Living With Cancer: Deciding About Dying by Susan Gubar

 The New York Times Well

October 22, 2015

 

Fifty-five years ago, when I was 15, my mother made me promise that I would not commit suicide. I intend to keep that promise if and when I ask a doctor for passive assistance — ending life-sustaining support — or for active help: palliative sedation or a lethal prescription. To my mind, treating cancer pain aggressively even when it accelerates the dying process should not be equated with suicide.

Because the prospect of a protracted dying with ovarian disease scares me, I am grateful for activists who are beginning to address the issues of the terminally ill. Versions of Oregon’s Death with Dignity Act have been adopted in Washington, Vermont and Montana, and will soon be legalized in California. Yet physician-assisted dying remains illegal in my state, as in most, for reasons that I can comprehend but that do not pertain to the needs and wants of some — though certainly not all — incurable cancer patients.

Since 1939, when the Nazis directed German doctors to administer “mercy death” to the incurably sick in a program of involuntary euthanasia, people of conscience have worried about the genocidal potential of physician-assisted death. The same historical period also proved that if disabled or mentally ill or elderly men and women could request and receive the termination of their lives, medical professionals would face a slippery slope of problematic decisions. Exactly when, under which circumstances, would assenting to such an appeal be humane or inhumane? Many patients might lose the benefits of often effective palliative care.

The Holocaust has made me personally aware of the grievous repercussions of suicide. During the Shoah and decades afterward, a number of my relatives responded to the trauma of persecution by killing themselves. Partners, siblings and offspring of people who commit suicide often suffer pervasive feelings of guilt, anger, abandonment and the haunting dread that the act might establish a repetition compulsion: that it will “run in” a family and ruin future lives. This was the alarming thought that troubled my mother.

Even in the circumstance of late-stage cancer, suicide can have grave consequences, or so I learned from the moving meditations of Andrew Solomon. In several forms — an autobiographical novel, a book about depression and a New Yorker essay — Mr. Solomon has recounted the complicated story of his terminally ill mother’s decision to obtain the acceptance and assistance of her loving family, as well as more than enough Seconal, to kill herself.

In all of Mr. Solomon’s accounts, it becomes clear that the stash of drugs relieved his mother’s anguish by providing her a modicum of control. “Everything that had been intolerable to my mother was made tolerable when she got those pills, by the sure knowledge that when life became unthinkable it would stop.” However, helping her die took a heavy toll on solicitous caregivers who felt complicit in a kind of murder. Mr. Solomon calls suicide “the saddest thing in the world” and “somewhat toxic to everyone it touches.”

Neither disabled nor mentally ill, Mrs. Solomon was suffering from incurable ovarian cancer. A physician-assisted death would have ameliorated the Solomon family’s confusion and suffering. Indeed, it could have removed the stigma of suicide. To do just that, proponents who seek to change the laws — like Dr. Robert Stone in my community — advise us to be careful about our language.

Physician-assisted suicide suggests that death eventuates from a doctor’s collusion in the willful decision of a patient to shorten her life. Physician-assisted death suggests that death, hastened by a doctor, eventuates from the inevitable physical deterioration caused by mortal disease.

I prefer the phrases physician-assisted dying or aid-in-dying, which imply that the doctor supports an already dying patient throughout the dying process. We know little about death, after all: There are no survivors to tell the tale. But we do know something about dying.

Over many decades, hospice has established that dying need not be a miserably lonely, painful or terrifying experience.

Of course I honor the position of people who say, “My life is a precious gift that I must not relinquish even when I am dying with an incurable disease.” What baffles me is the sentence “Your life is a precious gift that you must not relinquish even when you are dying with an incurable disease.” Surely this decision should be made individually by each of us, and we ought to be free to make it in accordance with our own values.

Terminal cancer patients like Brittany Maynard and Christy O’Donnell have focused national attention on the problem of current laws that claim to prolong life but actually prolong dying. Given that many doctors today do treat pain aggressively even if doing so accelerates the dying process, shouldn’t we liberate them from having to lie about helping to extinguish an existence no longer tolerable to someone like Brittany Maynard, Christy O’Donnell or me?

In my case, not now or soon, I hasten to add, but whenever that time arrives: “The readiness is all.” My expectation of reaching a state of readiness and my relative longevity strike me as extraordinary privileges.

 

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