Two Irrational Beliefs About Old People
INTERESTING STUFF – 14 November 2015

The Right to Die

At age 74, I am healthy, happy enough and curious about what each new day might bring. I am also grateful that I live in one of five U.S. states that allows physician-assisted suicide.

It's not something I dwell on and I certainly was not thinking about Oregon's Death with Dignity Act when I moved here five years ago. But it comforts me at this time of life to know it is there if it comes to pass that I want it.

When we get old, we are more likely than in younger years to be diagnosed with terrible diseases – sometimes treatable, other times not so much. I like knowing that if I become terminally ill and if my life, in that circumstance, becomes too painful or otherwise unbearable, I will not be required by law to suffer.

In no way am I eager to reach that impasse. I like life and hope I'm here for a good while longer. But any old person who doesn't understand that getting through old age unscathed by a serious health issue or two or more is fooling herself.

In all the five U.S. states and the other countries that allow doctor-assisted death, applicants must clear a high bar before being granted the right to die. And although I would rather see the choice available everywhere, that is generally a good thing at least for awhile as we debate the issue publicly and politically.

Even though I am mostly content and satisfied, I have periods of despair and melancholy. (Don't most people?) I consider them normal but who knows if at some future juncture I might, during a dark day or two, think to end it all.

It is then that I appreciate the barriers to the permission to end my life as much as I am glad for the choice.

Regarding a diagnosis of Alzheimer's or other dementia when there is usually a remaining period of lucidity before you lose yourself, I have a running joke with a friend. Or maybe it isn't a joke; we laugh about it but maybe we are deadly serious: since we both like living, we repeatedly ask ourselves if we will be able, in the case of dementia, to gauge the “sweet spot” between still functioning enough to arrange for physician-assisted suicide and being too far gone to be allowed to make the choice.

Oy. A tough one. What else is there to do about such a potential future except laugh.

These thoughts have been rolling around in my head over the past couple of days since I viewed a short, 21-minute documentary from The Economist titled 24 and Ready to Die.

A shocking statement due to the young woman's age compounded by the fact that she is not terminally ill.

She lives in Belgium where doctor-assisted death is legal. She tells us that she can recall at age three not wanting to be here anymore and says she has suffered debilitating depression pretty much ever since during which...

Never mind. Just watch. I didn't know even that much about Emily when I looked at the video and there is no accompanying print story with explanations. Even though she is much younger than most of us are, she gave me a lot to think about as “death with dignity” and “right to die” legislation is expanding enough that it is no longer an anomaly.

Comments are disabled where the video is available on the YouTube page and on the page at The Economist so I am looking forward to reading what you, TGB readers, have to say.

Comments

I, too, am doing fine and life is good but....

If I decide to die --- I want to have that right.

I am a stanch advocate of the right to die laws. Unfortunately I live in a state where no such law exist. I did for a number of years seriously consider moving to Oregon so that I had the option the law there provides. Even picked the town of Salem, Oregon as where I would move and did some research on cost of living and housing availability. But in the end I chose just to remain here for the better or worst of my end days.

As for the video however, to some measure it made me fairly angry and devoid of any sympathy at all. I don’t see mental disorders such as professed by the young lady in the video having any relationship whatsoever to the purpose of the right to die laws that are currently in force. I see a definite distinction between the physical health circumstances allowing someone the right to die under the law and mental health circumstances such as those she exhibited and or professed.

To put it quite bluntly, if someone who complains about their circumstances in life wants to end their misery, then get a gun and do it! But if you don’t have the balls to do it yourself, don’t start screwing around with the right to die laws in an effort to have someone do it for you, if unlike the young lady in the video, you can even go through with it.

The ‘right to die’ laws that exist now are pretty straight forward and coherent. We don’t need a completely different type of health issue to start clouding the water surrounding the right to die laws that have already been confronted and resolved. The mental health issue is in my opinion a completely different animal and has no part in a discussion about ‘right to die’ laws.

What brave and compassionate people those doctors working with Emily must be!

This is difficult for me to process for a few reasons. We recently lost a young nephew to suicide by gun. He was in his early thirties, with a wife and three young sons. This young man had a good education, a good job, and a beautiful and supportive family who loved him very much. He seemed to be in good physical health, but had increasingly been using alcohol over the past couple of years, and was seeing a therapist and taking medication. I can't even imagine what demons he felt he was struggling with. I'm sure there are all sorts of possible explanations, and while he may have been released from a suffering he thought he could not live with, that seems to have been transferred to his family, who were devastated by his action. Parents, grandparents, siblings, his children and wife, nieces and nephews, friends, co-workers and young people he worked with, so many people have been left in pain and confusion. I wonder whether, had he had the option that Emily had, might the outcome of his story have been different?

