Ex-palliative care nurse dies by suicide
August 2, 2015 2:58 PM   Subscribe

Healthy 75-year old dies by assisted suicide in Switzerland. Gill Pharaoh's last blog post is here. She has written two books about carers.
posted by mgrrl (49 comments total) 20 users marked this as a favorite
 
I hope that someday people of sound mind here in Canada don't have to go to Switzerland to do this.
posted by Klaxon Aoooogah at 3:10 PM on August 2, 2015


A spokesman for the anti-assisted dying group Care Not Killing told the newspaper that the case was “deeply troubling” and showed how little society values elderly people.

No, it means we treat them like every other person in society, an adult capable of making their own decisions until proven otherwise.

Just because you think dying sucks doesn't mean it isn't for everyone.

Reading her blog though, it makes me think back to that first episode of Scrubs:
J.D.: Most of my patients are, uh...older and sorta checked-out, mentally.

Dr. Cox: Pumpkin, that's modern medicine. Advances that keep people alive who should have died a long time ago, back when they lost what made them people.
If someone wants to go out while they can and not spend years of their life as an empty husk simply for the sake of respirating then by all means let them go.
posted by Talez at 3:37 PM on August 2, 2015 [25 favorites]


This is matched by the research that shows that doctors tend to choose less aggressive treatment programs for themselves when they have terminal cancer. These are people who know what is coming for them and make a decision about how much they personally are willing to endure.
posted by srboisvert at 3:41 PM on August 2, 2015 [4 favorites]


The tone of the Independent article seems provocative to the point of dishonesty--calling her "healthy, active" when she describes not being able to garden for more than 15 minutes at a time due to fatigue secondary to shingles and excerpting “I just felt it was so bleak and so sad. We all did what we could but, for many of those old people, there wasn’t a lot you could do. We do not look at the reality. Generally, it is awful,” as "deciding old age is 'awful'" seems incredibly unfair.
posted by kagredon at 3:58 PM on August 2, 2015 [17 favorites]


The tone of the Independent article seems provocative to the point of dishonesty...

There's big money in keeping people breathing as long as possible. We simply can't have consumerspeople deciding they no longer wish to continue spending their moneyliving.
posted by Thorzdad at 4:10 PM on August 2, 2015 [8 favorites]


they personally are willing to endure.
posted by srboisvert at 3:41 PM on August 2 [+] [!]


Endure, yes, but it's also the writing on the wall. Anyone with an IQ greater than a cockroach can see there are many ways things will likely not end well. If you interact with and care for older peeps on a regular basis, you can see that sometimes the end process sucks.

You need, of course, to pay attention.
posted by pjmoy at 4:12 PM on August 2, 2015 [1 favorite]


One of the few really deep-seated hopes I have is that I will be able to leave this world as well and as easily as my dog did, and that I will be trusted to make the decision for myself as I was for her.
posted by Wolfdog at 4:24 PM on August 2, 2015 [17 favorites]


On one hand her suicide is none of my business and I feel that people should be allowed to determine their fate as they see fit. On the other, after reading her blog I feel like she may have been helped by a mild anti-depressant and some simple anti-inflammatories for aches and pains. It's unfortunate that some people think not taking medication is some badge of courage. But, it was her choice and I can't argue with that.
posted by photoslob at 4:40 PM on August 2, 2015 [4 favorites]


My previous snark aside, the past year or so dealing with both my mom's dementia and my father-in-law's declining health has really forced me to think hard about my future. Neither of them are living anything close to a quality life now, and it scares the hell out of me to think I could easily end up the same way.

I hope I can muster the bravery that Pharaoh found in herself, when the time comes.
posted by Thorzdad at 4:41 PM on August 2, 2015 [6 favorites]


On the other, after reading her blog I feel like she may have been helped by a mild anti-depressant and some simple anti-inflammatories for aches and pains.

If only that trained career nurse had had a chance to hear your medical advice.
posted by Greg Nog at 4:46 PM on August 2, 2015 [89 favorites]


Doctors specializing in old age are few in number and among the poorest paid in the medical profession.

That said, old age is , said Bettie Davis, Not For Sissies. I am an older person, and I have seen friend after friend suffer from all sorts of things. It is not pleasant.

