. with advanced directive and DNR in place. Whether taking the cup herself, or authorizing a helper to push drugs into an IV for her, were matters of physical enablement as much as dignity, insofar as I can see (as a man with some personal experience in helping severely disabled people, and hearing their stories of adaptation and resignation).

If you are sure you want the choice, should it come to that, secure now the sure means you will need, and review that option regularly. Drugs don't keep indefinitely, and guns need maintenance. Consider carefully that you only truly retain control of your end, if you do not require assistance or approval to make it certain.
posted by paulsc at 9:41 PM on August 11, 2006

Reading this really struck a cord. I hold no hope our country will adapt such laws, and that's horribly depressing to me as I get another year older.

Mr Dad (my father in law) died about a month ago. His liver and kidneys had been all but destroyed by faulty mediciations and lousy doctors who don't read charts. Dialysis had gone as far as it could over the years, but each time he came out sicker than he went in and his tissues in his arms (where the vien they used was) began to break down. In the end he decided enough was enough, he'd forgo the juggular port that only buys a few months, and just go.

It took seven days and three missed dialysis treatements. Seven days of hell for us, and him, as his remaining faculties disappeared one by one as his body slowly shut down. I would have done anything to spare him those days of hell. It seemed so cruel to just sit there and watch it happen and know there was nothing to do.

The Hospice people were great, don't get me wrong, they were very comforting for him and us. Wonderful service. It's just that they aren't allowed spare him the pain of living - just the pain of dying. And that hair thin line of definition is the problem.

Morphine and Vicodin and the rest only does so much, becasue there's only so much you can give before it's lethal. Not even if they are actively dying and in a living breathing hell, you have to keep it below a certain point. And that's just wrong.

I hadn't really put much though to it before this year, never had any people in my family so ill that it came up, but now I can't seem to get it out of my head. After having lived through ten years of watching Mr Dad wither away bit by bit has certainly changed my opinion on the issue. Or at least I have one now.
posted by Dome-O-Rama at 11:36 PM on August 11, 2006

Compelling read(s), the original post and the comments. I don't think I realized before that self-administered medications are so unreliable. When the original attempt didn't work -- I didn't expect that to happen. Powerful.

This is one of those issues that I go back and forth on, depending upon the latest viewpoint I hear. When I have a position, I favor as a compromise some limited access with many safeguards ...
posted by ClaudiaCenter at 1:19 AM on August 12, 2006

It's worth pointing out paulsc that in the UK, where this story is based, handguns are largely illegal, as are most firearms. It's possible to get shotguns if you're a farmer or clay-pigeon shooter, but the forms to obtain them legally are lengthy and involved.

The police would certainly ask questions about an 80 year old man in an UK urban home trying to obtain a firearm, and they last thing they wanted was evidence of his involvement or the suspicion of the police - assisting a suicide is often treated as murder here.

I don't find the story sad. I find it makes me angry. I'm angry that despite the overwhelming number of the British public (over 80% in some surveys) in favour of some form of official euthanasia/assisted suicide option for a quick, painless death for those in great pain or with a terminal illness, we're still forced to sometimes endure years of suffering and slow decline. That people have to go to dignitas while they're still strong enough to go, in fact going earlier than they'd like to, because they can't have a simpler solution at home.

Doctors do kill their patients sometimes on a 'nudge nudge' basis, but as suggested it's through over-use of morphine, to 'help their pain', or slow treatment of infections. Such secrecy causes pain to doctors, and certainly causes unecessary pain to patients and their families. The secrecy around this, that deaths of old people in treatment by doctors are not investigated as strongly as they might be, because no-one wants to press this hidden truth, allowed Doctor Shipman to murder so many of his patients.

We need an effective, straightforward and humane method of assisted suicide with safeguards in the UK, staffed by volunteers. We won't get it because the Government cares little for the will of the people.
posted by ArkhanJG at 1:44 AM on August 12, 2006

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posted by annieb at 10:26 AM on August 12, 2006

I've already decided should certain circumstances befall me, I'll be jumping out of a plane over a desert, parachute-less. My ipod strapped to my head, listening to my favorite song. I probably have a good 50-60 years before it may come to that, so the song may change, but I can't think of any better way to go.
posted by Mach3avelli at 11:46 AM on August 12, 2006 [1 favorite]

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posted by verveonica at 7:55 AM on August 13, 2006

I used to work in a nursing home. One of my patients starved herself to death. She didn't want to live anymore if she couldn't take care of herself in her home.

Those who are against euthansia under any terms should have to watch someone starve themselves to death.
posted by QIbHom at 10:13 AM on August 14, 2006

This guy is my hero. I only hope that if I get a disease like that, I'll have someone willing to help me go. (Unfortunately, my closest living relative is pro-life and I somehow don't think any of my other relatives would support the right to go on your own decision.)
posted by jenfullmoon at 1:48 PM on August 14, 2006

I don't regret what we did, but I am very angry about the way it had to be done. It seems crazy to me that you must either risk jail or go to Switzerland to do something you should be able to do provided you do it yourself and nobody else is involved.

Batshit Crazy. I am glad they found their peace, it is an unfortunate fact that it will remain elusive for many others.
posted by prostyle at 2:03 PM on August 14, 2006