Friends, an elderly couple I will call Buck and Pearl Greenwood, died, he of Alzheimer’s in 2005, she of a broken heart and multiple organ failure in 2006. Greenwoods planned their deaths. Each made an advance directive to their physician instructing that no heroic measure be taken to prolong their lives, if terminal. Each selected a trusted family member to make end-of-life decisions, if Greenwoods were incapable of doing so. Each expressed to family and friends (me included) that they did not wish to linger in their twilight months. Greenwoods did what Washington law allows to avoid dawdling death. Greenwoods even hatched a private compact of mutual suicide assistance, which Washington law does not (and should not) permit. Still, Buck and Pearl suffered exactly the prolonged deaths they sought to avoid.
Buck’s short term memory faded. One day, Buck accidentally knocked frail Pearl down. Osteoporitic bones fractured. Pearl healed, but Buck spiraled downward. During their last day at home together, panicked Buck flagged down traffic to warn of dangers apparent only to Buck. Buck entered Alzheimer’s care. Buck’s ability to recognize loved ones deteriorated. Months later, I found Buck smooching another resident at a communal movie in the locked living room. I asked him to introduce his friend. He said, “This is Pearl, my wife.” Finally, all recollection departed. Buck died from an intestinal bleed after a year.
Pearl visited Buck daily at first. As he declined, as he ceased to recognize Pearl, her heart broke. The stress of caring for Buck, combined with Pearl’s own failing health, sapped her. She elected to stop eating, which is an option open to Washington residents. It turns out that intentional starvation is harder than one might imagine. Hunger induces weakness and delusion. Delusional starving people lose resolve; they eat. So Pearl started her own grinding demise. She died in the company of her valued Ethiopian caregiver, after months of semi-consciousness.
Suicide is complex, both ethically and socially. I cannot presume to tell you how, or whether, to live. In my view, life is generally worth living. Life should be surrendered only under dire protest. Depressed persons should be medicated and loved. Despairing persons should be encouraged and helped and loved. Ill persons should be treated, their pain addressed, and loved. Nevertheless, I am not competent to ask terminally ill persons to persevere despite their pain, or emptiness, or fervent wish to flee life. Nor do I believe you are competent to do so.
Can a preference for death be, under certain circumstances, reasonable? R-1000, the death with dignity act, preserves to the terminally ill individual, with appropriate review and counsel, choice about ending one’s life, with the skilled assistance and comfort of one’s physician. Thanks for voting for R-1000. I did.