And, as noted in the comments, doctors are taught to do all things to keep patients alive, no matter the cost or indignity involved.

Should a p,erson have a right to decide when life has lost meaning, interest, is too painful? I suggest Yes, but we have trouble in our country with any and all social issues, the right of center people always calling on this or that god as the only one to decide such matters.
posted by Postroad at 4:50 PM on August 2, 2015 [8 favorites]


Thanks for the post. Bookmarked for future reference.
posted by HuronBob at 5:10 PM on August 2, 2015


No, it means we treat them like every other person in society, an adult capable of making their own decisions until proven otherwise.

How would we feel if a person in her thirties wrote about ending her life because, among other reasons, she didn't want to travel any more, had trouble working in her garden, and preferred having friends over for lunch instead of dinner? At least I suspect that media coverage would have stuck to guidelines for reporting on suicides aimed at preventing further such events, such as not printing the contents of suicide notes.
posted by Ralston McTodd at 5:24 PM on August 2, 2015 [7 favorites]


"How would we feel if a person in her thirties wrote about ending her life because, among other reasons, she didn't want to travel any more, had trouble working in her garden, and preferred having friends over for lunch instead of dinner?"

Speaking as that 30's-aged person--someone who was suffering life-altering chronic pain in my 20's, and is heartily sick of the restrictions on my life that will never go away, for however many *more* decades I end up living--

Sounds fine to me.

I do not actively want to end my life, but I frequently wonder what I am doing here.

...
If you think being unable to participate in the activities you enjoy--large or small--is not a reason to consider checking out, you need to examine your privilege again.
posted by galadriel at 5:46 PM on August 2, 2015 [43 favorites]


This is one of the most thought-provoking things I've ever read here. I am utterly unable to make sense of my response to this. Intellectually I find myself agreeing with her right to make this choice at the same time as being deeply disturbed about what this would mean for society if it became routine.
posted by shimmerbug at 5:49 PM on August 2, 2015 [6 favorites]


If only that trained career nurse had had a chance to hear your medical advice.

Easy to be glib but I have a mother-in-law who is a palliative-care nurse at a VA and I know first hand that she has experienced things that I can't imagine. To say it's a difficult job is an understatement. She is also the type of person who won't take medication and when you ask her why it's for a variety of very irrational reasons that I won't go into. The fact that this woman at the relatively young age of 75 decided life was no longer worth living hints at a level of depression that might have been treated.

But like I stated, it was her decision and I respect that.
posted by photoslob at 5:51 PM on August 2, 2015 [19 favorites]


Not only is it "only 15 minutes of gardening", but she says even 15 minutes of gardening can result in the whole next day unable to do anything. Given the advances of medicine in the last fifty years, for someone who's 25 now to take their life because of a chronic pain condition would seem tragic, but there's a huge difference between that person and somebody who today is 75. There's no promise of something that's going to change this within the next few years, and everything she described, she had no reasonable expectation that it was going to do anything but getting worse. You go from doing a big party and loving it at 70 to worn out by making lunch for a few people at 75, and what you reasonably have to expect by 80 is not "still making lunch for a few people". 15 minutes of weeding is exhausting at 75, and at 80 you don't have a reasonable expectation that you'll be able to keep a garden at all.

It is, to me, like life is a night out. If you want to go home twenty minutes in, something's really wrong and it should probably be fixed, or at least maybe if you stay a little longer we can figure out how to fix it. But... as the night goes on, some people will be tired and want to head out at 11pm, and I think that's their call. If they think that their being tired is just going to make staying out any longer a burden, they know that better than me. If some people want to stay up until 3am and wring everything they possibly can from the night, that's also fine. Just as long as all those people are making those decisions themselves, and not because someone else wants them to stay... or someone else wants them to go away. There's a point where I trust people to know when they're ready to go.
posted by Sequence at 5:52 PM on August 2, 2015 [17 favorites]


Even if we were to sit down and decide who should be able to decide to end their life, I think 75-year-old palliative care nurses should be right up there on the list anyway. "Informed consent" is a standard we use for figuring out the acceptability of many things. If anyone can demonstrate informed consent, it's them.
posted by bleep at 6:01 PM on August 2, 2015 [8 favorites]


After my mom's heart stopped beating at 68 people would say "Oh, how sad, she was so young" and you know, it really hurt me more than anything else people said. I wanted to protect my dad from having to listen to all the "Oh, so young"-ers because dammit, she lived from start to finish, who are you to judge? She died happy, that's what matters.

