Jack Kevorkian's death this past week has, again, brought his campaign for "death with dignity" into the forefront, but even with all the attention on legality and ethics, there hasn't been much said about the real, underlying question of why the terminally ill kill themselves. I never thought I'd be in a position to answer. In good health, my opinion was clear: Euthanasia is wrong and so is suicide. They are both selfish. Neither option should be an option.
Then came my own cancer diagnosis, and I understood a little immediately. That understanding has deepened after battling a cancer that has been labelled "incurable" and "terminal".
With diagnosis comes a flood of emotions stronger than ever felt before: shock, confusion, denial, paralyzing fear, extreme sadness and an anger with no direction. All these are felt -- stronger than ever -- in that one appointment. Even for someone with iron emotions. it's too much to bear.
Then, simultaneously, you begin thinking about worst-case scenarios. "I'm going to suffer mercilessly, vomit incessantly, lose control of my bowels, end up on oxygen with a wheelchair and entirely dependent."
When you leave, there is no counselor with you telling you where to go and what to do. You may have even gone to the appointment alone. It's then that you realize you have to tell your family and bestow the same pain you felt upon them. This could send anybody over the deep end.
The first reason someone already dying would kill themselves is simple: severe depression.
But it's not that simple. The depression is brought on by their diagnosis, along with feelings of fear, hopelessness and anger. This is coupled with a desire to "protect" the ones they love from the suffering of watching them become sick, the burden of their care and being a drain on finances.
They convince themselves it's the best option for everybody; that it's heroic -- the boldest type of stoicism, a chivalrous suicide.
The susceptibility to want to die in order to spare others continues throughout treatment and may worsen during times of decline, financial hardship or family stress.
It never goes away and neither does the feeling of powerlessness felt at diagnosis. The only way it can be mitigated is when you have an outlet -- whether it be controlling your health or health care by becoming a demanding patient, educating yourself, changing habits, talking to others etc.
But not everybody can find that outlet, and the easiest path to controlling your health outcome is to take the reigns and plan your death if death is inevitable. This way, you get to choose the time, the date, the place, with who and how. You can be entirely prepared, and you only need a little help. A need to regain power and control is reason number two.
After years of treatment and the label of "incurable," I, too, wanted to have some control. Everything had been taken from me: I could not walk more than a few steps, I could not breathe without oxygen, I could no longer play with my son or do the things I loved. I became a burdensome blob only capable of existing on the couch. I felt like a parasite, always taking and never contributing. I wanted to relieve my family of the stress they had been feeling for years. I wanted them to go on with their lives without the constant thought of me on their shoulder and I wanted to stop suffering. I'd had enough. I was ready to die. I believe this is how most people feel when they consider assisted suicide.
At this point I could have simply stopped taking my prescribed medications and my body would have slowly passed, but curious, I read stories about patients who didn't quite have the gusto to do the "act" themselves.
After that, as easily as finding a recipe for dinner on the Internet, I found an agency that provides instructions and an assistant after a review of your medical situation.
The easy access scared me. Even scarier, I qualified, but having this option did not provide me with comfort.
That was over a year and a half ago. In a moment of clarity I chose to exercise other treatment options, and eventually, I got off the couch, climbed out of the wheelchair, and walked without oxygen. I needed more time, and I am haunted by the thought of what I would have missed.
Had I set up an appointment, the outcome may have been different. I would have felt obligated to follow through. I would have had a sense of "there's no going back now." If it is easy and convenient, like a scheduled assisted suicide, people are more likely to follow through, just like more suicides occur when a gun is in the house. This may be a reason the dying kill themselves: the inclination and convenience.
My feelings regarding euthanasia are not as black and white as they were when I was not in the "terminal" category. The dying process is a deeply personal individual experience. There is no guidebook on dying with dignity and dying in a controlled manner to regain power, alleviate loved ones' stressors or to stop your own pain can be enticing. What I continue to believe is wrong is the inclusion of others who will suffer the consequences of your choice possibly in this life and beyond.
Janice Van Dyck: Reflections on Jack Kevorkian: Who Owns Death?
Assisted Suicide: A Right or a Wrong?
Euthanasia and Physician Assisted Suicide: All sides to the issue
I am glad that the author was able to regain a lot of function. Not everyone, however, will; Ultimately, Oregon has it right--when medicine can drag death out incredibly, it should be up to the patient to decide when to call it quits.
Funny you should mention "vet use" for the drug from Mexico. I live in a small town in CA. We had a very popular vet whose compassion for animals and their owners was legendary. A very quiet, compassionate, and skilled man. He himself became very sick. He had to sell his vet practice which he treasured. So, he too, rented a hotel room and took a bottle of dog tranquilizer to commit suicide.
A lonely way to die for such a beloved man in town. Sad.
Some few years ago, a palliative care nurse in Australia used Nembutal to depart, when her bone cancer became unbearable. She knew from experience how inadequate palliative care can be. She made the decision to end HER life when it was necessary. The only burden was that, because of our regressive and idiotic laws, she had to do it in secret: she hired a motel room and was not able to tell her family (who knew her wishes and supported her) when or where she was going to leave. She wasn't able to have them with her, in case they were prosecuted. Even getting the Nembutal from Mexico put her friends (from Exit) in danger of prosecution: it's banned except for veterinary use here. I don't think this woman should have had anyone imposing their essentially religious beliefs on her about how to conduct herself, how to approach her illness and departure - and implying that anyone will be "judged" for it in the hereafter kowtows to a deity not worth anyone's time.
Dr. Kevorkian had one take on end of life care. Here's another one: http://www.soonerorlaterbook.com
I wish you well on your journey, but it isn't time for you to go yet. Make the space between your years as care-free and joyous as you can. Your article is insightful & tender.
God Bless! Damiano de Sano Iocovozzi MSN FNP CNS at the Thomas Edwin Walls Foundation