Death and dying

On Tuesday, November 8, Colorado voters approved a measure legalizing assisted suicide, following the lead of Oregon, Vermont, Washington, and a couple of other states in taking this step.

A century ago, dying was generally an event or a very quick process. Today, dying is more often a lengthy process than an event. Life support measures such as respirators, intravenous feeding, and hydration can frequently sustain the mechanics of life for long periods, preserving the appearance of life in what is known as a persistent vegetative state (PVS). Medical treatment can concurrently prevent the person dying from a growing array of previously life-threatening diseases and injuries. (For a fuller, clearer exposition of this change, read Haider Javed Warraich's "On Assisted Suicide, Going Beyond ‘Do No Harm’", New York Times, November 4, 2016 at http://nyti.ms/2eaeL36.)

In one case that received much media attention, a Florida woman, Karen Ann Quinlan, was kept in a PVS at the insistence of her family of origin and contrary to the wishes of her husband, her legal next of kin. When the courts finally ended the standoff, siding with Quinlan's husband, an autopsy revealed that her brain had suffered considerable deterioration even though the rest of her body gave the appearance of being alive.

Having been diagnosed with a specific fatal disease (life itself is eventually fatal, always ending in death), the shift from dying as an even to dying as a process, debates about assisted suicide, and the use of heroic measures to sustain life, or at least the appearance of life, prompt several thoughts and feelings.

First, I don't think that I fear death. I don't fear falling asleep at night; death, at its worst, may be the permanent loss of consciousness, not unlike falling asleep permanently. And optimally, death is just another waypoint on a journey to an even richer, more abundant form of life. Still, I'm in no rush to die, continuing to enjoy much of life, and eagerly looking forward to my cancer going into remission sometime in the next few months.

Second, I have no desire to remain in a PVS or to suffer uncontrollable pain from an agonizingly slow death. Although pain may be a precursor to something good (e.g., medical treatment and natural healing processes may cause pain, but that pain is incidental to the healing process), pain per se is never a good.

Third, existing (perhaps better described as subsisting) in endless pain with no hope of healing and no hope of leading a fuller life is not a good. Only the individual who lives in severe, unending pain – in consultation with loved ones and healthcare providers – is in a position to decide whether any continuing enjoyment of life outweighs the pain. Depression, a frequent side effect of long-term serious disease or suffering, can wrongly skew that judgment. This justifies the stipulation that decisions about treatment be made in consultation with loved ones and healthcare providers.

Fourth, a dying person may not be able to make healthcare decisions in a timely manner, e.g., being in a coma. Consequently, everyone should think about this set of problems, consult with loved ones, and then prepare an advanced healthcare directive and other requisite documents to ensure that their desires are honored if and when necessary.