It's toughest when the most painful words come from those who mean to help the most.

Some of the reaction to Gill Pharaoh's suicide reminds me of that. I have been touched by the heavy hand of unnecessary and -- here it's hard not to be hypocritical around wounds that never close -- "Oh, so young" suicide, but I understand Pharaoh and, though my opinion doesn't matter in the least, I'm fine with her decision. Who am I to judge?
posted by Ice Cream Socialist at 6:19 PM on August 2, 2015 [5 favorites]


As someone who has experienced taking care of someone in hospice at home, which it often is in America, guess what? There are no hospice people coming into your home and sitting by the bedside of your dying loved one. It is you: they are gasping for air, you are giving them morphine and Ativan. The nurse comes twice a week. The rest of the week, it is you, hospice is just a fancy word for: we won't accept your elderly relative into the hospital anymore, so you have to take care of them at home. If you don't have the resources, then fuck you.

They can't got to the loo? It is you, helping them or changing their diaper. If they have an attack, you cannot call for an ambulance, because part of the agreement on putting them on hospice at home is that you will never go to the ER again. You have to call the nurse, and she will instruct you to take the box out of your refrigerator and administor Haldol to calm them down, no matter how in distress your loved one is in, you are not allowed to go to the emergency room or call an ambulance, because they are now on hospice, and you have agreed to be their caretaker. And I guarantee you, that nurse will be cranky at 10 p.m., while your relative is gasping for breath.

They stand up and try to walk to the door and fall and split their head open? You call the Medicare hotline and they go, um.... while you're in the bedroom holding a towel to the bleeder and the EMT's are there and guess what? I am not going to ask your fucking permission to take my dad to the hospital now, hospice people, who prey upon people with elders, and put them on this "delightful" program, only for them to realize that they have given up all of their rights to go to the hospital in case of an emergency, and they are the sole caretakers of their relatives, not some sort of benign institution, but yet another that traps them into a byzantine structure of a nurse visiting so many hours a week and you can only get the meds via this nurse (aka you are not allowed to talk to your doctor anymore), and then you are stuck there. Doing 24 hour care for someone, who you love, and you feel so guilty about it, and so tired and so distressed, but the hospice at home situation is really fucked. It is not looking at your loved one, smiling peacefully in the bed, it is another layer of some institution taking over the healthcare and billing Medicare for it. Because hospice is like, well, if you have less than 6 months to live, we can get a shit ton of money off of you, and if the relative is there to take care of them, more money for us.

They fucking did this when my Mom was in the hospital, in a coma. Too many days. Hospice took over. It was all about insurance. There was no grace. It was mercenary. God save the insurance industry in this country. I get it, you want to eek as much as possible out of us as we are dying, and I totally understand someone who wants to circumvent that.
posted by Marie Mon Dieu at 6:45 PM on August 2, 2015 [49 favorites]


A few weeks ago I was in a nursing home. 3 people to a small room, just enough space for a thin human to walk on either side and administer medications. No space for personal things. Three tvs not quite angled towards the bed, on intermingling with eachother.Just them and a wallsheet that was open because it was noon. These people just kept making small noses in their medicated state, mostly covered by the tv and machines beeping.

It was absolutely terrifying.

I really encourage people to take looks at nursing homes. Not the nice ones you want but the ones that they put you in when the money runs out. Walk down the floors. Because not only do we need awareness of what is happening now, but we need people to advocate for change.
posted by AlexiaSky at 7:20 PM on August 2, 2015 [25 favorites]


We have no choice about being born. Therefore I believe we all absolutely have the right to choose the time and manner of our death, subject to informed consent.
posted by feckless fecal fear mongering at 7:50 PM on August 2, 2015 [6 favorites]


I've been spending a lot of time taking care of an elderly relative. Thanks to a heart attack and a couple of strokes, she went from still being able to work her garden, and telling me very detailed stories from her near-photographic memory, to becoming a near-imbecile in a matter of a few days. I'm happy to help her stay alive, stay comfortable, and have what small pleasures are left. If she were cognizant of what was going on, she'd want to be alive. She always thought suicide was a very serious sin.

