Note: I don’t believe in political trigger warnings, but this essay discusses death and suicide, so if that is something that is going to be upsetting to you, I just want you to know that now so that you can stop reading here if that’s what’s best for you. If you are ever thinking about suicide, the National Suicide Hotline is 800-273-8255. Don’t do it! Suicide, except in palliative conditions as discussed below, is a permanent solution to what is almost certainly a temporary problem. If you’re considering suicide, I want you know that it’s all going to be okay. You feel like it won’t be and can’t be, but it will be.
My dad died a year ago today.
The worst wasn’t the death.
The worst was the last week leading up to it.
He was delirious. The cancer had spread from his pancreas to basically everywhere.
He was also in a lot of pain.
To move him caused him even more pain.
But, regardless of the pain, he wanted us to move him pretty frequently because he kept wanting to urinate. Five minutes after urinating, he’d say he needed to go again. He couldn’t remember that he’d just done it, so we’d repeat the whole process.
And when I say “we” had to move him, what I mean is my mom and I.
We had to constantly reposition him. And my mom is also in poor health, so I was moving him to the end of the bed so that I could pick him up so that he could pee. It was awful to see how much physical pain he was in, but I’d help him like that all over again if I had to, a hundred times, so that my dad could meet the end of his days without having to piss himself in a diaper.
He was a proud man.
Having his son hold his whole body up multiple times an hour so that he could pee was the last thing in the world he wanted.
But he also didn’t want to urinate himself.
After the pain got really bad and he couldn’t take it anymore and the palliative medication was (understandably) increased, he couldn’t say much of anything but he knew how to communicate to me that I needed to pick him up out of his bed and hold him up so that he could pee in a cup that my mom was holding so that he could hold onto his last shred of dignity.
His dignity meant everything to him.
If how he ended is how he wanted it, then so be it. I’d gladly do everything the same way again if that’s how he envisioned his end. But I don’t imagine that is how he hoped it would go. He was a proud man and I could tell that it humiliated him.
It should never have come to that. If he wanted it to end before that, there should have been an easily accessible means of doing so. Because physician-assisted suicide is illegal in Alabama, his only choices were the brutal, lonesome finality of a gun-under-the-chin suicide or the suffering and indignity of his painfully drawn out dying process. I’m not saying that I wish my dad had died sooner, but I am saying that he had wanted to be done a week sooner (and in many ways he did want to be done a week sooner), that should have at least been an option for him.
Several years earlier, an acquaintance of mine (she was also a graduate student at Boston College) revealed that she had terminal brain cancer. Over the next several months, I took a day or two a week and helped take care of her and we became fast friends. We’d work together -she was finishing her Ph.D. too- and we’d hang out and we both tried to act like the cancer wasn’t a thing. Her condition got worse over time, as these things do.
It got to the point where she’d be excited when I was coming over because, other than her husband, I was the only one both trusted enough and strong enough to shower her. Then that got too hard too and so there was hospice care. A month or two after that, she needed to be moved into an assisted living home. I kept visiting, obviously. A few weeks after she was there, while I was visiting, she needed to go to the bathroom -immediately- and there was no way the nurse would make it on time. So I picked her up, gown and all, and carried her to the toilet. We made it in the nick of time.
I wish I could say that the look that passed between us as she made it was one of relief. It wasn’t. I don’t know how to describe it. The loss of dignity was a lot smaller than it had been if we had not made it, but it was still there because of how close it was. And it was so real. I watched her lose a small part of her dignity that she would never recover. It was emotionally shattering.
She was a wonderful person and she should never have been reduced to that. I kept her from going to the bathroom on herself. It was a small thing but, whatever else I do, helping a good person hold on to most of her dignity a few days longer was one of the best things I’ll ever do.
A few days later when I visited, I could tell that she’d lost the rest of it. She put a brave face on it and we didn’t talk about it, but it was obvious. She lost her dignity before she lost her life. Come to think of it, shattering doesn’t begin to describe what it was like to watch that.
At the end, for many people, they do not hold onto life. They are ready to let that go. But they cling to their dignity. They hold onto it by their fingernails. As they should.
Life is important but it is not the be all, end all. Dignity is the be all, end all. It is everything. If a person believes that their life can no longer be led in a dignified manner and wants to hold onto their pride instead of their life, and wants a doctor’s help in doing so, they should be allowed.
I apologize for burying the lede but the ultimate point of this essay is to make the case for death with dignity, what some people call physician-assisted suicide, not with statistics or charts but instead by asking you to consider your own dignity and the dignity of your loved ones and what you and they want at the end.
If I am ever in the position that my dad or my friend Kiara were in, I want to have the ability to ask a physician to help me hold onto my dignity. I try not to be an overly boastful man, but just like my father and just like Kiara, I have some pride. I do not want to go to the bathroom on myself. In fact, I’d rather die than get to the point where I cannot stop that from happening on a regular basis. If that is sinful pride, then so be it.
There are some people, particularly some social conservatives, who want to stand in the way of people being able to get a doctor to help them choose dignity over life. They have their religious beliefs and I don’t want to be disrespectful of that, but they shouldn’t get to stop me from preferring dignity to life, if it comes to that, simply because they would not make that choice.
After I die, I’ll stand before God and, in addition to all of my other moral shortcomings, he may tell me that I was a fool to not listen to his messengers about the evils of suicide. On the other hand, He may tell me that I was right to prize compassion over tradition. But what He won’t do is see a soul eager to see others die. I cheer for no one’s death. What He’ll see is a soul that could not bear to watch good people suffer. That is where my support for death with dignity comes from.
Death with dignity needs to be carefully regulated and no physician should ever have to participate in it if that would violate their conscience. But, in principle, it is both the pro-freedom thing to support and the compassionate thing to support. It should be an option for those who want to safeguard their dignity at the end.
-GW