A Peaceful Dignified Exit, and to All a Good Death

Death, a natural and unavoidable part of life, should be painless, peaceful, dignified and a celebration of the life that was.

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My dad’s best friend died a few weeks ago. They were friends for over 70 years and our families were intertwined for most of those years. Growing up I benefited from having a second dad without all the “dad baggage.” Someone I could chat with and get wise advice from with no strings attached. He was confidential, easy to speak with, always ready with sound common sense advice and never burdened by a need to judge, criticize or “fix” my problems. I was greatly saddened by his death and frustrated by my inability to be there by his side in the end. Profound anger and deep sorrow–these are the strongest emotions I still feel when I think of his end-of-life suffering.

He and my dad grew up together in the 1930’s (before the rebirth of Israel in 1947) while the country was under British rule. They joined the underground together, fought the war of independence together, formed the Israeli Defense Force together and built a country together. They were a band of brothers with a bond formed in hardship, sacrifice, struggle, blood, tears and loss. They came of age at a time of profound change, purpose, energy, and elation in Israel’s history and were both part of that great generation that partook in and lead the amazing journey of Israel’s rebirth. As is often the case with long-term close friendships forged by intense and extraordinary events, they became family by choice and my dad’s best friend was the charming & good looking one, always the center of good times for all he touched.

His last battle with cancer–which he spent imprisoned and betrayed by his broken body–lasted several years. A formally vibrant and charismatic man was reduced to a basic, childlike and helpless dependent-existence in a hospital bed. Medicine and doctors kept him “alive” using machines and flooding him with drugs to take the edge off the excruciating pain. Lying there, day after day, mouth open and drooling, eyes vacant, mind overtaken by the fog of disease and drugs and artificially kept alive by a feeding tube, was not his (or my) idea of “living,” nor is it anyone’s choice for an end-of-life finale.

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The truth is we all think we will live forever, especially when we’re young. If we actually pondered that concept for a spell (and we don’t), we would probably come to the conclusion that living forever is not the best of ideas, nor is it a practical one. The natural reality is we are all going to die. The big question is when, how and on what terms?

In Whose Life Is It Anyway (click to a great trailer), the 1981 film adaptation of a 1972 TV movie and play of the same title by Brian Clark, Richard Dreyfuss stars as a sculptor (Ken Harrison) who ends up paralyzed below the neck as a result of a car accident. Refusing to accept his misfortune and resulting total dependent existence as “life,” Ken engages in a legal battle for the right to refuse treatment and be discharged from the hospital, which in essence allows him the choice to die.

These complex and painful ethical, legal and human issues are part of everyday life and warrant substantially more public and national discussion and debate. Three real life examples of these issues come immediately to mind:

 1. The Terri Schiavo Case.

Diagnosed by her doctors as being in a persistent vegetative state after a 1990 collapse from cardiac arrest, and after 8 years of various unsuccessful therapies, her husband petitioned the court to remove her feeding tube, an action opposed by her parents. A legal battle ensued ending up granting the request, which prompted several appeals and federal involvement, inclusive of Congress passing legislation, then signed by President George W Bush to keep her artificially alive. Her ordeal ended with her feeding tube being removed by court order and she died March 31, 2005.

 2. The Karen Ann Quinlan Case.

In this case, a legal battle ensued after her parents, informed there is no hope of recovery, requested that their comatose daughter be disconnected from the respirator and allowed to die “with grace and dignity” and her doctors refused to comply. After a prolonged legal battle, the request of her parents was granted by the court ten years later. Karen Ann Quinlan was then allowed to die a natural death.

3. The SungEun Grace Lee Case.

In this far more disturbing case, Ms. Lee, paralyzed from the neck down, suffering from terminal brain cancer and on life support, was determined mentally competent to make her own decisions by a psychiatrist and conveyed to her doctors her wish to be taken off life support. Her father, a pastor, objected since he believed it would constitute suicide which violates his faith, and took the case to court. Ms. Lee was eventually released to her parent’s care and ended up passing away 5 months later back at the hospital. Her request to be taken off the respirator for what she labeled “diminished life” was not granted since she “appeared” to accept the position of her father.

We all assume that when our time comes, we will have a painless and serene death surrounded by our loves ones (there to say goodbye and see us off to the next great adventure) as we float into a warm and comforting white light.

Unfortunately,  many of us will not experience death that way. Pain, incapacity, helplessness, indignity, deterioration and loss of all control over our lives and bodies will play key roles in the dying process for many of us. The critical issue at hand is:

Do we have a right, as intelligent humans, to a dignified and peaceful death? If so, under what circumstances and following what process?

We are and always were able to make the choice of an easy and peaceful death for our beloved pets. I was able to make the agonizing decision to put my dog to sleep (with me from age 13 to 24) when keeping him alive in a state of agony was inhumane. I loved that dog deeply and was devastated by losing him. The only silver lining was my ability to provide him with a peaceful, painless and dignified death. I cannot, however, provide that same kindness and relief to myself or to a human loved one.

In the US, Euthanasia (defined as intentionally ending a life to relieve pain and suffering) is illegal. It is legal in the Netherlands, Belgium, Columbia and Switzerland. What is legal in some states (Washington, Oregon, Montana and Vermont) is Physician Aid in Dying (PAD). The critical difference lies with who gets to administer the medication: Euthanasia = Physician or Third Party administers. PAD = Patient has to self-administer. Obviously, when we reach the point where this is a reasonable choice, we are often not able to do it ourselves. What is currently possible for us to do is decline heroic measures and life support (including a feeding tube) and choose to not be resuscitated (DNR), by completing the appropriate legal documentation of our wishes (hoping they will be honored by family, doctors, hospitals and courts, which is clearly not always the case). That will leave us to die from starvation, a painful and prolonged death, aided possibly by drugs to minimize discomfort. What we cannot choose in the US, even in the specific dire circumstances described in the examples above, is Euthanasia (having the doctor give us a shot, we go to sleep and simply do not wake up).

These issues are not new and have been debated by ethicists, doctors, legal experts, religious leaders, politicians/legislators and the rest of us for many years. Practical criteria and a framework already exists to cover the states with legal Physician Assisted Death. What is missing is the freedom for people to clearly and specifically express their end-of-life wishes in the right legal documents, confident that if those outlined specified catastrophic events come to pass, their wishes–expressed while they were in full control of their faculties–will be honored and their physician will provide them with a peaceful, painless and dignified exit.

Death, after all, is an inevitable and natural part of life. As such, it should not be feared or kept under wraps. We should discuss death as soon as we feel the need as kids, get comfortable with its inevitability and accept it. And when it enters our lives and we lose someone, we should concentrate on celebrating the life that was and the joy and love we shared with the person while he/she was alive, and we should be able to do so with the confidence of knowing our final gift to them will be accepted in peace, dignity and, finally, a good death.

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–Main Photo: Giulia Geraci /Flicker Photo2: Maggie Osterberg/Flickr
–Photo3: Chris Jones/Flickr