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Rev. Amy Ziettlow

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To Kevork or Not to Kevork, That Is the Question

Posted: 07/13/11 04:16 PM ET

Jack Kevorkian died several months ago, in a hospital bed, hooked to machines, suffering from chronic illness, a frequent flier in the same hospital where he died. He could have ended his life prior to going to the hospital one last time, but he did not.

On first glance, we may be tempted to infer that his choices at the end of his life call into question the validity of his life-long crusade for the right to die. Maybe. Or maybe his choice gives us a glimpse of how knowing and following what we believe about life, and hence about death, is far more complicated than a checked box on an Advanced Directives document.

In my more than 10 years of serving in hospice I have known only one patient to actively end his life. By gun. Was his home, like most of our hospice patient's as well as our own, full of medicines and methods that could have killed him in a less bloody and traumatic fashion? Yes. This patient's death reminded me that although we all have the means to end our existence, most of us don't. However, most of our patients and their caregivers talk about how they would like to die. And most of us on the hospice team know that the conversation is less about death than it is about control.

We like to have control. Amen.

In hospice we use the term "self-determined life closure." Those are just fancy, psycho-social words for control.

Even our most primitive responses to challenge or conflict, the urge to fight or flight, are rooted in a desire for control. When faced with an illness, a common first response is battle. It is often our first response because healthcare professionals naturally train to be Four Star Body Generals, at least in their own minds. We gird ourselves with chemicals, pharmaceuticals, laser or knife to fight the tumor, the virus, the infection, and eventually we turn to fighting the symptoms of sources that can no longer be vanquished. We become survivors. We show our battle scars, lift our wigs, rattle our pill boxes. Like Dylan Thomas impassioned, we "do not go gentle into that good night," we "rage, rage against the dying of the light."

Yin to fight's yang is of course flight. As quickly as our hands can close into a tight fist, they can release in open submission, to cover our eyes or ears in denial. We can plan our end, imagining snifters of brandy and a library, like author Terry Pratchett, or moments of music and memory spent with loving friends, like Dudley Clendinen. And why not? What a beautiful picture of hope for a life lived fully. But we will be wise to take comfort from the hope of a full life, and not from the illusion of control.

I've been reading Thomas Lynch's "The Undertaking: Life Studies from the Dismal Trade." As a poet and an undertaker, he reflects on the art and ministry of embalming, graves and death in general. Early in the preface to the book, he paints a picture of how the baby boomers will face aging and death, which offers a humorous and pointed statement about the limits of control.

"My generation, those boomers ... we age with the grace of polar bears on roller skates. Wary of being caught unawares, we planned our parenthood, committed to trial marriages with pre-nuptials, and pre-arranged our parents' funerals -- convinced we could pre-feel the feelings that we have heard attend new life, true love, and death. And for all our planning, for all our micro-management, for all our yammering about our parents' mistakes, we abort more, divorce more, and soon will kevork, more than any twenty generations on the globe before us."

Yes, Lynch turns Kevorkian's name into a verb, and he is right. In the next 20 years, I imagine we will witness the options for end of life choice and control expand for those facing chronic or terminal illness, chronic or terminal pain, chronic or terminal malaise and meaninglessness, even chronic or terminal boredom. We all have a right to personal agency, just choosing honestly and choosing wisely may not be the same thing.

This morning on the way to day camp, our stylish mini-van of mom and kids listened to Justin Roberts' song about Daniel in the lion's den:

"The king put Daniel in the lion's den,
the lion's den, oh the lion's den...
He thought Daniel'd be crying,
Because he'd be afraid of dying,
On account of that lion,
But the king, instead, he heard him sing...
Here kitty, kitty, kitty, kitty, kitty...
Won't you come, kitty, kitty, kitty, kitty
I am not afraid, no, I am not afraid,
Here kitty, kitty, kitty, kitty...
Won't you come kitty, kitty, kitty...
The Lord is with me, and the Lord is with you..."

At some point, a diagnosis or deed will place us in the lion's den. As we face the complex mystery of death in the midst of life, whether we choose to fight or flight or something in between, I pray that we know no fear. The Lord is with you, and, as hard as it can be to believe, the Lord is with the lion too.

To read more about aging, death and dying from Amy Ziettlow visit FamilyScholars.org

 
 
 
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11:55 AM on 07/17/2011
As I read the comments, I find the level of understanding the issue of human mortality and the process of death we are all bound to go through is equal to the incorrect statement that the writer made in her leading statement in the article.

Dr. Jack Kevorkian did not die months ago, he died June 3rd, that was weeks ago.

Let's look at the problem in our socciety from a different point of view. Americans are enslaved to medical tyranny and are at the mercy of the state at the time of their demise. In other words, there will be no mercy in a state-controled death.

Here is something else to ponder. Those who "in the name of god" protest euthanasia are very much frightened of their own mortality and they cling to a level of belief that smothers the soul.

GOOD DEATH will come to the planet because the groundwork has already been laid.

Thank you for reading my words.