We have a terrible suicide rate here, especially among young people, not even counting suicide that may be committed through drug and substance overdose and abuse and not called suicide. I've always thought that control over one's life should extend to the option available to the young woman in the film, but if it were my child exercising that option would I feel the same? I can't presume that I would, but I would hope so, especially if the mere option could possible end up saving my child.


I think until that time that we know more about mental illness and depression, perhaps we should restrict The Right to Die to those who are terminally ill or facing a life of assured pain and suffering.

That was a very powerful doc.

Interesting ending.

Makes you think.

I think the Belgian way is very sensible and would like to see similar laws in this country. I think we are in charge of ourselves and should have the right to end misery, but I also think that a panel to help make the choice either way is very important.

We should not have drive up end of life windows.

I agree with those who thought that mental illness was a whole different animal than living with a physical ailment. I also believe that right-to-die should be available to all of us. I liked the idea of the panel of doctors.
As for Emily; Sometimes we need validation. She was extreme in the way she went about it, in my opinion. Of course, with mental illness, isn't that often the way? I wonder now, if she changes her mind again down the road, if she'd have the same support.

It seems to me a depressed, suicidal, mentally ill person is almost by definition not competent to choose physician-assisted suicide as outlined by our current right-to-die laws. Cases like this are a different breed of cat and should not be included in laws addressing patients who are hopelessly, terminally ill. This young woman is not facing an end-of-life situation.

This was a very disturbing video. I have always thought that suicide was a permanent solution to a temporary problem. I also think it's a selfish act. As Cathy so poignantly pointed out the devastation the suicide leaves behind is cruel.

I agree with Bruce. They are making so much progress in understanding how the brain functions there could be a breakthrough in treating depression and Emily is so young that to give up on life when time could possibly offer a cure for her illness is unwise in my view.

Mental illness is an illness just like cancer, but the difference is there is no longer a cure for a terminal illness in which assisted suicide is a mercy, but there could be a cure for depression in the future.

I am 100% for the right to die and wish my state were as enlightened as Oregon, but I do think it should not be all encompassing and should be limited to physical pain and suffering and/or a terminal illness.

The reasons people want to kill themselves are numerous and complex and, as with so many mental health conditions, there is much stigma and misunderstanding. Just because we can't see the condition, as you would a life threatening disease, doesn't mean a person isn't suffering. Read "Dancing with Mr. D" by Bert Keizer, a physician in Holland, who sees all applicants who want to end their life. Not all of them get their wish and the reasons for refusing are given.

Time and again, this issue is presented to British politicians and each time the vote is "no. People determined and wealthy enough are resorting to a Swiss clinic for assistance.

As for the "sweet spot" between lucidity and hopeless confusion for people with dementia, the film with Julianne Moore "Still Alice" highlights this very dilemma.

A tough one, but I think I agree with Bruce who said, until we "know more about mental illness and depression, perhaps we should restrict The Right to Die to those who are terminally ill or facing a life of assured pain and suffering."

I do agree somewhat that pain and suffering from terminal Illness and mental pain and suffering are separate, but then there's Alzheimers. It's not terminal , but most people don't want to live like that knowing it will only get worse. To me they should have the right to die too. I believe they do now in Canada. But I also would want to be able to end it if I was just tired of living and had had enough, maybe lonely with no real purpose. I strongly believe we should have that right. I worry about it a lot and fear greatly having to live when I don't want to. If I had an option I could count on, I could relax and be free from that anguish.

I think I have to disagree with Bruce. It's true, our understanding of mental illness is not very good, and maybe someday cases like Emily's will be curable. But that's a "maybe" and a "someday." What if it turns out to be "not" and "never"?

To me, it comes down to this: it is morally wrong to demand that people must endure unendurable suffering just because the idea of someone taking the only escape there is, now, makes us uncomfortable.

What Belgium's procedure did was allow Emily to decide for herself, but openly, with plenty of counseling, and plenty of chances to engage with and say goodbye to the people in her life. In the end, she decided to go on living precisely because she had the option not to.

How does excluding mental suffering from a right to die law help someone like Emily? Answer: it doesn't. It doesn't keep them alive. All that it means is that such people eventually choose their death in secret, alone, without guidance or company, and they leave behind friends and family loaded with guilt on top of grief -- "There must have been something we could have done!"

