Allow Natural Death

Archive for March, 2012

Murder/Suicide and Allowing Natural Death

It may seem that the contemplation of allowing natural death would disallow the act of suicide. But today’s newspaper tells me something different. The headline reads, “Snelling’s brother in murder-suicide”. Turns out Snelling was a governor of Pennsylvania,  that is apparently the reason this story was covered by news outlets across the country. The link here is to the local coverage of the death of two 81 year old people who had celebrated their 61st anniversary six days before. After hearing of their death, friends realized that the lovely and upbeat dinner was really a good bye.

According to the family of Charles and Adrienne Snelling, the couple “struggled greatly to manage the effects” of Adriennes’s Alzheimer’s Disease for six years. “After apparently reaching the point where he could no longer bear to see the love of his life deteriorate further, our father ended our mother’s life and then took his own life as well. This is a total shock to everyone in the family, but we know he acted out of deep devotion and profound love.”

It occurs to me that other options for Mr.Snelling were unacceptable. He may have promised his wife that he would never put her into an institution for care. In the New York Times essay that Mr. Snelling wrote in 2011 he said, “although he had “wonderful helpers” caring for his wife, “real care for a loved one with Alzheimer’s cannot be delegated. I did not need to be told that; I felt it in my bones.” Finances were not an issue, he had hired folks to assist in the care of his wife for 14 hours a day.  Clearly, Mr. Snelling’s devotion was non-stop.

Alzheimer’s Disease is one of the most feared diagnoses for most of us. When worst fears are realized, suicide is contemplated soon after. The intersection of allowing natural death and suicide for me is a question of the “allowing”. Might some of us prefer to forgo almost all treatments at some point so as to allow death to come? And if so, do we really know how to do that? Have our health care providers suggested that at some point we may wish to stop taking some of our medications? Or do they have a policy of offering to insert a feeding tube when nutrition is compromised? Has anyone suggested the possibility that an infection could be allowed to run its course, to bring death in just a few days? Are there ways that by the omission of some of our medications we would be spared months or even years of terminal suffering?

When death is allowed to occur it is possible that suicide may be unnecessary. Sometimes.

Conjuring some courage

It is for good reason that I have become so enamored of the words “Courage My Love”. It is absolutely because I am in need of encouragement to speak my mind even here. I have been told often that I am already courageous for speaking openly about my views in some of the hallowed halls of academic medical institutions. It is my firm belief that this wasn’t a career enhancing action for me to take. But there are no regrets and all is most certainly as it should be for me. After two years far from the front lines of care, I am more free to consider the ways things might have been. By which I mean, the way things might have been if the medical model of care did not dictate the care of nearly ninety percent of elders as they die. After spending so much time and energy creating new and better ways to care for frail elders in hospital, I am more clear than ever that the hospitals and nursing facilities that we have created to care for elders will never be able to give elders the dignified death that they desire.

But I do often lack the courage to say exactly where all this continued looking and listening and learning has taken me now. After the publication of Letters To The Editor in my local newspaper I have been accused of supporting euthanasia. (I don’t) I have been contacted by some heavy hitters who challenged my support of  Death With Dignity/Right To Die legislation. I don’t like it when others refuse to dialogue with me. I realize that I am far too sensitive and sometimes seek to avoid confrontation in any form. But it is exactly that same sensitivity that has led me to feel the prolonged distress that I have felt when I see the plight of frail elders whose care is prolonging their suffering. Care that is dictated by a system that is skewed in ways that are both subtle and direct but always lacking in peace and comfort and oh yes, very expensive.

More and more I am hearing from others who insist that they will commit suicide before they will allow this to happen to them. I am also hearing about increased rates of suicide in those of advanced age. Sometimes I hear about murder/suicide in an elderly couple who are reported by elders to be wonderful neighbors whose health had begun to fail them. I hear from folks who work at the front line of care where they see first hand the awfulness of being completely dependent on others for all your care needs…others who demonstrate their own distaste for the work of providing that care. I am one of those persons who says, “I will kill myself before I am forced to accept care from others in such environments.” And for those without a great deal of financial resources, it is only this sort of care that is available.

But the stated intention to commit suicide before accepting the fate of dependent care in a Medicare supported facility will really require a lot more planning and that is something I have been thinking about for a long time. And it is certainly something that will require a huge dose of that courage I sometimes lack.