Carol Loving, Author
My Son, My Sorrow: The Tragic Tale of Dr. Kevorkian's Youngest Paitent
08:43 AM on 07/14/2011
The late actor, George Saunders supposedly committed suicide because he "was bored." I'm sure that was not the whole of it, but there does come to some of us who are aging, that the road ahead might not be as wonderful or as interesting for us as it is for others. I am coming to that point, and although I have yet to truly consider all the consequences, I do not see much advantage to living with ever decreasing eye sight and other illnesses that make life less than pleasant.

I am looking at the lion in the distance as he looks at me ---
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ConservativeAmongWolves
One guy against a pack of Howlers
09:32 AM on 07/14/2011
For those of us who believe we are here to learn from our entire lives, you have not yet all of yours out. Eyesight starts to fail (my eyes will soon need glasses); our bodies don't feel good like they used too; we start having to contend with chronic illnesses and potentially fatal ones.

Live your life to the fullest. Extract satisfaction from overcoming the "challenges" of older/old age. when the time comes when you have to choose whether to fight some significant or terminal ilness, the choice is COMPLETELY UP TO YOU.
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taoistpunk
because the monks wouldn't have me..
02:01 PM on 07/14/2011
While I can agree with most of what you’ve stated, and do appreciate your thoughtful point of view, I do not follow your reasoning on, “the choice is COMPLETELY UP TO YOU.”

I think that the Terri Schiavo case shows that our end of life choices are all just a sound bite away from becoming a political football.

Beyond that there is the more nebulous ground where someone is diagnosed with Alzheimer’s, and knows that, mentally, they will degenerate well past the point of choice, long before their body is ready to die without medical assistance.
GHarry
Kitty wrangler
08:29 AM on 07/14/2011
So Zietlow's view is that the answer to confronting the scariness of our inevitable death is to have an imaginary friend. Come to think of it, that sums up every religion ever invented. But she carefully avoided the real issue: whether assisted suicide should be legal. As someone who has witnessed family members die slow and agonizing deaths, suffering needlessly for weeks and months because of stupid, religion-based laws that prohibit assisted suicide, I have little sympathy for those who refuse to deal with this issue frankly and honestly.
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ConservativeAmongWolves
One guy against a pack of Howlers
09:36 AM on 07/14/2011
As the spouse of a physician, I KNOW that pain can be treated and dealth with in almost every case. There is even a process called terminal sedation where a person suffering a terminal disease, who is in a great deal of pain, can be put on pain medication at a level that masks all pain.

I happen to be a religiously oriented person so any form of suicide is a sin, but I understand those who seek it. There is a way around suicide or assisted suicide and that is that if a person is no longer able to care for themselves they can request no further assitance with eating or drinking......they can simply request medication to deal with the results of their rejection of any further assistance. In other words, they choose to end their lives naturally WITHOUT assistance.
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11:26 AM on 07/14/2011
"I happen to be a religiousl­y oriented person so any form of suicide is a sin"

Many of us aren't. Why should there be laws that take away our choice to satisfy your religious beliefs?
GHarry
Kitty wrangler
12:14 PM on 07/14/2011
You need to pay closer attention to the intensive care unit. 1) In the late stages of terminal illness sedatives often don't work well. Besides, why should anyone choose to go through weeks of intense pain, even if partially dulled by medication, when they could choose a quick, painless death? That's crazy. 2) As for the "no further assistance" option, instead of quick, painless death, why should anyone choose to die slowly of thirst, dehydration and malnutrition? That's also crazy.
08:09 AM on 07/14/2011
We do not just fade away as nature intended in these times of advanced technologies. When over one quarter of the medical dollars available are being used to "keep people alive" because they chose to fight a lost battle rather than face death for themselves or a loved one, then policies must and will change and an "other" will decide when to pull the plug because we could not!

I read an interesting book "Denial of Aging" by a Harvard educated Doctor who treats the elderly and it's shocking how families want the best and most expensive technologies for their comatose parents and grandparents even tho all hope is gone. If we really understood that hanging on because of fear of death is being paid for by our grandchildren and great grandchildren then we really accept that policy will be forced to take over.

It is not a "right" to demand that society use unlimited medical dollars to keep a terminal patient alive that could be used otherwise as in research and education. A comfortable death....Yes! A right to go on indefinitely despite the prognosis...No!
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ConservativeAmongWolves
One guy against a pack of Howlers
09:44 AM on 07/14/2011
I have no doubt that there is not a single fellow human who would want to be kept alive artificially if they were in a severely damaged or comatose condition....there may be a few who truly fear death, but if they could go back a few years and see themselves laying there probably unaware of their surroundings and certainly unable to interact with people and life around them, they would say "pull the plug."

