Death with Dignity

Any topic that qualifies as a complicated conversation generally contains a lot of heated passion from every side, regardless of the topic being explored. I will of course be talking from my own point of view, so go with the assumption that it’s my opinion. When I give facts, I will also provide the appropriate links so that you know it’s NOT my opinion.
So before I wade into the fray, I remind my gentle readers that regardless of how much of a twist your knickers get into, this is still a POLITE conversation. Anything less than polite (flaming, obscenity directed at the author or the other comments, hate speech, derogatory remarks without real substance for an alternate view, or sheer stupidity) will be deleted and the user will be blocked.
“Once more unto the breach, dear friends, once more…” (Shakespeare, “Henry V”)

Do not stand at my grave and weep
I am not there. I do not sleep.
I am a thousand winds that blow.
I am the diamond glints on snow.
I am the sunlight on ripened grain.
I am the gentle autumn rain.
When you awaken in the morning’s hush
I am the swift uplifting rush
Of quiet birds in circled flight.
I am the soft stars that shine at night.
Do not stand at my grave and cry;
I am not there. I did not die.
~~Mary Elizabeth Frye

Too many people are uncomfortable, even fearful, of talking about death. This is a (relatively) new view of the end of life, compared to the knowledge of its inevitability in older, generally agrarian, societies. When your whole life is tied into the cycles of nature, you know that death is just a part of that cycle. Now, with technology, science and pharmacology, death has become a somewhat hidden and mysterious action. I do mean on a personal level; we are all too inured to mass deaths, whatever their cause.

It’s a shame that we have purposefully turned to making death, or the discussion of it, almost taboo. We have cloaked it in secrets and somehow try to make it not a natural part of the order of things, including our own lives. We certainly do this with celebrity lives, as shown by the recent deaths of David Bowie and Alan Rickman. Comment after comment talks about we thought they would always be there. Somehow.

Death is a natural event. Every person you know will be dead eventually. Even you shall die–and that’s the death that scares us the most, I think. We are so afraid of dying, of not being here on Earth, not existing. But while death is inevitable, it is also nothing, NOTHING, to be afraid of. There are things worse than death. Like being in terrible, untreatable pain. Having a disease that is shutting down the body; limiting your life little by little until it finally traps your mind in a shell that cannot function.

All right, so let’s say that we can all understand the concept of our eventual death. Now let’s talk about voluntary death, sought after and desired death. Whether you call it suicide or euthanasia, it’s still the end of life. Why then would anyone willingly choose to kill themselves? There are many, many reasons why someone would seek death. The two examples above, of things worse than death, are only two reasons for suicide. Clinical depression is another. When you’re depressed, you are NOT sad. It’s not a feeling that will go away on its own. It is a particular chemical state of being within the organ we call the brain. Being chemical means that it can be treated with the right medications–which may or may not have side effects that can actually make the depression worse, or side effects that are so bad, you’d rather live with the depression. Or the medications make you feel good enough, you don’t think you need them any more…and stop taking them, to then crash, face first, back into that depression.

But let’s talk about physical causes for choosing suicide. Great pain and/or a terminal disease. Imagine someone you love deeply, someone you have had in your life, being told, “You have about 3 months to live and the pain will only get worse.” Imagine it’s you. Now what? Do you just live out the time, and let the disease kill you on its terms? What if endless burning waves of pain is a part of this disease? And the doctors cannot give you enough morphine to stop the pain without killing you? (And they won’t, you know.) What if this disease takes away all ability to live the life you had, or want to have? It slowly removes each ability for living: you can’t dance, you can’t walk, you can’t feed yourself, you can’t control your bladder or your bowels.

I am not just making these examples up to scare you. I have seen each of these happen and more than once. I was a nurse’s aide, dealing specifically with the geriatric population, for about 5 years, 3 years of which were served in a skilled nursing facility, aka “nursing home”. We had space for 40 residents and were always full. And in the 3 years I was there, I saw 50 deaths. You might say that I have more than the average person’s experience with death.

Fifty deaths in three years. Not one of those deaths was dignified, or how you’d like to see your grandmother or grandfather’s death…or yours.

It is not “dignified” to scream in pain for 6 days before dying, the cancer so wide spread that it can be felt under the skin. I watched a woman go through this. (The <very bad word> doctor of the nursing home refused to give her anything more than Tylenol.) It is not “dignified” to be catatonic, in the fetal position, with only a feeding tube providing energy for the body to keep ticking; with not even the movements available to a newborn baby. The saddest part of that was the fact that this resident’s (also elderly) spouse thought that their beloved was going to get up and walk again. It is not “dignified” to look younger in death than alive because the lines of constant pain are gone.

