THE DAY MOM DIED: A Commentary on the Euthenasia Debate

WIn August of 2005 my mom died.

Her passing wasn’t sudden or unexpected, for she had been in declining health for several years and, as a result of progressively worsening case of dementia, her mind had been going as well. Fortunately, she still knew each of her children right up to the end, but I have to admit that her condition had turned her into little more than a frightened and sometimes very angry child, making it occasionally difficult to be with her those last few months.

It was hard to imagine my mother this way. Here was a woman who had always been so strong, so vibrant, so self-reliant. She had worked hard her whole life raising me and my five siblings, had spent countless hours every summer day tending to her beloved garden, would single-handedly create a Christmas light display that people would drive for miles to see, and yet still found time to travel all over the world. And now here she was in the last months of her life, reduced to pleading for us to take her home, begging that we not leave her, and throwing tantrums when she didn’t get her way. In the end I came to realize she had passed on long before her heart finally stopped beating; she had died the moment she could no longer live in her mountain home and tend her gardens. What I was seeing then was only a shadow of the woman I had admired and loved all my life.

The thing that most haunts me about that time, however, is an incident that occurred a few months before she finally died. As a result of Mom’s rapidly deteriorating state we could no longer take care of her ourselves, finally forcing us to begin looking for a facility where she might receive better care. (For anyone who’s ever had to go through this process, it can be a heart wrenching and depressing affair, and one that leaves you feeling like you’ve betrayed the woman who spent her whole life taking care of you.) Eventually we thought we found a pleasant and friendly facility that was close by and we moved Mom into her new “home” as well as we could. However, hers was not to be an easy or quick transition and within a week she began to display increasingly violent behavior towards the staff. Just a couple weeks later an outburst was so violent the staff was forced to restrain her and call for paramedics, who immediately took her to a geriatric Alzheimers unit at a hospital across town where she was confined to a seventh floor wing along with about forty other patients in similar states of dementia-induced rage, trapped in a virtual prison with no means of escape.

Of course, my siblings and I visited her each day in an attempt to keep her spirits up, though that was usually a losing proposition. I especially recall one terrible day when I stopped by for a visit and found her sitting by herself in a wheelchair in the hallway looking understandably depressed. After giving her a kiss, I remember her looking at me with a look of utter defeat in her eyes and asking if I would bring her her gun so she could end it all. (Mom owned several firearms and knew how to use them, so it wasn't out of the question that she may well have acted on that impulse if given the opportunity. Of course, by this time all of her firearms had been taken by my siblings or sold.) I tried to explain to her that I couldn’t do that, but she refused to accept no for an answer. Even after informing her that if I did agree to do so I would be sent to prison, she seemed determined that I help her take her own life and was furious at my lack of willingness to help “put her out of her misery,” as she liked to put it. Of course, the only recourse I had was to change the subject and wait patiently for the storm clouds to pass.

The problem was as I left for home that day that I actually wished that I could have fulfilled her request. I know that might strike some people as heartless, but I just wanted her to move on and would have, had circumstances permitted, very seriously considered helping her take her own life. Of course, I don’t mean I wanted to literally provide her a firearm, but if there was a pill she could’ve taken, I would have been sorely tempted to pour her the glass of water with which to wash it down. In fact, if there was a button I might push or a knob I might turn, I can’t in good conscious maintain I wouldn’t have done so. In any case, she passed on a few months later making the whole issue of my helping her end it all a moot point, though the incident continues to haunt me to this day.

I recount this unpleasant story because it got me thinking about assisted suicide and euthanasia in general and what I really believe about these things. It also got me wondering what the spiritual perspective on the issue might be, and since we live in a nation in which the elderly population is growing at a vociferous rate, it makes the issue of euthanasia an increasingly common one we—or our children—will likely be forced to face one day. As such, I thought it might be helpful to look at the issue and examine the spiritual ramifications it might entail in some detail. I can’t be sure, but I suspect Mom would have wanted us to have this discussion.

