The right to die

A former student of mine, Thetis Abrera-Mangahas, who was in the very first sociology class I  taught in the 1960s read my column about life and illness last week and suddenly remembered our discussions about life and death in Sociology 101.  She sent me a sweet note and enclosed a fascinating essay by the writer Andrew Solomon, entitled “A Death of One’s Own”, from the May 22, 1995 issue of The New Yorker.  “A few months ago I read this article and cried remembering and feeling the sinking pain of my mother’s own death,” she wrote.

The article deals with euthanasia, or the right to die when there is no hope of relief and when degrading pain or loss of control prevents — in the playwright Seneca’s words — “all for which I would live.”  Andrew Solomon’s mother, who was afflicted with cancer, took her own life after going through repeated debilitating chemotherapy.

She had acquired the sleeping pills long before she actually decided it was time to use them.  She was  not suicidal, but she was determined not to go on living the moment life became unlivable.  “As long as there is even a remote chance of my getting well, I’ll go on with treatments,” she told her family. “When they say that they are keeping me alive but without any chance of recovery, then I’ll stop.  When it’s time, we’ll all know.  I won’t do anything before then.  Meanwhile, I plan to enjoy whatever time there is left.”

She was obviously a strong and clear-minded person.  She had also apparently argued her case very well before her doctor.  “I wrote a prescription for sleeping pills for someone who couldn’t sleep,” the doctor said.  “She was in the late stages of an illness that was clearly terminal.  She had voiced from the start her intention not to suffer.  She had made it clear that she wanted to die with dignity, and that wish seemed to accord with the rest of her character.”

Medically-assisted suicides continue to be banned almost everywhere.  But there is a resonant dialogue going on in Europe and the US.  “Euthanasiasts” have organized themselves into articulate groups like the Hemlock Society, Choice in Dying, Americans for Death with Dignity, Compassion in Dying, and ERGO! (Euthanasia Research & Guidance Organization) to force a public debate on the issue.  “Final Exit”, a controversial book authored by Derek Humphry became a best-seller after its sale was prohibited in Europe. I was surprised to see it openly displayed in local bookstores.  The book contains detailed recipes for dying.

Today, living wills, in which persons specify that they be allowed to die a natural death in cases of terminal illness instead of being subjected to extraordinary life-saving measures, have been given a legal standing in many states.  And although Dr. Jack Kevorkian, inventor of the “suicide machine”, the Mercitron, may have gained a certain level of notoriety everywhere, he has yet to spend a day in jail for the 22 suicides he has assisted since 1990. Indeed there are signs of liberalization on this issue although the ambivalence towards euthanasia persists.

The main problem appears to be the entire institutional complex which not only criminalizes but also stigmatizes euthanasia.  Under US and Philippine laws, if a doctor suspects suicide, he is legally bound to report it to the police. An autopsy is prescribed, and an investigation could be undertaken.  Without a  cooperative and understanding doctor, the whole affair could be very damaging and socially embarrassing.

Interestingly, without provoking a policy debate on it and risking the wrath of the Church, Filipinos may have found a way of getting around these institutional obstacles in order to give final relief to terminally and gravely ill patients.  On several occasions, I have heard friends say without any trace of guilt that they had requested their doctors to let their loved ones die peacefully.  A growing number of sensitive doctors are also learning to subtly ask families of comatose patients:   “Do you want me to limit artificial intervention and let nature take its course?”

Andrew Solomon says the discontinuation of artificial life-support systems for irreversibly comatose patients  is only  one, and the least controversial,  of 6 degrees of euthanasia under discussion in the US.  The others are: “discontinuation of feeding or hydration for a comatose patient”, not giving life-extending treatment to a terminally-ill patient at his request, providing an ultimately fatal pain relief to a patient in great pain, providing a patient the means by which to kill himself in order to avoid great suffering from a terminal illness, and “administering a lethal injection (at the patient’s request) to a patient who is severely or terminally ill.”  Methods that do not take into account the consent or knowledge of the patient are presently outside the scope of the present debate.

Are these the grumbling of a decadent culture or the sigh of a sublime civilization?  Is there any virtue in wanting to end a life of degrading pain and physical dependence?  Or is physical suffering such an integral part of life that embracing  it can only purify the spirit?

I have not found  the answers to these large questions, but about this I am certain:  I wish I could be like Andrew Solomon’s mother who knew what she wanted out of life and resolved to accomplish her agenda with dignity and care while she had the strength and the spirit to do so.  “She set aside a day with each of her friends — and she had many friends — to say goodbye…. she made sure that each understood the large place he or she occupied in her affections…. She set about having all our furniture reupholstered, so that she would leave the house in reasonable shape, and she selected a design for her tombstone.”


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