Death in our modern society has lost all semblance of dignity. Doctors who refuse to accept the obvious inevitability, insisting on medications and therapies to keep the person alive beyond what their body would have been able to do alone. Families who keep their loved one alive by insisting that the doctors do ALL they can to keep that person breathing. Death, gratuitous or “comedic” or gory, is perpetuated in films; we see people die all the time. But those people are actors. They get up after the filming is done, they go on to “die” in other movies. (Like poor Sean Bean.) We do not see death, the inevitable end of life, in the setting of our specific surroundings very often, perhaps not at all. I don’t mean no one in your family and friends has not or will not die–I just mean that you do not witness the moment of their death.

Having experienced this, I can tell you that death (for the elders) doesn’t usually come quickly. It’s generally not “one minute he was fine, just talking and eating, and the next, he was dead.” I know that that kind of death can occur, but it has been my experience that there is a real process to dying–and it’s not unlike being born. There is a “labor”, a particular pattern, to a person’s dying. As their body begins to shut down, they withdraw into themselves. It’s almost a dream state or deep meditation. They are less responsive, will stop eating, and may even be comatose.

The entire process takes a certain amount of time but may not have been recognized as end stage until the person has already reached the withdrawn/comatose stage. Their bodies also make less oxygen, so it’s not uncommon for them to feel cold (even while sweating). As the heart becomes weaker, circulation fails to adequately reach the hands and feet and they will become cool to touch and the nails maybe bluish, while the arms and legs may be pale, grey, mottled or purplish.  As they get nearer to death, there is a change in their breathing pattern (called Cheyne-Stokes breathing) consists of shallow quick breaths followed by spaces of no breathing; this can continue for a few days, hours or minutes before the person actually stops breathing, but rarely does a person improve from this stage.

The mysteries of death are like the mysteries of birth. Only those who are actively participating can know how it really felt. The rest of us, standing by and watching, experience the deep feeling of “something amazing happening”. Obviously for death, it may not be considered amazing, but both are an act that is beyond the comprehension of the watchers. It’s a spiritual, sacred event. How you frame that within your religious or spiritual beliefs is yours. Not everyone follows exactly the same set of beliefs we call “religion”; so your response to birth or death is a very personal one, of course.

But, again I tell you, there is nothing mysterious about the physical process of dying. Each stage can be noted and measured. Each “labor unto death” follows a documented and known order. Understanding the physical process can help with accepting the death of loved ones. Generally, it’s with the elders that we first experience death, which makes it somehow a little easier to accept–they were old, they were sick, they had lived a long life. Death at that point “makes sense”.

My first actual contact with death was not until I was almost 30 years old. Older relatives had died, but I hadn’t seen them do it. My family and I were at my grandmother’s side for her last weekend on Earth. Friends stopped by as the word got out that she was dying. She would struggle long enough to see who they were–and to all of them, she said, “I love you.” It was the most gentle death I have ever seen. She wasn’t in pain, she just slipped away from us as her own body knew it was time to shut down. It was, I think, a “dignified” death, done on terms that kept her humanity and soul both recognized and honored.

But…back to suicide and a chosen death.

I find it disgusting that we are allowed, even encouraged, to euthanize our pets, our beloved furry family members, when they are old or sick and have no quality of life. But gods forbid we should seek to do that for ourselves or for family members who have asked to be released from their body. Death is such a personal thing, why do we not have the power to make our own decisions about how? Or leave legal instructions for the manner of death we choose?

How many stories have you heard where one partner kills the other–at their pleading, because of great, untreated pain? And the one left behind then goes to jail for fulfilling a dying wish. We need to stop telling people how they will die, dictating the “correct” method of ending a life. We do not tell anyone how to be born, or arrest women who deliver the “wrong” way, whatever society decides is unacceptable.