I must confess to having mixed feelings about the idea of voluntarily terminating one’s life. Certainly, I don’t want to live in a society where the elderly and dying are simply disposed of with no more thought than one may give to putting down an old dog, but on the other hand, I can’t help but but think that there is something wrong with a society that denies individuals the right to make their own decision about when and how to end their own life. Such strikes me as its own type of cruelty, though one cleverly dressed up in the trappings of compassion.

As a person who thinks about these sorts of issues, it’s difficult to determine how spirituality figures into the mix. Certainly spirituality is about living life as fully as possible, which would seem to be inconsistent with things like assisting someone to commit suicide (or taking one’s own life for that matter). On the other hand, it is even more about seeing life in a broader context outside the realm of this single physical experience we call “life,” thereby placing things like euthanasia and assisted suicide firmly on the table.

When such thoughts come up, I think of Mom and try to imagine how she would’ve felt had she been more coherent and out of pain. I recall her as being a woman who wasn’t afraid of death—tending to see it simply as a natural part of the life cycle—so I don’t think she had any serious problems with the idea of ending her own life. Of course, she had grown up on a farm in Minnesota and so was used to the idea that things died with some regularity. She also had watched animals being slaughtered for food, so I think she well understood that sometimes death was an integral part of life, which may have given her a perspective about these sorts of things many city dwellers could never appreciate.

That’s not to say she didn’t value and enjoy life. She loved to tend her flower garden and dance the polka and make wedding cakes. She loved taking occasional trips to Hawaii or driving back to Minnesota every summer to see her relatives. She even enjoyed travelling to such distant places as Turkey and Finland, so I know she was not one who saw life as a burden. It wasn’t until her physical and mental health began to deteriorate with frightening speed that she came to see life as an enemy to be defeated rather than a gift to be enjoyed. So no, I don’t think Mom hated life or really desired to die; I just think she knew her life was, for all practical purposes, finished and she just wanted to end it on her own terms. This strikes me as a particularly sane and coherent philosophy and one I suspect most people in her situation would embrace.

I understand that perspective as well, for I know the thought that I might be kept alive against my will long after I should have made my transition—“transition” being the term that “spiritual people” use when discussing death—makes me feel anxious. It’s not that I’m anxious to be moving on any time soon; I just want to know that when I do it will be on my terms—at least to whatever degree possible—and not up to the whims of some self-appointed moralist or in accordance to a bureaucrat’s set of government guidelines and procedures. It’s not that I don’t see life as a precious gift; it’s just that I also think that sometimes death can also be just as precious a gift. I think it’s my spirituality that helps me appreciate that fact.

Of course, I realize this is at variance with society’s insistence that death be resisted at any cost, and I respect the right of people to fight it with every last ounce of strength they possess. What I can’t understand, however, is why they would prefer to drag the dying process out as long as they can and what they imagine they might gain by doing so. In the end they are still going to lose the battle. Death always wins. Always.

Obviously the desire to fend off death as long as possible using whatever means available is tied in with the natural fear of death and the unrealistic hopes that a recovery may still be possible, so I can appreciate why a terminally ill person’s first instinct would be to fight. In fact, I fully support the rights of those who wish to battle the grim reaper for as long as they can and wish them all the luck in the world. I know they’ll lose—as I suspect they do as well—but I have no problem with them trying.

The problem I have with the issue is when I see others who, for various political, ethical, or religious reasons, decide it is their prerogative to make this decision for us. I know most of them mean well and believe they are acting in accordance with some self-measured standards of medical ethics or even imagine that they’re doing “God’s will,” but they still frighten me nonetheless, not for what they are trying to do, but for what they represent.

To me, people who are adamant in denying a dying patient the right to end their own life represent a sort of dichotomy between the role of God and the role of man in the affairs of life. They sincerely believe they are looking out for the rights of people, though I submit the real reason they oppose euthanasia is fear. I am convinced the reason most anti-euthanasia activists oppose it with such determination is because they imagine that if it ever becomes permissible, it will be only a matter of time before bands of “death squads” are walking hospital corridors executing anyone in a wheelchair.