Far better to have it out in the open.

Ronni once again your topic is at the top of my list. I'm 75 and like my doctor says after 75 things start to go south. As someone who suffers from aging anxiety I am definitely in favor of The Right To Die law which is becoming more popular and was just passed in California. I recommend watching the Brittany Maynard tape for understand the importance of The Right to Die.


I've always been a supporter of Right-to-Die laws, even in my younger years. Like other readers, I think the situation for seriously ill or incapacitated elders (including those dealing with dementia) is different from Emily's. I'm not judging her or rendering any opinion--I went through some very dark periods in my 20s and early 30s--but what I experienced then is absolutely not the same as what may confront me in my late 70s and 80s. Emily is not facing an end of life situation in my view.

Although I'm not quite ready for drive-up end of life windows either, I'd prefer not to be subjected to a panel or additional hoops to jump through when the time comes. I believe that any mentally competent older adult nearing the end of life whose existence on a daily basis is an unremitting and unrewarding struggle should have the right to decide when and how their life will end and access the appropriate assistance. Fortunately, I live in Washington, which is also a right-to-die state. I'm not sure how I regard right-to-die for young people. I've lived many happy and productive years that I would not have had if I'd followed through with my plan to jump off the Golden Gate Bridge at 26!

It's difficult with easier problems and, to me, nearly impossible to know, to really feel, what living with severe mental illness is like. And I have known some who with their families suffered greatly and who chose to take their own lives. I agree with Sylvia's viewpoint, and believe everyone is better off to have it out in the open.

In the end, it was this woman's choice, and I felt the process (though most of it not shown) was extremely sensitive to everyone and intelligently conceived and carried out.

I make no distinction. If a person wishes to die, I believe they should "be allowed" to do so whether the pain is mental or physical - in the manner of their choosing. I'm sure that, as in most major decisions in life, different people would make such a decision in different ways.

Trust me as one who has been through the aftermath: someone who uses a gun to end his/her life may be doing no favor to his/her family. Dying with appropriate medical oversight is much to be preferred from the standpoint of preparing one's family. Still...it should be the person's choice!

Sylvia summed up my thoughts pretty well regarding the video and the notion that knowing one has been "approved" for assisted death can sometimes offer relief in itself.

I'm struck by the care with which this young woman's wishes were handled, the validity accorded her, and the kindness that seemed evident throughout. I wonder how she's doing now. I also wonder about the contrast between the system in Belgium of such seemingly conscious consideration of life and of death, and what seems to be in most places in the US a refusal to accept the potency of an individual's understanding of when it is time to end one's life. It is as if even the gift of ending one's suffering, whether physical or mental, is too much for a culture of denial to be able to allow. Except, of course, in Oregon and the 4 other states that allow a chosen death.

I find it interesting that so many people are for the right to die but feel ---

one's right to die is only ok if it follows guidelines and criteria thought out and accepted by others.

Why? If you are an adult, it is your life, it should be your choice.

What Bruce said.

Yes, I think so, too, Victoria. It's your life and your pain - whether physical or mental. And I really admire the adult and caring way that Emily's case was handled.

Ronni, could you contact who ever it is in Oregon that handles this.
My sister lived in Oregon. She was told she was applying too late? And was not allowed to participate in this. If you could see what is required to participate... It may be helpful to others here too.
My sister had stage 4 ovarian cancer.

Debi...
Here is worksheet of requirements to participate in Oregon's Death With Dignity Act.

There is additional information at Compassion and Choices.

I agree it should be possible - some of us elders have saved up pills which taken with acohol can do the trick. But maybe not...and welcome news about assisted suicide.
Incidetnlly, I have often written about suicide prevention when it comes to younger people who may kill themeselve in a moment of despair exascerbated by alcool use. We need to hear far more about being under the infleunce of alcohol - indeed in so many crimes, anti-social, risky or even highly regrettable beeaviors are committed under the influence of alcohol. Hear all about it at open AA meetings.

As for young people suicide, the sorrow they bestow on others needs to really get out there on a public level. Also that these things usually pass at that age. ETCTERA

PLEAE EXXCUSE ALL MY TYPOS IN MY ENTRY

Bette, typos are a regular thing for this group - no worries - I could read and understand your well-expressed points about alcohol and young adult suicides, with which I feel great concern also.

