A Good Death

When my mother died several months ago, I was aware of both sadness and a selfish concern over the inevitability of my own death. As I watched her slip away towards the end of a long dying, I saw not my mother, but a corpse struggling to breathe. When at last she lay in morphine-induced sleep, she was fragile and thin, bones I never knew she had protruding sharply from her chest, framing her chin. Her chest heaved slightly with the effort to bring air into her lungs. I saw no other motion. She lay quiet, her body still, her hands finally unclenched.

Her mouth often stretched open, as if aping Munch’s Scream, that slanted O we all recognize as expressing the essence of existential angst. No more of the anguished cries of Mutti, Mutti, that broke our hearts bit by bit as we listened; the morphine had quenched that. Now and then there were tiny sounds accompanying the expiration of air, but never a rattle, no, nothing like that. While once she had looked at peace while she slept, at the end, the concept of peace or contentment became altogether irrelevant. She was too close to being matter only.

Estimating the duration of the dying process is difficult even for the most experienced of physicians. Several times her excellent doctor gave her less than a week to live, and she kept on living, and dying. He stopped making estimates. A strong woman, she attained the ripe age of ninety-eight for a reason; she was a fighter. Her body’s instinct was to keep on keeping on, no matter what. Her spirit held another view. I remember how we talked almost a decade about her feeling that reaching ninety would be enough for her. She had no desire whatsoever to go further. “I’ve had a good life,” she said more than once. “And I have had enough.” But she didn’t have a choice in the matter. Nor do I, when I reach the same point.

The sadness triggered by watching her die has the unfortunate concomitant of making me realize that I am myself trapped in the same choiceless system. Our society’s quasi-religious attachment to ancient doctrine means that I too have little control over the form of that end towards which we all move once we leave the womb. It strikes me as grossly unfair that public policy demands that intelligent persons, with decades of experience in making judgments regarding all kinds of serious matters that affect their own lives as well as the lives of others, are denied the right to call an end to living when living is no longer sustainable at a meaningful level.

Is it too much for a person of eighty or more to ask to want to live only as long as it is possible to do so with a functioning brain? And without resorting to extraordinary remedies like radiation, dialysis, heart and lung machinery, and ex┬Čtraordinarily expensive medicines that only prolong the dying? I, for one, don’t think so. I want the right to choose my own end-of-life life and the option to opt out, if necessary. Having an option is the essence of liberty.

Society has an interest in this question that goes beyond the philosophical desire to honor life. The public cost of keeping sick old people alive during their last year adds millions of dollars to the annual budget deficit. If practical people who recognize their own imminent or not-so-imminent but hoped-for demise wish to reduce their participation in the costly final medical adventure at a time of their own choosing, they should be treated as patriots concerned about the common fiscal welfare and allowed to die. So much money would be saved by permitting (and assisting) such people that they could be said to be dying for their country, a concept with which we seem to have no moral component when we send young able-bodied people off to die for us. Why that death-enhancing choice is more acceptable to the self-pointed arbiters of public morality remains a puzzle to me.

If my mother had had the option, now illegal in most states, to determine her own end, I believe she would have chosen to die when the small stroke she suffered three years earlier had diminished her cognitive faculties. After a short period of limited recovery, she actually became demented in a quite pleasant way. She stopped being hypercritical of the people in her life and allowed her natural tendency toward positive thinking to prevail. And, since she had the assets to pay for the best nursing environment available, she passed the intervening months peacefully and with considerable gratification. She became so cheerful and so cooperative, to the best of her limited abilities, that all the caretakers fell in love with her and treated her to the highest level of tender loving care that anyone could wish for.

But what kind of life is that, I ask, and she would have asked, had she retained her analytic abilities. Unable to wash, dress or toilet herself, she was dressed each morning for the purpose of sharing meals with her peers and filling the hours with kindergarten activities. Is there pleasure in such a life? Is there purpose? Is there sense? I answer those rhetorical questions with a resounding negative for myself, and, tentatively, for her, though it makes no difference now in her case.

I know that others think differently. I spoke to family members of other residents of her dementia-only nursing boutique. Many of them suffer and worry when their loved one falls ill or is rushed to the hospital. “We almost lost him,” one devoted wife said to me in recounting the recent surgical experience of her hus┬Čband, a well-known former surgeon reduced to idiocy. She was sad, while I was envious. Didn’t she, at some level, want him to die and end this sentence to limbo? No, I am sure she didn’t. But the doctor himself? Does he wish to keep on living? Or the former judge with whom he shares mindless activities, day after day? Does he?

Life, I believe, is for the living. Granting some legal choice for determining one’s own end would add immeasurable joy to my final years. To yours, too, I bet.

[6/25/08-02/10/12]

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