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April 14, 2010

The Last Goodnights

Assisting My Parents with Their Suicides
John West

This book valiantly, at considerable personal risk, provides the essence of the argument for physician-assisted suicide. (There is, after all, no statute of limitations on the felony charge of murder, and Dr. Kevorkian's situation presents a frightening precedent.) It was written by a lawyer who knew exactly what he was doing. A decade later he shares his legal and emotional dilemma. It is highly recommended for "anyone who expects to die in the future, with or without help, and/or by his own hand . . . or not."

The situation is somewhat unique in that both of his parents were professionals. Both knew what they asked, and both understood the implications. His father, a psychiatrist, had a rapidly progressive, extremely painful terminal cancer. He discussed with his son the "psychology and autonomy of self-deTermination." His mother, a psychologist, was in rapid decline due to Alzheimer's. For neither was there an answer except to "suck it up." Mother, when alert, was in full possession of her faculties, and "would not allow herself to devolve into a walking broccoli, a drooling, diapered, disoriented 'non-creature.'"

West chronicles, "blow by blow" what he--and they--faced and experienced as he helped them consummate their deaths. He is candid, with a touch of irony, as he explores the problem, separating his problem within context, from theirs, making a compassionate plea for serious consideration of this ever-growing dilemma.

He asserts many valid points, and makes them well. Along the way he ruminates about the obscenely complicated rituals of hospitals, not a few of which I have experienced myself (e.g., getting prescriptions from the pharmacy at the time of the patient's discharge which is unconscionably difficult. His father was a renowned faculty member which, as with me, made absolutely no difference. All parties are equally abused.)

In a fugue of "black humor" he recites the "stock observations" about suicide's possibilities--tall buildings, arching bridges, railroad tracks, etc . . . all of which are predicated on an alert orientation, physical mobility, and a certain élan over doing yourself in.

After his first "assist," when he was required to force pills down his father's throat since he had begun to slumber before he had had sufficient medication, he observes: "Although I'd known it intellectually for months, I finally felt--viscerally--that this was precisely why assisted suicide should not be attempted by amateurs, and why it should be a legally accepted part of the doctor-patient relationship." The emotional impact was severe, and made his relationship with his parents difficult, even though he was "comfortable" with their decision to ask, and his decision to comply. "Emotions I had to hide [from others, including family, in whom he could not confide.] Emotions that kicked my ass."

Throughout the book, he maintains a wry sense of humor, bordering on the mordant from time to time, as he discusses the attendant anguish and personal pain, yet the recitation is seasoned with love and insight.

The situation is, compared to that described in Tuesday's with Morrie, exactly opposite. And "Morrie" is relevant because he chose to die differently; hence the dilemma.

My concerns, as a physician and amateur philosopher, is what happens if/when assisted suicide is sanctioned? We can all understand the spectrum and both poles. We may well acknowledge that people ought to be able to select their mode of demise, and yet the example of Holland bears heavily on my mind. A situation in which "the kids" are now free to "off Gramma" to relieve themselves of the burden and/or get at their inheritance a little early. One who understands human nature, and considers progressive, omni-tolerant government, must take into account what may--and likely will--become the standard should physician-assisted suicide become legal here. They're already there in Holland. It isn't pretty, and there is likely no turning back.

Rigorous caution, careful consideration and debate are necessary!

Posted by Curmudgeon at April 14, 2010 2:51 PM