But there's no way in hell I will let myself go through this situation. Even if it means suicide when I'm still relatively healthy, then so be it. I completely understand why Gill Pharaoh took this way out.
posted by honestcoyote at 8:01 PM on August 2, 2015 [4 favorites]


Thanks to this woman's frank reflection on her choices, we may all get a sliver more permission to direct our own deaths, just as we have directed the rest of our affairs, as we see fit.
posted by gorgor_balabala at 9:15 PM on August 2, 2015


My MIL has steadily-increasing dementia. My parents are mentally fine but physically slowly deteriorating. I'm not sure which is worse since my MIL doesn't seem to realize the extent of the deficit and never seems particularly distressed. At least if a person is "only" physically ailing, s/he will still be allowed to make the choice to end things. It's the most horrifying irony(?) that by the time life isn't worth living, the person wouldn't be of sound enough mind to be allowed to make the choice. So, yeah, as sad as it is that she was in this position, at least she had the chance to make it.
posted by Beti at 11:18 PM on August 2, 2015


I don't get angry easily but I was enraged to tears when the euthanasia bill was voted down a couple years ago in Massachusetts.

I just don't get it. If your religious beliefs forbid it then fine, nobody is forcing you to choose this. People generally should have no right to advocate what another intellectually and mentally stable human ingests.

When a dog or cat has end-stage cancer or is horribly maimed then it's universally considered inhumane not to put them to sleep. Yet somehow humans apparently don't deserve the same compassion as dogs.

If I come to the end of my life in significant pain I alone will choose how to exit with dignity at the time of my choosing. I anticipate the U.S. will be more progressive in this regard by then but if not, I'll be taking a vacation to Switzerland or becoming an Oregon resident for about an hour.

A fast acting lethal dose of a barbituate mixed with an anti-emetic and an opiate, surrounded by family at the time of my choosing would be the most beautiful way to end my life that I can think of.

If not, I'll just open a tank of nitrous in my car and put on some Slowdive. Whatever.
posted by WhitenoisE at 12:32 AM on August 3, 2015 [8 favorites]


The discomforts and indignities of old age are a burden, but to give up your whole existence entirely because they are likely to be part of your further life is an impatient, radically disproportionate response. It looks like tragic folly to me, perhaps a misunderstanding of the black catastrophe death really is.
posted by Segundus at 1:26 AM on August 3, 2015 [2 favorites]


I love being alive. I want to stay alive, and to love and be loved, for as long as I possibly can.

BUT

I have spent many years contemplating the concepts of existence and nonexistence. As a result, the end of my own sentience, in and of itself, is not a thing I fear. I fully intend and expect that my last instant of consciousness will either be perfectly ordinary (if I die in my sleep) or astonishingly fascinating (if I notice it happening).

Should I ever be in the position of having made a considered decision to die, it will be for good and sufficient reasons, and I will quite literally fight to the death to get it done.

I will not ask for help. I know myself well enough to expect that I would rather put up with whatever condition could make me conceive of death as my best option than duck-shove the responsibility for managing my own demise onto somebody else.

But I would certainly view anybody who forcibly frustrated my suicide with implacable, irredeemable, irreversible hatred, a hatred that I would consciously employ as a spur to outwit them and wear them down; and my last breath would be marked by a splendidly transcendent sense of schadenfreude.

Because if you are arrogant enough to play Doctor Knows Best with my death, and project your own fear of nonexistence onto me, you have not seen arrogance. Here, let me show you it.
posted by flabdablet at 1:46 AM on August 3, 2015 [8 favorites]


Her blog-post is saddening - she definitely seems depressed, and lonely. Or maybe lonely and depressed, in spite of living with a husband she loved, and having children and friends around her. It makes me think about the aging of baby-boomers, many of whom have lived a very individualistic life, and have felt independent and free of other people since their teens. How are they going to handle old age?
Even if we could buy all the best care in the world, and treat her pains and depression with both medicine and therapy, this woman would perhaps still be unhappy and lonely and angry about her dependence on others, because she feels independence is her birthright and identity.
posted by mumimor at 2:45 AM on August 3, 2015 [3 favorites]


I find the idea of measuring the value of life disquieting enough that I'll probably avoid it as long as possible, if it ever comes into question. (Though obviously, there are actuaries doing it for us.)

