The subject of assisted suicide is painful to think about – and very controversial, as I have found out.
I hadn’t intended to research assisted suicide. It was a bargain bin that seduced me, offering A Chosen Death: The Dying Confront Assisted Suicide for fifty cents. It turned out to be a well-spent pittance, informing me about this contentious area.
Although the book is now out of print, I thought that it was worth reviewing. (It’s available as a used book on amazon.ca.) Its author, Lonny Shavelson, follows five individuals wrestling with illness and disability, all wanting assisted suicide from a doctor, relative or friend if the pain gets too severe. Interwoven with personal experiences are details of the larger picture.
Shavelson begins his exploration of physician assisted suicide (PAS), which is illegal in Canada and most states south of the border, with details from his own life. His pre-ordained role in life, he was taught, was to become a doctor and find a cure for his mother’s disease. If that didn’t work, he was to give her a fatal injection of potassium chloride.
“In the household of my childhood, my mother simply assumed it would be appropriate for me, the son, to help end her life when she decided she was ready. As a child, I thought this was a common family arrangement.”
This pressure affected Shavelson, sending him into a depression of his own. Although he left home at sixteen, he did become a doctor, and later, a journalist. In his early forties, he was thrown into awareness of the controversy about PAS when Dr. Jack Kevorkian was arrested for assisting suicide – and Final Exit by Derek Humphrey, a how-to-manual for suicide, sold 520,000 copies.
“I realized that, secretly, in darkened bedrooms across the country, thousands of parents, children, husbands, wives, sisters, brothers, lovers and friends were deciding whether or not to aid in the death of a loved one,” writes Shavelson.
The first story is about Renee, a young woman who developed brain cancer that metastasized to her lymph nodes. When she felt she had had enough suffering, she took a certain medicine (we’re not told which one) and some vodka to strengthen the effect. Unfortunately, she was still alive many hours later. Shavelson had to decide whether to leave her in a coma or help to finish the suicide. He declines to be explicit, stating, “Euthanasia is a capital crime.” In resonating with hundreds of other families who have struggled with similar decisions, he concludes, “this is not how it should be.”
Pierre was a gay man with AIDS. The unusual part of his situation was that gay men in California were not arrested for assisting suicide. While Dr. Kevorkian was being prosecuted in Michigan, gay suicide helpers in California could openly assist with no fear of arrest. “Isolated by a society that had rejected them, gays were making their own rules – especially about death and dying,” says Shavelson. He notes that gay men suffering from AIDS exchanged recipes of lethal drug combinations the way women exchange recipes for coffee cake.
Even though assisted suicide was available to him, Pierre kept putting it off. He threatened suicide if he ever became bed-ridden or had to use oxygen, but when these conditions actualized, he would shift the criteria to avoid “doing it” that day. Shavelson calls this the “moving line in the sand” that terminally ill patients often use. Pierre died in his sleep, knowing that he could have assistance if he wanted it.
Interwoven with the stories are many philosophical points, the pros and cons of legalizing assisted suicide:
• If physician assisted suicide becomes legal, will doctors spend the time to determine whether patients requesting that service are temporarily depressed or are indeed suffering unbearable pain? Some fear giving the doctors this power will enable them to either act too quickly or refuse a valid request.
• Will poor and handicapped people be unnecessarily euthanized? Will rich elderly patients be pushed into death by greedy relatives? These are concerns voiced by the anti-assisted suicide forces. The subject has become polarized between “Right to Life” and “Die With Dignity” camps.
• Shavelson points out that abuses of assisted suicide do exist today. “In the absence of legally available aid from physicians,” he writes, “abuses are occurring at the hands of unregulated freelance euthanasists, illegal suppliers meeting an otherwise unmet demand.”
• Shavelson claims that the public supports physician assisted suicide. “… opinion polls have repeatedly shown that some two-thirds of the public favours the right of people with terminal illnesses to end their lives, and to have professional help to do it.” He also claims that up to 37 percent of doctors surveyed have admitted to aiding in the death of a terminally ill patient.
The Hemlock Society is one of many “right to die” organizations that provide literature, meetings, and conferences about assisted suicide – and details of the various methods of “self-deliverance.” Although Hemlock says that members do not provide counseling or end-of-life assistance, no effort is made to police the membership. Shavelson details the actions of one Hemlock member who provided lethal drugs to a sick man – and then, when he decided he wanted to live – forced him to go through with the suicide. Hemlock was notified of her behaviour but nothing was done about it.
Palliative care groups wrestle with PAS
In A Chosen Death, Shavelson reports the American Academy of Hospice and Palliative Medicine (AAHPM) as being against Physician Assisted Suicide. The whole hospice movement took a vehement position against clients even talking about the possibility. If a hospice worker heard that a client might be considering assisted suicide, that client was cut off palliative care services.
Since Chosen Death was written, things have changed. Because the Canadian Hospice and Palliative Care Association changed its position from prohibition to one of “studied neutrality,” the Americans followed suit. In their statement to the media in February of 2007, the AAHPM recognized “sincere, compassionate, morally conscientious individuals” on either side of the debate. “[Our] members should … continue to strive to find the proper response to those patients whose suffering becomes intolerable despite the best possible palliative care,” AAHPM claimed.
Another change: instead of PAS (physician assisted suicide), many groups are using PAD (physician assisted dying). The workers in favour of legalizing this area felt that PAD was a more marketable term, a softer verbal landing spot for a distressing topic.
Spirits may need help to move on
There’s one aspect of assisted death that people might not be aware of. I have learned from other books that when a person dies naturally of illness or old age, the body gives off a “signal,” alerting spirit helpers on the other side to come and assist with the transition. There’s a chance that in an assisted suicide, the signal would not be given off and the spirit would be stranded on the earth plane. We call such spirits "mind-set spirits" or ghosts.
One solution I have read about is for family and friends to light a candle and pray for the spirit of the deceased, asking that he or she receive the help needed to go to the light. Perhaps a priest performing last rites for a person intending assisted suicide would help the spirit as well. This could be an area for right-to-die groups to look into, providing spiritual counseling and end-of-life spiritual ceremonies when requested.
I emailed Lonny Shavelson to ask if he and his subjects had discussed belief in the afterlife. Here’s his response: “I don't recall any focus on the afterlife (or lack of it) in my conversations with the folks in the book. Although I'm sure we talked about that, the focus was distractingly on the details of ‘how can I get there in as dignified a way as possible,’ much more so than ‘what happens once I'm there.’
“That, again, is one of the sad things of having dying people and their families in isolation deal with planning, dosages, timing, comfort, etc. when they could be exploring the more profound aspects of their deaths and whatever may follow.”
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In A Chosen Death, Lonny Shavelson has provided a thought-provoking exploration of assisted suicide. He makes a good case for allowing it to be legalized. One of the safeguards he recommends is that of having two physicians examine the patient, and to consider medical and psychological help before approving assisted suicide. He suggests that an attempt at regulation, although there might be some abuses, would be better than the unregulated mixture of amateur attempts that we have now.