The most important point, and least controversial, is that the INDIVIDUAL has the RIGHT to CONTROL THEIR LIFE......no "death panels"....no third party, keep them alive no matter what cause celeb.
08:07 AM on 07/14/2011
A person should have the right to end their life whenever they choose.
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MikeDu
Both salubrious and lugubrious concurrently.
11:09 AM on 07/14/2011
I always suspected that's the subtext of the pro-gun lobby. They say they want a lethal weapon in the house to protect themselves from maurading cycle gangs, but you get the feeling that they really want a gun in the house for the inevitable day when their liver is failing from thirty years of hard drinking and they just don't see a point to it all anymore.
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Edward Standley
opinionated jerk
12:17 PM on 07/14/2011
Feeling especially lugubrious today? :)
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leftLibertarian
Don't vote for Obama or Romney
07:49 AM on 07/14/2011
I don't see why the state should interfere if a person wants to end their life. In all seriousness, if I choose to end my life, what will they do, arrest me?
PATOISJAM
reason: strategize: succeed
07:36 AM on 07/14/2011
Death is not a mystery because God gives us information about it
Death is the result of sin.
Death is an enemy to humans and it stalks us every second
Death was not coded into our DNA, life was and that is why humans hate death
Death is unnatural
Death is a deep sleep from which only God can awaken us
Death can be killed only by God which he promises to do

Revelation 21: 4: "and He (God) wil wipe out every tear from their eyes, and death will will be no more, neither will mourning nor outcry nor pain be anymore. The former things have passed away."

While we wait on God to rectify matters, no one should judge anyone how they choose to end their lives. Sickness taints your mind and heart and flesh and cause massive distress and since God is the only one who can know the heart and mind is the only one to judge wrong and right.
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Mari Harmon
Your Kung-Fu Is Weak And Obsolete!
06:40 AM on 07/14/2011
"The Lord is with you, and, as hard as it can be to believe, the Lord is with the lion too."

This seems to be code language for "It's god's will", or "God has a reason.." "Bad things happen for a good reason." or that there is a "Divine Plan" that will make sense in the end. And these reasons tend to be the only arguments offered against assisted suicide for terminally ill patients. They tend to rest on the premise that suicides don't get to go to heaven since they've rejected God's "gift of life."

I'd rather not have those reasons, the personal religious beliefs of others, have anything to do with my own life. I'm an adult, fully capable of making my own decisions as I have had to do for this long. If my life begins to end in a painful and untreatable way, choosing to end it will also be a decision I will make on my own.
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OneFish
Various and assorted mutualistic microbial buddies
12:47 AM on 07/14/2011
I doubt very much that death is quite as complex as so many seem to belive. Whatever.
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Misterioso Adversario
THE THIRST MUTILATOR!
11:30 PM on 07/13/2011
People deserve to decide for themselves when to end their life. My grandmother had terminal cancer that progressed rapidly and caused her an intense amount of pain. Once she was diagnosed she was put on chemotherapy which took away not only her hair, but her appetite. During the entire time she was on chemotherapy, she couldn't even eat, all she could do for sustenance is drinking protein type drinks, solid food would not stay down. After it was discovered that chemotherapy could not help her, the only thing left to do was wait to die. She spent months in agonizing pain, and in the last few months of her life, was forced to be sedated pretty much 24/7 because the pain was so unbearable.

Assisted suicide was not legal when she died, not that I am sure she would have done it. But doing it or not is her choice. People don't need to get up on a soapbox and preach the dangers of assisted suicide, to people who are dying and in intense pain, all for the sake of being able to stand high on some supposed moral high ground.
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ConservativeAmongWolves
One guy against a pack of Howlers
09:54 AM on 07/14/2011
I'm sorry for your mother's suffering. There is an interesting study out that in the case of terminal illness, those who choose hospice care vs. agressive treatment, actually outlive those who seek treatment. The other advantage of going into hospice care is that almost all pain is treatable.
If I was told I was terminal, other than getting a second or third opinion, I would start looking around for the best hospice service/facility.

Also, as I said in my comment above, a person can choose to not accept food or nourishment.....it ends in the same place as "assisted suicide," but without any assistance.
RealistBC
Micro-bios must pass muster.
11:10 PM on 07/13/2011
The Lord may well be with you and the lion, but it's Caesar who will decide when the plug gets pulled.
Genders
Love, Tolerance, Enlightenment
09:17 PM on 07/13/2011
I have a friend dying of the worst cancer you can image, in terrible pain every day, with absolutely no chance of recovery and having already outlived the average by 4 times. He never wanted to look at the suicide issue, till all hope was lost and pain consumed ever waking moment.

Thank god we have assisted suicide in his state.
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11:50 PM on 07/13/2011
Thank you for putting that to words.
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ConservativeAmongWolves
One guy against a pack of Howlers
09:55 AM on 07/14/2011
Your friend needs a physician who will treat his pain....it is almost always manageable.
Genders
Love, Tolerance, Enlightenment
03:32 PM on 07/14/2011
No, it's not. He has all the pain killers he wants. The cause him to completely space out, and to soil himself, totally humiliating him. It's just prolonging and his hell.
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exxman
Visualize Whirled Peas.
08:05 PM on 07/13/2011
Was it the fact that this is the religion section or the title "Rverend" before her name that threw you off?
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toofarleft4thisworld
The Right Is So Wrong
07:30 PM on 07/13/2011
my body, my choice and no one, not the church nor the government, has providence.
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cheryl tobin
Alpha Dog with my pack!
07:25 PM on 07/13/2011
Didn't know this was going to end with a sermon about the Lord.
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11:47 PM on 07/13/2011
Note what section it is in. Not only is the ending predictable, so is the distaste for the entire concept.