About dementias... "dignity" means what, "self" means what? A particular organization in time of memory, attention, intention. The loss of self is a kind of death, terrifying to imagine as your own future, and horrific to witness, especially in someone you love -- it's a terrible injustice that family are so often left to do it. But witnessing or facing or imagining this loss isn't the same as experiencing it, as it happens. I don't know how informed anyone can really be about that. The judgement of the value of this kind of life comes from outside that experience.

I firmly believe that we're nothing beyond our materiality, that nothing exists beyond it, and no thing directs it. I don't believe we're here for any reason/s in particular, we make those up as we go. And yet I can't seem to rid myself of an irrational attachment to life as given -- by what? by nothing, by accident, but there it is, only for as long as it is. I don't think I could easily let it go.
posted by cotton dress sock at 3:10 AM on August 3, 2015 [3 favorites]


It seems to me, that regardless of the rationale, the question of choosing euthanasia for oneself is quite different from choosing suicide for oneself. Most suicides give no thought to the trauma of whoever is going to discover them (probably someone who cared more about you than the norm) or who is going to have to clean up after you (even if it is their profession). As such, it has a selfish aspect to it that a planned (legal) euthanasia would not.
posted by spock at 5:27 AM on August 3, 2015


"I dare say that quite a few people have contemplated death for reasons that much later seemed to them to be quite minor. If we are to live in a world where a socially acceptable "early death" can be allowed, it must be allowed as a result of careful consideration.

Let us consider me as a test case. As I have said, I would like to die peacefully with Thomas Tallis on my iPod before the disease takes me over and I hope that will not be for quite some time to come, because if I knew that I could die at any time I wanted, then suddenly every day would be as precious as a million pounds. If I knew that I could die, I would live. My life, my death, my choice." - Sir Terry Pratchett
- Final lines of his Richard Dimbleby lecture Shaking Hands With Death on euthanasia and assisted suicide, quoted in "Terry Pratchett: my case for a euthanasia tribunal" in The Guardian (2 February 2010)
posted by Fizz at 5:51 AM on August 3, 2015 [4 favorites]


Well Spock, if you make a thing illegal then it's going to be a bit messy. It's not fair in my book to carp overmuch about how selfish suicide is, if we haven't offered a clean alternative.
posted by wotsac at 6:01 AM on August 3, 2015


The problem not addressed is that quality of life versus time in nothing like a monotonically decreasing function. If it was it would be simple to decide at some point it ain't worth it and I'm out. But for most people you have some real good days and some real bad days and the hope for a few more good days can get you through a lot of shit.

Anyway other than that her rationale looks pretty rational and not depressed.
posted by bukvich at 6:40 AM on August 3, 2015


Well Spock, if you make a thing illegal then it's going to be a bit messy. It's not fair in my book to carp overmuch about how selfish suicide is, if we haven't offered a clean alternative.

This. Look, I have given this matter some thought, because people in my family have had some bad drawn-out ends that bankrupted their families and were full of suffering. I would like to avoid that.

But clean, humane options are not legal for me. What would that leave me, if I wanted to go and didn't have the scratch for a trip to Switzerland? Or the ability to get the right kind of drugs? Well, guns here in the US are pretty easy to come by. I'd hate to mess up my car or home or be found by loved ones. So probably a drive to a secluded area, get out of the car, leave my ID/phone/note in the car, and take care of things that way.

I would indeed feel bad for whatever stranger found me. But what exactly are my options in this case?

I hope I never have to do that. I certainly don't want to think about dying, at all. But it pains me more to think about an end that tortures me and my family, while also bankrupting them. We live in a savagely non-compassionate society when it comes to dealing with illness and death. Don't blame people who escape the worst through the only means they have.
posted by emjaybee at 7:20 AM on August 3, 2015 [6 favorites]


Like emjaybee, I have given this a world of thought. I am still young (44) but I have watched and been present at the end of dozens of lives. Mostly AIDS, also cancer and dementia.

I have been depressed. I have had clinical depression. But I am not depressed currently nor have I been in a number of years. I do not have any intention of having my ass wiped for me by a stranger (or a loved one for that matter) beyond my ability to think clearly. I have a clear plan and I intend to execute it (pardon the phrasing) when I deem it necessary.