Bette D. and Ronni: you're spot-on about the potential role of alcohol especially as it relates to the decisions of young people to end their lives. I speak from experience. I was under the influence when I conceived THE solution to all my "insurmountable" problems (see above: me and the Golden Gate Bridge). I was under the influence when I drove to the bridge, got out of my car and walked across looking for the perfect jumping-off point. I still don't know why I didn't make the leap--chicken, perhaps?? Or perhaps I was afraid I'd be the one (of hundreds) who actually got rescued alive?

Subsequent to my NOT committing suicide that night, I survived a divorce/remarriage/ divorce, a relationship involving domestic violence and years of economic ups and downs, mostly downs. However, I also survived to meet my wonderful (3rd) husband of nearly 38 years, and to enjoy a productive professional career, a rewarding volunteer gig in retirement and a furry family of beautiful rescue cats. At going-on-79 I'm in reasonably good health and am not ready to go yet. But when I am ready, I want the time, place and method to be my decision.

As usual, Elizabeth Rogers, we are in almost total accord on an issue. Except---except for this one little problem. Even in a "right to die" state which California just became, thanks to a Democratic legislature and the empathy of our 77 year old Governor, the numerous requirements and hoops to jump through are not exactly my idea of being allowed to decide the time, place and method of my death.

California's law, which was reportedly modeled after Oregon's, requires 1) having six months or less to live; 2) two oral requests (witnessed by non-relatives)) a minimum of 15 days apart; 3) and 4) confirmation by TWO doctors, your attending physician and a consultant, including verification of mental capacity to make this decision; 5) physician verification again (witnessed) immediately prior to "ingestion" that you really, really mean it and 6) finally being given the drugs but not without all sorts of additional documentation and checklists.

I don't know about the rest of you but by this time I would be a mental wreck and that might disqualify me. Because there's one BIG omission in this right to die stuff as far as I'm concerned. It doesn't allow anyone with mental impairment---read Alzheimer's---to take advantage of this law. And Alzheimer's, to me, is by far the most compelling reason to want to be allowed to die. It doesn't matter at all that you have an Advance Directive (witnessed and notarized) that gives your personally designated Attorney-in-Fact the power to make your medical decisions.

The many great comments on this post are testament to the capacity of older people to make their own decisions, and maybe "right to die" laws are better than nothing, but that's all they are to me until our legislators get real enough to trust elders completely.

Ronni, I am writing a group discussion manual on dying and death. And you started it when you wrote that column about the tasks of aging. It started to come together when I took Tai Chi with a group of older women (early 60s to mid-70s). One day I asked them if they ever thought about the rest of their lives in terms of "How much time do I have left to live?" And they laughed (literally laughed out loud) that they think that way every single day. And within 6 months, I started doing the research for the manual. (At the pace I'm going, it could easily take another year.) Now, recently, it has taken a bit of a turn. I was speaking with an elderly man (much older than you) at a Vet Day Potluck, and he said, "I don't need to know how to die -- I know how to do that. I have needed a school to teach me how to grow old and with some dignity and grace." So, ANYWAY, I thank you for that column of yours.

Secondly, YEARS ago, almost 20 years ago, I read a book by a MD in New York. In it was this quote. I made a professional picture of it; wrote and thanked the author; and have passed in on to many people over the years. It is as below:

"The sense of life’s preciousness, which I inhale from the streets on my way home from work, is how I survive the daily spectra of disease and death. It is how I maintain my emotional perspective day in and day out. Not only do I never fear the daily reminders of my own frail mortality, but I am grateful for this exposure, the realization that we are all ultimate HIV-positive, in that we are all going to die sooner or later. I acutely realize that someday, regardless of my own final disease or injury, I, too, will join my many patients on their sickbeds. The poignant stories transpiring everyday on my AIDS ward, my crucible of hope and despair, have taught me that having a life that denies the relevancy and immanency of death actually robs that life of the wonder it should have. I have come to believe that a content life is one that gracefully carries death on its shoulder as a friend and not as a feared adversary."

Daniel L. Baxter, MD., The Least of These My Brethren

I support euthanasia as my grandpa died of the human variant of mad cow disease (CJD) and there is mental illness in my family as well. But this kid was RIGHT to pull the plug at the last minute. For mental illness GIVE YOURSELF A CHANCE. It isn't terminal cancer, ALS (motor neuron disease), or quadriplegia with pain- for example- that would JUSTLY put you in the right to die category. Suicide for depression of any kind is a nasty business, so please think of the good things that CAN HAPPEN with the right kind of therapy (drug and talk) for you.

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