Of course, this fear isn’t entirely groundless. After all, the Nazis did something very close to that when they initiated a state-sponsored euthanasia program during the 1930s designed to remove those elements of the population it considered either physically or mentally incapable, and in doing so they laid the foundation for the later decision to exterminate eleven million people deemed inferior during the Holocaust. As such, some degree of caution is warranted, especially where government involvement comes into play.

Then there is the religious perspective to consider. There are millions of people who oppose euthanasia on the grounds that to end ones suffering by willingly stopping a beating heart by whatever means necessary are somehow circumventing “God’s will.” In effect, they believe that only God has the right to decide when a person is to die, and if God wants Aunt Flo to linger until next Tuesday then no one—apparently not even Aunt Flo—has the right to stop her heart on Friday afternoon.

Personally, I can’t imagine a more absurd argument—or presumptuous one—than that God wills one to die a slow and often agonizing death and that no doctor—or even the patient himself—has any right to intervene in the process. As Doctor Jack Kevorkian—the most notorious (or courageous, depending upon one’s point of view) proponent of doctor assisted suicide—correctly points out, giving a person an aspirin or curing cancer is as much an attempt to circumvent “God’s will” as is stopping their heart with an injection of morphine. If those who maintain the “God’s will be done” argument want to be consistent, then it could be reasonably argued that we must shut down all hospitals and stop dispensing medications immediately and be content to simply stand back and let the Almighty’s "perfect will" be done. Of course, I’ve never heard a euthanasia opponent make this argument—which strikes me as a bit of an oversight—but I’m willing to wait them out.

Obviously the idea that our life is in God’s hand or is being played out according to His will is a mindset that harkens back to the Dark Ages when humanity lived in the throes of superstition and fear. If we believe that God truly gives us free will in all areas of our lives, why do we imagine he withholds the right to make the specific decision as to when we die and saves it for himself? Either we are free to do with our bodies as we want—including, I might add, abusing it with drugs and alcohol—or we are subject to his designs, thereby superseding our free will entirely. So which is it? Clearly he can’t have it both ways.

In the end I don’t fear “euthanasia squads” strolling the halls of nursing homes looking for their next victim as much as I fear seeing doctors unwilling to—or prevented from doing so—help a person end their suffering due to legal restraints or religious taboos placed upon them by people who have decided it is their moral or religious obligation—or even right—to protect such people from themselves. The idea that a person in the peak of health can dictate whether a terminally ill patient is to suffer needlessly strikes me as its own form of callousness, however well cloaked it may be in the mantle of mercy. In the end, it strikes me that what opponents of euthanasia are really afraid of are not irresponsible doctors or inhumane euthanasia squads, but of their own mortality.

There is another argument that must be considered, however, which is less clear cut, and that is the issue of terminating the life of those who are unable to make their personal will known. It’s one thing when a person is mentally and emotionally capable of making a decision about ending their own life but quite another when that person is unconscious, comatose, or otherwise incapable of understanding what their choices are. This, I suppose, is where fears about euthanasia hit squads come in, especially in the case of terminally ill patients who have no family or friends to advocate for them.

I agree this is a difficult issue, but here is where I’m prepared to side with the religionists and let God—or, more precisely, the circumstances—make the decision. In effect, if an individual is incapable of sustaining their own life—including breathing without a ventilator or being fed without assistance or otherwise managing basic survival needs—then perhaps involuntary—or, more precisely, unconscious—euthanasia might be considered. Who exactly would make this decision is problematic of course—the department head or chief of surgery working from a carefully articulated set of guidelines perhaps—but it may be the only really humane thing to do.
Some would call this “forced” euthanasia, of course, which it is. However, this is precisely the criteria we use when we decide whether it’s time for the beloved family pet to be put down. Clearly the animal has no say in the matter, but once it becomes too feeble to walk or it exhibits great pain or is no longer capable of keeping its food down, the decision to euthanize the animal is not only the right thing to do, but the most humane course of action. In fact, we sometimes consider the owners of pets who insist on keeping their animal alive long after it has lost all quality of life to be “cruel” even though their rationale for doing so is one driven entirely by love for the animal. Yet with humans, precisely the opposite mentality reigns; we consider the desire to end a comatose loved one’s life before absolutely every technique or procedure designed to keep them alive another day has been attempted to be “insensitive” and “heartless.” Obviously, we’ve got it backwards.

