How To Be Alive And Like It Too

The lower you go down on a trampoline, the higher you go into the air. Perhaps this dynamic of one extreme begetting another is at play in the heating up of opinions on assisted suicide. I think the more that technology allows life to be extended at all costs (literally and figuratively), the less we feel in charge of our final days. Hellish stories abound of health professionals keeping people alive by tortuous procedures who cannot communicate their potential wish to discontinue them. In other words, it is coercion. But assisted suicide can involve coercion as well.

I think fear fuels both extremes. The futile treatments and withholding of pain medications which may shorten life is about the fear of death, whether originating from the one dying or their loved ones. It is an attempt to escape the fear rather than letting the person die. But the wish to legalize assisted suicide stems from the fear of facing the remaining days of a life so dreadful that it would be worse than death.

There is a middle ground despite the vested interests of some institutions and health care professionals to keep it hidden. There is an alternative to actively prolonging life or finding an escape clause in a death ahead of schedule. Rather than work to ban one extreme or the other, I think our efforts should be to make that middle ground so attractive that patients and their families will resort to the extremes less and less. (I feel the same way about abortion. I am not in favor of banning it. Instead, society should make alternatives available and attractive. In both cases, assisted suicide and abortion, I am talking about incentivizing life.)

While not a cure-all so to speak, hospice is that middle ground. How ironic that uninformed individuals think that going on hospice means “giving up.” I never have heard anyone refer to assisted suicide that way. If someone contemplating assisted suicide is reading this, then can you at least “give hospice a try” before going the “nonrefundable” route? See what the nurse can do about pain. See what the social worker and chaplain can do about feelings of guilt and depression regarding emotionally and financially depleted caregivers. See what the whole hospice team can do to join your search for any potentially remaining sources of meaning. Some unexpected reason for living may turn up. As for the other extreme, hospice is the gateway to appropriate pain relief such as morphine that other types of care preclude due to fear of legal consequences, addiction (obviously an irrelevant concern for terminal patients), or ignorance. It is also a safeguard against “treatments” that increase or prolong suffering. Not only are many if not all such treatments not allowed in order for patients to remain on hospice, the hospice team is available to address their or their loved one’s fears behind the desire to pursue such treatments.

As with any fears, the more we lay them bare, the more each of us will restore control of our destiny.

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5 thoughts on “How To Be Alive And Like It Too

  1. Consuelo M Beck-Sague, MD says:

    If only I had the experiences with hospice that you describe. If only South Florida were not so full of charlatans and fraudsters. If only guilt were not so human an experience. If only US healthcare facilities were not rewarded for pointless, excruciating prolongation of death. If only… I guess that’s it.

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    • Hospices as with anything else in the world subject to human influence, are no exception to corruption. I do not wish to idealize hospices, but i think it is fair to say that many of the hospice team members on the “front lines” including the vast majority of the nurses, etc. that I have met or have heard about, are there to provide compassionate care,and subscribe to the hospice philosophy of “neither prolonging nor shortening life” and to enhancing the quality of life when possible. If there is some other middle way that you or others can describe, we can continue to treat the malady of poor end-of-life care by making those middle ways more and more known, and more and more accountable to a higher standard.

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  2. As usual, very thought-provoking, Karen.

    I tend to veer towards approving of assisted dying and even abortion, in extreme cases. (Who wants a child every time they make love? Not many. And how often do we hear of contraception failure? I often hear of it). I think you are courageous to raise this issue because I get the impression, rightly or wrongly, that people in the US are more puritanical than we are in Europe (as far as one can generalise).

    As the law stands at the moment, in the UK anyway, doctors risk prosecution if they too openly assist the terminally ill to die. I think our draconian laws are appallingly unfair, to doctors and patients alike.

    But you put a good case for trying alternatives, Karen. I feel lucky and grateful that in my area we have an exceptionally good local hospice – this is not the case for all across the UK, or elsewhere.

    Would I travel to the Dignitas Clinic in Switzerland if I contracted a terminal illness? Depending on what I was diagnosed with, probably yes, and I speak as someone with resurrected religious beliefs. But you have made me hesitate so that I would certainly think long and hard about what you have said about trying alternatives.

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    • I really appreciate your very personal remarks. You are courageous too. Writing publicly is always a vulnerable act, especially regarding a controversial issue. I am glad this post has made you consider that once you are near the end, that the remaining time might be of a high quality indeed. For some people, of course depending on their physical and mental condition, there can be many poignant and intimate moments that make this period of time if not a highlight of one’s life, then a worthwhile portion of it that should not be foreshortened.

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  3. […] guest article about hospice as middle ground first appeared on Karen’s blog and we reprint it with her permission; the second part of the title and subheadings are ours. The […]

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