I want to live. I have no desire to die, but I have even less desire to live in a state of obliviousness and pain where I am unable to get my needs met. That should be for me to decide and me alone. I understand that some depressed people will take their lives and there are all kinds of other ethical arguments in that soup pot, but I believe that we should each have the power to decide when our time has come to leave this mortal coil.
posted by Sophie1 at 7:46 AM on August 3, 2015 [4 favorites]


The really sad thing here is the part economy plays - in her suicide, and in our comments.
Assisted suicide is particularly attractive when sufficient care is not available. And sufficient care is not available because few people can pay for it. Even in countries with advanced social programs, care today is limited by costs. In her blog, Gill Pharaoh writes about how care for the elderly is a on a separate budget from health-care in the UK - so even though the UK has good healthcare, they can still have bad care for elderly people.
To my mind, that is a disgrace. The people who are old today and need care have spent a lifetime contributing to society and paying taxes. Now, we throw them under the bus.

I find it difficult to discuss wether assisted suicide should be legal as long as economy plays such a huge role in the decision-making.

For all the people arguing that they don't want to end up demented, that they want to control their end of life - I get that. But the thing is that with new therapies, even demented people might have a happy end of life. I've visited a nursing home where they worked with memory therapy and even design for dementia, and there were almost none of the indignities we have seen elderly people being put through from when they are not cared for properly.
posted by mumimor at 7:49 AM on August 3, 2015 [4 favorites]


"I am making a decision that is sad, but I feel it is necessary. "

is not the same as

"I am making a decision from a place of depression."

We had to make one such decision last week; Best Dog Ever was sick. He no longer played with toys or enjoyed eating; he only had brief moments in which he enjoyed anything. It was not an emergency; he was not going to suffer physically, immediately, if we did not make the decision. But his quality of life was almost entirely gone, and he was only going to get worse.

That was a sad decision, but not made out of depression. In fact, it was made out of love. There was no reason to continue making him unhappy, just to make him stay with us. So, for love, we called in the vet and held and cuddled him while he recieved the lethal injection. And we cried.

...
A person should have this right, to know for him/herself when the moments of joy are not enough to make up for the rest of the pain. It should be a decision you can make when it is not a crisis, so that you can consider it rationally.

A person who has made that decision may sound sad or resigned, without suffering from a clinical mental illness. If your body prevents you from doing what you enjoy--and you will never be able to do it again!--then you should be able to leave your body.

A serious, deeply considered decision may not sound joyous, but that does not make it depression.
posted by galadriel at 8:12 AM on August 3, 2015 [7 favorites]


" with new therapies, even demented people might have a happy end of life [...] I've visited a nursing home where they worked with memory therapy and even design for dementia, and there were almost none of the indignities"

I am thinking that you did not see any end stage dementia. There is no dignity, only suffering. Do you genuinely think dementia sufferers remain happy when they have forgotten speech and can not communicate, forgotten how to walk and can not indicate where they would like to go in a wheelchair, forgotten toilet use and must wear a (often dirty, since they can not communicate that it needs changing) diaper, dementia has taken their ability to swallow but their families can not bear to let them go so they have a feeding tube.

This is not a "happy end of life," and it can go on for *years*.

Dementia takes indiscriminately from memory, both conscious learning and unconscious muscle control. There is no treatment yet that can stop the memory deterioration or restore memory. The only way, currently, to avoid suffering this way is to die early of something like pneumonia, or to check out voluntarily while you still can. Death by dementia is a horror, no matter how well it might be managed while the dementia patient still has some awareness.
posted by galadriel at 8:34 AM on August 3, 2015 [6 favorites]


I find it difficult to discuss wether assisted suicide should be legal as long as economy plays such a huge role in the decision-making.

No kidding. Economy, and attitudes towards pain medication. The fact that this article was written by a health care professional speaks volumes to me. She doesn't sound depressed to me necessarily. From here in my armchair, I'd say it's more like chronic pain, which really does a number on you mentally.