Finally we have the issue of what we should one do with those patients who are neither terminally ill nor in pain but who simply have lost the bulk of their mental faculties—such as is often the case with patients suffering from the advanced stages of Alzheimer’s? I admit that this is a far more difficult question to answer, especially as it so wrought with substantial moral, legal, and religious ramifications.

In many ways, people who fall into this category are the most tragic of all, for the issue of when life should be ended is less clear, potentially leaving them in a sort of medical limbo for years. On the one hand, it can be argued that since the person is not in pain, they should be maintained indefinitely (until God “takes them” naturally, it is assumed) while the argument that such extraordinary measures are an immense drain on an already overextended medical system and has long-term financially and emotionally detrimental effects on the patient’s family must also be considered. Another point to consider is what is meant by the term “terminal” illness. Technically, since we are all mortal beings, we are all “terminal” in the broadest sense of the word, though, of course, this is not what medical ethicists are talking about. However, in the case of a ninety-year-old Alzheimer’s sufferer, I think it is a fair question to ask. Even if the patient is not dying of some symptomatic disease, the Alzheimer’s itself is eating away at the brain; as such, even if the body remains comparatively healthy, the mechanism that keeps it all running is itself dying, making the health of the body that houses it immaterial. The same argument, in fact, could also be made for comatose patients or those with such severe brain trauma as to be effectively in a vegetative state.

Further, what of individuals who are suffering from such diminished quality of life issues such as paralysis or extensive burns? In effect, does a person have the right to end their own life if the only option available to them is living out the rest of that life as a quadriplegic or waiting as Lou Gehrig’s Disease or multiple sclerosis saps them of their strength, vitality, and finally their independence? Isn’t this something that each individual should decide for himself, or should the state or church be the entity to make that decision for them? What would you want to have happen if you were in that situation?

The problem is that many spinal cord injury patients go on to live full, rich lives, and many debilitating diseases can take years before their most severe effects are fully felt, making the issue of if and when assisted suicide might be a reasonable option more problematic. On the other hand, I can’t imagine anything more terrifying than being trapped inside a body that is deemed too healthy to be euthanized and being utterly unable to do anything about it. Such would be a sort of living death or, more precisely, a living hell in my opinion. The problem, of course, is that many medical ethicists are squeamish about permitting otherwise healthy people—especially if they are young—to request that their life be terminated largely because it opens the door to the prospect that anyone could request euthanasia for any number of non-life threatening injuries, including physical disfigurement and even clinical depression. In the end, it’s really just a quality of life issue, with the only question that needs to be asked being not whether a person is suffering physically, but whether they are suffering mentally and emotionally as well—which is a type of pain that can be every bit as debilitating as physical discomfort. (And, of course, the emotional pain and suffering of the family must also be taken into account—especially in the case of families whose loved ones are in a vegetative state.)

In the end, while I understand there are huge ethical, moral and legal land mines that need to be worked through, I believe the universe is gracious in understanding our human predicaments. Even a personal God, if such existed, couldn’t fail but see through the heated rhetoric that passes for compassion these days and see into the heart of the matter.

God’s will be done? Perhaps it is simply a matter of understanding that His will is that we choose for ourselves what is right for us. Some will call that blasphemy and an attempt to throw God off His throne, but I call it compassion and an example of God’s faith in us to do the right thing. Spirituality is about living, not merely existing. I suspect God would understand the difference between the two even when well-meaning men and women cannot.

I don’t know for sure, but I suspect somewhere up there Mom is smiling.