Monday, November 24, 2014

THE RIGHT TO DIE

This essay addresses the question of whether and under what circumstances a person should have the right to end his or her life voluntarily.  Pretty heavy stuff, I know.  While I have read some literature on the subject, I am no moral philosopher.  So this may be the height of naiveté on my part, as there have been hundreds of volumes written on this subject by others who have given these questions a great deal of thought.  Nevertheless, I find that I have strong beliefs on the question.  And my goal here is simply to share some of those beliefs and to test those beliefs by writing about them and by inviting others to help me to refine or rethink them.

There are a host of variations on the question of the right to die, but in this essay I would like to address just one subset of that larger question.  To do that I would like to preface my thoughts with the following personal experience.

In January of 2009 my wife Geri’s only brother, Frank, was diagnosed with lung cancer.  He had been a moderate to heavy smoker for much of his adult life but had stopped smoking cigarettes for several years.  So the diagnosis came as a shock to him and to us.  Unfortunately, as with many cases of this disease, Frank’s cancer had metastasized by the time it was discovered.  The 5-year survival rate for metastasized lung cancer is only 4 percent and 50 percent die within the first year of diagnosis.  Frank announced that he was going to use every means available to fight the disease.  My guess is that he was never informed of the terrible odds he was facing.

Frank had never married and for several years had been living with his (and Geri’s) widowed father, Frank, Sr., by then in his late 90s.  Following the diagnosis, Geri several times made the drive from our home in Milwaukee to the Twin Cities to support Frank while he underwent rounds of chemo and radiation therapy.  This was a particularly busy time for us.  Work for me was especially hectic.  In addition, I underwent minor back surgery in May and shortly after that we traveled to Duke University for our son Jeff’s doctoral graduation.  In June Jeff got married to his fiancee, Bei Wang, and the wedding was held in Milwaukee.  Not only were Bei’s parents coming from Chengdu, China for the wedding, but so were our daughter Michelle and her then husband Earl from Australia.  Some of Geri’s relatives from the Twin Cities were also driving down for the wedding, but Frank decided that he was too weak to travel.  No one said anything, but I think it was then that we realized that he wasn’t going to make it.  

In late July Geri and I drove up to the Twin Cities to visit Frank.  I had not seen him in a number of months and was shocked by his appearance.  He had always been a big person, 6’ 4” and weighing close to 300 pounds.  When I saw him in July he had lost over 100 pounds.  Worse, he was no longer talking about treatments.  Instead, he pointed out all of the places—in his chest and abdomen, in his neck, probably in his brain—where the cancer had spread.  Psychologically and practically, the fight was over.  Frank had always been quiet, not given to deep discussions, but always the one to look for the joke.  Now he was even quieter and there were no jokes.  Instead, there was a deep bitterness apparent in his face and in his voice.  

One incident particularly sticks in my mind.  Frank had always enjoyed sitting out on the patio behind the house in the evening, and during our visit he expressed a wish to do that again.  By this time he was so weak that he could no longer stand up or walk by himself.  But it was a warm evening and we managed to get him out to the patio.  After 15 minutes, though, he had had enough and asked to be moved back inside so he could lie down.  In addition to his weakness, he was unable to eat, had become incontinent, and was in a great deal of pain.  He talked about the pain but never complained about it.  Even so, hIs entire focus had come down to when he would get his next dose of morphine.  He said it was the only thing he cared about.  Frank had begun receiving hospice care, which included visits twice weekly from a nurse who oversaw his pain medications and counseled us on how to deal generally with his situation.  She helped us arrange a number of logistic matters including a hospital bed set up in the living room and round-the-clock attendant care.

We had planned to drive back to Milwaukee on that Sunday, but Geri decided to stay longer.  She and I kept in touch by phone and she reported that Frank seemed to be disengaging further.  His pain medication dosages had been increased, and he was sleeping a great deal of the time.  Then very early Wednesday morning I got the call.  Frank had died at 3:30 a.m. that morning, August 5th, less than seven months after his initial diagnosis.

One could say that Frank was always destined to succumb to that terrible disease, but that was not his initial attitude.  He began his fight with confidence, but at some point his situation became hopeless and he realized it.  That was maybe eight weeks before his death, eight weeks of unrelenting pain and despair . . . for what? The same end result.

No one ever spoke to Frank about choosing the timing of his death, and I doubt if he thought about it.  He wasn’t that kind of guy.  But I have no doubt that he would have chosen to hasten his death, if that were presented as an option.  And that’s my question: Should it be an option?  My answer is an unequivocal yes. 

I want to be clear that in this essay I am not addressing whether individuals who are not terminally ill should be allowed to end their lives.  Nor am I addressing if or whether someone else should be able to make that decision for an individual lacking the competence to do so.  Those are topics for another discussion.  

What I am talking about are situations in which a mentally competent individual is facing imminent and inevitable death.  In those situations there ought to be a discussion—perhaps a difficult discussion—of the individual’s future and the options that are open to her or him, including choosing when and how to deal with that future.  Moreover, such an individual should have the ability to enlist the aid of a medical professional to ensure that that process would be painless and certain.  Finally, everyone involved in such a situation—the persons conducting the conversation, the loved ones who need to cope with the loss, the medical personnel who assist in the process, and most importantly the individual making the choice—should be recognized for making a courageous decision.

I recognize that my point of view raises questions and involves potential pitfalls and slippery slopes:  What does “inevitable” mean?  “Imminent”?  “Competent”?  But I believe these are manageable issues.  Currently, assisted suicide is legal in Oregon, Washington, Montana, Vermont, and New Mexico, and I have not heard of any abuses of that right in those states.

I understand that many people disagree with this position, so I want to be clear about some of the aspects of my worldview that inform my point of view.  I hope that, if we disagree, it is because we are starting from different foundational beliefs, not because I can’t think straight.  You can decide for yourself.  Here is a list of those relevant beliefs, which are significantly interrelated. 

1. There is no personal God who is concerned with our actions or who is sitting in judgment of those actions.  Thus there will be no punishment or reward for our actions, including suicide, beyond any consequences they may have in this life.

2. There is no ultimate (divinely directed) meaning to our lives.  However, we each create our own personal meanings.  For me these meanings include enjoying family and friends, engaging in hobbies, making a contribution to the greater good, appreciating the beauty that I see in the world around me, pursuing truth.  They are what drive my life. 

3. We are all mortal.  Regardless of what you may have read, no one has escaped death.  Ever.  Death is just a matter of when, not whether. 

4. Death is final.  There is no existence, i.e., consciousness, after death.  Period.  Essentially, for each of us death ends any present, any future, or any past.  Once you are dead it doesn’t matter what might happen going forward.  Death also ends any pain—or pleasure—you otherwise might have experienced.  In addition, once you are dead the past no longer matters.  You will have no memory of your triumphs and no regret over your failures.  It’s as if you never lived as far as you are concerned.  Moreover, it won’t matter to you what others might think of you after you’re gone, that is, if they they think of you at all. 

As I said, while I have given this some thought, I am no moral philosopher and I am sure my point of view has been affected by my personal experience.  One of my goals in writing this has been, hopefully, to hear other points of view regarding this subject and to sharpen or modify my perspectives in light of those viewpoints.

© 2014 John M. Phillips

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