Mary* had terminal cancer that spread to her brain. She said, "I am done," as in "I am done. With life."
She said this to her family and to her hospice team, medical angels funded by the government to usher her into the world beyond.
Mary wanted to stop eating and drinking so that she could speed up her journey. "Okay," cautioned Penny, her hospice physician. "But wait a couple of days for us to discontinue your medications."
"Sure," said Mary, ever obliging.
But she didn't follow through with Penny's orders, stopping all food and water immediately. Her hunger strike lasted less than a week.
"Does it hurt?" I was curious.
"It's uncomfortable the first two days or so," Penny replied. "And we use morphine to help ease the pain."
Judy, another patient in Penny's care, also decided to hasten her exit the same way. She too went on a hunger strike. And Judy told her hospice team, family and friends, "Don't feed me if I get hungry and ask for food when I am confused." Everyone agreed.
She stopped eating and drinking and two days later entered a state of delirium.
"I am so hungry," Judy pleaded, half-awake. "Please, may I have something to eat?"
Of course they fed her! Have you ever tried to deny a dying hungry person something to eat? It's tough, I tell you. Judy died anyway, soon after being fed.
But John, another hospice patient who decided on ending his pain quickly, did something altogether different.
He hung himself.
"He killed himself!" the hospice team said.
"He committed suicide!" said his son, angry and betrayed.
"He killed himself!" echoed society, angry and violated.
Why did John commit suicide and Mary not?
The dictionary defines suicide as "the act of taking one's own life voluntarily and intentionally." The intent was clear in both cases. Both John and Mary wanted to end their lives as quickly as possible. Why did the method matter?
John's technique was more efficient and quicker than Judy's, with less protraction of suffering. Ever tried to diet? Ever know the hunger that gnaws at you, at first slowly, and then building up to a crescendo? Judy knew. She anticipated and cautioned, informed by a lifetime of failed diets.
And yet John had committed suicide and Judy had not?
"It was the violence," explained Penny. "I associate suicide with violence. I know it isn't logical, but I do. John's death just seemed so... aggressive."
But aggressive to whom? To John? Or the society he left behind? If Penny had been allowed to assist, would he have chosen hanging as the route to end his life?
Oregon's Death with Dignity act, which dealt with physician assisted suicide, now deals with physician assisted dying instead. Same act, different words. Because suicide is a term fraught with so many negative connotations to those left behind in our tangible world.
A rose by any other name is still a rose. A suicide, by any other name, is still suicide. And death, despite the best medical care, is still a part of life. It behooves physicians, and society at large, to accept death in its inevitability and help terminally ill patients die in comfort, should they so desire.
For more by Gayatri Devi, M.D., click here.
For more on death and dying, click here.
*Note: All names have been changed.