Having watched both my parents, and one other family member, struggle with diminished capacity for periods ranging from a couple of months to a few years before death, I don't believe that life with less capacity or comfort is to be avoided at all costs, at least not for me. My family members didn't seem to feel that way either; in fact, the one who had been most in favor of ending life before you become incapacitated wound up changing his mind and fighting very hard for an additional two years. But in order to even consider accepting that stage of life, you need a lot of moral support and some sense that you will not ruin other people's lives when they have to sustain you physically and financially. After a few months in a care facility, my father said something like, "OK, I'm done." He had spent a lot of time talking to people and trying to sort out relationships; clearly that was a valuable time for him but he felt he had reached a good point to stop. But he was also horrified by how much staying alive was costing. He died shortly after, even though doctors thought he had a another year or two. So many people said "Good for him," as if that had been a well-timed decision but I think it was a coincidence, a lucky one.
posted by BibiRose at 8:36 AM on August 3, 2015 [2 favorites]


I live in the oldest non-planned retirement city in the US. The median age here is 67. Every day offers a glimpse into a possible future. One of the moments that tends to stick with me happened several months ago. I was working at a popular restaurant/bar with live bands every night catering to the boomer+ market. One of our regulars requested a table because it was date night with her husband. His nursing facility dropped him off at 6:30 and picked him back up at 8:30. His wife struggled to help him make a decision on what to eat and, then, to feed him. Two people in their mid-late seventies... one so vibrant & alive that she hung out at a bar drinking vodka and dancing 5-6 nights a week, the other struggling to eat or, even, speak.

There's really no way to tell which end of the spectrum we'll land on, assuming we're living relatively healthy lives in our younger years.

I have no qualms with her decision to take her life at a time when she felt she was ready to take it. My choice would have been to have waited it out a few more years and to eek out a bit more enjoyment in this world - but that's my choice and not hers.

Whenever right to death sorts of things come up, there are the inevitable concerns that this means we don't respect our elders and that a widespread acceptance of assisted suicide could lead to even further lack of respect. I disagree. I think it signals the exact opposite. We are respecting them and their power of control over their lives. Further, it seems that by learning to celebrate that, we would start to respect the impact that they can continue to have in both their own life and ours.

Getting old is not a curse. Becoming frail and having your control taken away from you is.
posted by imbri at 8:46 AM on August 3, 2015 [6 favorites]


When a dog or cat has end-stage cancer or is horribly maimed then it's universally considered inhumane not to put them to sleep. Yet somehow humans apparently don't deserve the same compassion as dogs.

Trouble is, we don't just put dogs and cats to sleep when they have end stage cancer or other painful irrecoverable conditions. We'll put them to sleep when we can't afford the care. We'll put them to sleep if their condition is disruptive to our lives but they are otherwise happy. We put them to sleep if they bite people. We'll even put perfectly healthy animals to sleep when they aren't adopted--humane organizations cite around 2.7 million healthy animals put down each year in the US.

So if that's the level of compassion we're talking about people deserving, it's good to pause and think really hard about all of the implications, because people who are old/disabled/have difficult medical conditions are already frequently denied the support and care they need to have good lives, and it seems a lot easier for society to not work on increasing that level of care and just nudge them towards euthanasia instead. My own individualistic instincts do want self suicide to be an option, but I worry about society's structure making it a "choice" like being poor is a "choice".
posted by foxfirefey at 10:12 AM on August 3, 2015 [7 favorites]


I am thinking that you did not see any end stage dementia. There is no dignity, only suffering. Do you genuinely think dementia sufferers remain happy when they have forgotten speech and can not communicate, forgotten how to walk and can not indicate where they would like to go in a wheelchair, forgotten toilet use and must wear a (often dirty, since they can not communicate that it needs changing) diaper, dementia has taken their ability to swallow but their families can not bear to let them go so they have a feeding tube.

