I'm looking forward to watching Peter Richardson's controversial documentary, "How to Die in Oregon," debuting on HBO May 26. The acclaimed film took best documentary at this year's Sundance Film Festival. In it, the filmmaker offers a galvanizing exposure to real people who plan to use Oregon's Death with Dignity Law, which allows a physician-assisted death by drug overdose for patients with less than six months to live.
I'm more knowledgeable than most people on the topic of death and dying. Last year I published a novel, "Finding Frances," about a woman's end-of-life choices and the effect her decision had on her family. I wrote about different views, beliefs and emotions on ending life, wrung from my own experiences and extensive research after my mother died. Although I was sure I'd fully intellectualized the topic, seeing the reality of a dying person voluntarily ending their life on screen will surely give me more to think about.
If you plan to watch the broadcast, consider some of the broader cultural issues before figuring out how you feel about it. First consider why we're so uncomfortable thinking about death. I offer one of my fictional character's thoughts when his mother is dying:
(Excerpted from "Finding Frances")
As a society, we're always trying to make certain life is happy, or that it seems to be, anyway. Sickness and death are embarrassing and ugly by our standards. Their presence in the middle of our otherwise happy lives is intolerable.
If we cheat death, we['re] champions. We dodge the bullet -- life won by a quick move in the nick of time. And if we lose, we['re] death's victims, as if we had nothing to do with it when we had everything to do with it!
...[O]ur society's got us running scared; we don't know anything about death anymore. Our whole focus is on life and living. I can't tell you how many books I've read about how to have a happy life. I've never even seen one on the shelf that would tell me how to have a good death. If I knew that, maybe I wouldn't be so afraid.
As I wrote my fictional character struggling with the same issues I did when my mother refused a chance at life-sustaining treatment, I had him ruminate on whether declining a chance at life is the same as causing one's own death:
If a person isn't wealthy enough or doesn't live in a place where medical help is available, we believe it's okay for them to die unattended. No one makes much of a fuss about it....But if a person lives in a country of privilege and they happen to be sick in a hospital before dying, the rules change...
That life no longer belongs to the individual or even to God. That life belongs to the doctors and nurses and hospital boards, to drug manufacturers and insurance companies and ethics committees. When did we turn over our deaths to institutions?
For thousands of years, right up until the Twentieth Century, death was a ritual of our species -- an unavoidable crossing each generation experienced and the next generations witnessed. It was treated with the respect of any significant passage, just like births, puberty and marriages were. Death was attended by neighbors, friends and relatives as a matter of course -- it was unexaggerated, unglorified. It was accepted with appropriate solemnity. It belonged to and, most times, was orchestrated by the dying person.
Any death, especially one that raises profound questions, causes strain on a family. My novel's characters each have different value systems they try to impress on each other. My fictional son considers our cultural attitudes toward extending a "pro-choice" attitude to the end of life:
People are against suicide because they believe a life doesn't belong to the person living it -- that it cannot be claimed like any other possession, and it cannot be terminated like any other contract. Religious people believe each individual life belongs to God... Non-religious people even generally believe [suicide is] wrong. It's against the human basic instinct to perpetuate, against the instinct rooted deeply in our brains and in whatever other physical mechanisms work to keep us alive despite the odds.
But people are not totally against death as a choice. Some claim martyrdom or just cause by killing others and/or themselves in the name of God....Likewise, it's okay to give up one's life for one's country--honorable even. ...Self-defense is a valid argument in a court of law. Millions believe in capital punishment...and in abortion, which terminates the beginning of a life. Yet there is a near-universal public policy of unwillingness to terminate the end of a life. The logic that dictates pro-choice at the beginning doesn't seem to cover pro-choice at the end.
One of the last issues to think about when considering the Oregon law is the spiritual life of a terminally ill person in the medical system. My fictional character speaks my own thoughts:
...[Institutionalizing] might have solved the problem of death's unpleasantness, but it has created another issue entirely....a hole into which all things spiritual fall and never find a landing. In a sterile hospital environment, with its science and protocol, there is no place left for our spiritual beliefs, no private place for religious rituals and prayer, literally no room for personal growth or understanding to occur as we learn from the evolution of an individual life. We no longer have individual participation in the natural order of life and death, or in the cycles of the universe. We have contrived in its place an institutional process for physical death that demands one-size-fits-all compliance.
...The increasing effectiveness of all this medicine and all these procedures only prolongs the inevitable. It keeps a body attached to the earth, often torturing the spirit and preventing it from being at peace.
The characters I wrote could be any one of us grappling with impending loss. Every day people die agonizing deaths from terminal illness. Every day their loved ones suffer with them. Every day the dying feel guilty for inflicting pain even while they are forced to suffer with their own.
I plan to watch "How To Die In Oregon" and continue developing my own thoughts on the matter. One thing's for certain: Someday I'll need to know how I feel about it.
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Janice M. Van Dyck is an award-winning author and writer. Her recent novel, "Finding Frances," is a gentle, upbeat exploration of a family's love and what it means to live and die in this age of modern medicine.
Do you know how you feel about Oregon's law for Death with Dignity for the terminally ill? Here are some links:
Organizations Against Euthanasia
Death With Dignity: The Case for Physician-Assisted Dying and Euthanasia a book by Robert Orfali
Compassion & Choices