Dr. Kervorkian (“Dr. Death”) offered a way of making the choice about death for oneself, at any point of  life. It was gentle, it was infallible and it was a vastly preferred method to dying in unending pain or the gradual, but inevitable and fatal loss of bodily function. Anyone who wants to use his machine has to have psychological therapy prior to being approved for this method. (So people who are merely (ha!) suicidal would not be given the chance.) The hallmark of an “acceptable” form of suicide is that it must be absolutely ensured or it fails as a method of dying. Guns can miss, pills can be pumped out of the stomach; hanging may end being a long struggle as you are slowly suffocated, instead of an instant death with the neck being broken; cutting your wrists is frequently nonfatal. We need the same assurance for suicide as we do for the euthanasia of our pets: to die without struggle and to DIE. No chance of resuscitation, no botched attempts at all. Suicide needs methods that are absolutely final.

After all, who are we, to judge another person’s choices about their own life, or the ending thereof?

It’s very easy for someone who is not dying, who is not in intractable pain, to say that God will banish them to Hell for killing themselves. I also acknowledge that there are those who are dying, in terrible pain, that believe they must live this way “until the Lord calls them home.” I respect everyone’s spiritual paths; I also respect each person’s right to make decisions about themselves based on their own beliefs. I don’t respect trying to make decisions for others, without regard to their personal situation and spiritual path. I have found several sites here on the Interwebs that try to use various Bible verses to say that suicide is just a form of murder, so it’s a no-go. That God made you as His temple and you shouldn’t destroy God’s temple. But those verses do not say, “Thou shalt not commit self-murder or suicide.” If this was so terribly important to God, one assumes that He would have stated it specifically and as plainly as the other commandments (there are a lot more than 10; there’s several hundred–and none of them say “no suicide”).

But even if you can find a verse that would support the “kill yourself, go to Hell” reason, what about this one:”God’s temple”: what is the temple? Is it your physical body, or is it your immortal soul? How is it evil? Evil people kill others. Someone who wants to kill themselves is not evil–just in terrible, terrible pain, physically or mentally. I view those who do this as passing a judgment on that person. And when someone says, “If you commit suicide, you will go to Hell”, they are judging another person, taking Jesus Christ’s role as if it were their own. There are some pretty direct verses that address judging others.

To live or not to live is probably THE most private and personal decision anyone could ever make. I don’t care what your point of view about it, what your religion says about it, or (most especially) what society says should happen. It’s nobody’s business but the person whose life is in question–and only theirs, even if they are married, have a big family, lots of friends, whatever.

When it is done successfully, there is no more pain, no more failing body, no more overwhelming depression for the person who has committed suicide. Those who are left behind are the ones who are left suffering. I believe that the loss would be easier to bear if we knew that this was their decision for their life and we support them in that decision. If you know that you have done all that you could to help someone but they still choose suicide…don’t think that you’ve failed. We come back to this simple statement: they CHOSE to end their lives. It is NOT a reflection on you, on anything you did or didn’t do; it has nothing to do with you.

An unforeseen suicide often is shattering for those left behind. Perhaps they weren’t given the opportunity to offer comfort or help. They may not understand the reason for choosing death. It is still that person’s choice and needs to be accepted, if not honored, for that reason.

Anything that can help someone make the choice that offers a better way then eating a gun or taking pills, has to be, at the very least a step in the chosen–and right– direction.

And to close, a brief essay that I share when someone’s pet dies; this could also hold true for a human’s death, if you believe in an afterlife:
(my changes to make it apply to a human appear in parentheses)

The Rainbow Bridge

Just this side of heaven is a place called Rainbow Bridge.

When an animal (someone) dies that has been especially close to someone here, that pet (person) goes to Rainbow Bridge. There are meadows and hills for all of our special friends (loved ones) so they can run and play (exist) together. There is plenty of food, water and sunshine, and our friends (loved ones) are warm and comfortable.

All the animals (of those) who had been ill and old are restored to health and vigor. Those who were hurt or maimed are made whole and strong again, just as we remember them in our dreams of days and times gone by. The animals (They) are happy and content, except for one small thing; they each miss someone (people) very special to them, who had to be left behind.
They all run and play (exist in joy) together, but the day comes when one (your loved one) suddenly stops and looks into the distance. His bright eyes are intent. His eager body quivers. Suddenly he begins to run from the group, flying over the green grass, his legs carrying him faster and faster.

You have been spotted, and when you and your special friend loved one) finally meet, you cling together in joyous reunion, never to be parted again. The happy kisses rain upon your face; your hands again caress the beloved head (hold onto them in a hug), and you look once more into the trusting eyes of your pet (loved one), so long gone from your life but never absent from your heart.

Then you cross Rainbow Bridge together….