I am thinking that you didn't proces what I wrote about money. My great aunt ended up almost a vegetable, but in a state-of-the-art nursing home, where the dignity and well-being of patients was prioritized. All but the last two or three months, she was aware enough to be happy talking with her parrot and re-remembering things from almost a hundred years ago. She was very sweet during her demented old age, always smiling and caring for others.
I am not here to judge that she would have preferred suicide at 75 to death at 97. She didn't have the choice, and her demented self was clearly more content than the hyper-intelligent, critical and angry not-demented person she was before.
It cost a fortune to keep her going, but gratefully, she died before politicians were even thinking about cutting down on care.
My great-aunt was not typical, and I don't see her as an argument for or against anything. But what I learnt from her old age was that respectful and holistic care makes a difference. Since she died, even better treatment has been developed. Dementia - as seen from the point of view of the patient - isn't necessarily terrible. It looks terrible, not least when you are a caregiver or a child of a demented person. But demented people given proper care don't have to suffer.
posted by mumimor at 10:18 AM on August 3, 2015 [2 favorites]


Trouble is, we don't just put dogs and cats to sleep when they have end stage cancer or other painful irrecoverable conditions. We'll put them to sleep when we can't afford the care. We'll put them to sleep if their condition is disruptive to our lives but they are otherwise happy. We put them to sleep if they bite people. We'll even put perfectly healthy animals to sleep when they aren't adopted--humane organizations cite around 2.7 million healthy animals put down each year in the US.

So if that's the level of compassion we're talking about people deserving, it's good to pause and think really hard about all of the implications, because people who are old/disabled/have difficult medical conditions are already frequently denied the support and care they need to have good lives, and it seems a lot easier for society to not work on increasing that level of care and just nudge them towards euthanasia instead. My own individualistic instincts do want self suicide to be an option, but I worry about society's structure making it a "choice" like being poor is a "choice".


Quoting this for truth and because I can't like it a thousand times
posted by mumimor at 10:19 AM on August 3, 2015 [6 favorites]


> Well Spock, if you make a thing illegal then it's going to be a bit messy. It's not fair in my book to carp overmuch about how selfish suicide is, if we haven't offered a clean alternative.

Yes, that's sort of my point. I'm non-political, but I was speaking of the issue generally, from 40,000 ft, (not discussing any particular country's laws for or against the matter).
posted by spock at 11:19 AM on August 3, 2015


"I am thinking that you didn't proces what I wrote about money. [...] But demented people given proper care don't have to suffer."

Sure I did. I am telling you that, completely unrelated to economic factors, you do not know as much as you think you know about end-stage dementia.

I have recently watched an Alzheimer's sufferer go through the absolute best care money could buy him. He suffered a hell of a lot, for years, and indignities were only the minor consideration. The family also went through misery, struggling to help him not suffer, when there literally was not more they could do. This is not a happy death.

Not even unlimited money can prevent that. Economic factors can not change what dementia does to the brain. The best care cannot prevent the suffering that will happen when you die because parts of your brain stop working a bit at a time.

The difference between Alzheimer's and, say, a stroke that might leave you similarly incapacitated, is that when you are diagnosed with Alzheimer's, you know it is coming. It could be possible to consider the options, and plan to voluntarily check out before you reach the intolerable period--as long as you're still in whatever mind is necessary to pass pre-checks wherever it is legal. (Which is a shame; it would be better to be able to say, "I want to go when I reach X stage or Y symptoms.")

Since Alzheimer's has a known hereditary component, this is not an academic question; it is one that my family is struggling with, with best hope being "maybe they'll be able to treat this by the time it affects the next generation." But "how do I keep that from happening to me" with a side of "find a way to kill me first" comes next.
posted by galadriel at 11:41 AM on August 3, 2015 [2 favorites]


I'm a hospice and palliative care nurse. I respect whatever choices a given person makes for themselves; I would absolutely choose to end my own life rather than suffer through the potentially many years of worsening dementia. I also feel this woman made an informed decision on her own behalf. The things we do to the elderly and terminally ill in this country are horrific, truly awful. Anyone who is familiar with this and opts out, well it seems pretty rational to me.
posted by yodelingisfun at 11:48 AM on August 3, 2015 [9 favorites]


Another nurse chiming in to support Gill's choice.

It's only anecdotal, but I've met way too many folk whose existence was reduced to that of "a decorative placeholder" (direct quote). I'd have been surprised if she hadn't sounded a bit depressed. Her life was situationally depressing and unlikely to change in any way reasonable to her.

She was suffering. Now she's not.


It's all about quality.
posted by ptochocrat at 1:51 PM on August 3, 2015 [3 favorites]


[Small text edit in the post by request of OP: "commits" changed to "dies by"]
posted by taz (staff) at 11:45 PM on August 3, 2015


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