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.”
*
* *** * *
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.
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