“If you expect heroics from the people who attend you, even if it doesn’t include hastening your death, you’d be well advised to treat your attendants as heroes. Mutual respect and consideration, honor and compassion should be the hallmarks of your relationship with them.”
(We pick up our discussion where we left off last time. Part 1 is HERE.)
One of the most predictable questions I get when I present on the topic of aid in dying is; how do I go about finding someone who will be willing to help me? And I always answer the same way; the only way to know is by asking.
I suggest that anyone looking for help with their end of life choices begin by interviewing those they love, to see who may have psychological, emotional, or moral reservations about assisting them in this fashion. I suggest that you never ask anyone to violate his/her ethical code regardless of how much you need help.
Once you find the person(s) you are looking for, I suggest that you check in with this person regularly to see if their level of commitment remains high, and excuse anyone who may have developed the least reservation about helping you as the time approaches. I suggest that you keep the number of people involved to the smallest number possible. One or two people at the most is my recommendation. Confidentiality and coordination of effort is essential and a large group make that virtually impossible.
At this point in the presentation I share two stories of very different death scenes to make my point. I was invited to consult on both occasions.
Jeffery was dying of AIDS. He and Alex, his lover of nearly twenty years, were preparing for his imminent death. Jeffery had a fear that he was beginning to slide into dementia, which was his worst nightmare. He wanted to short-circuit this final indignity and wanted to know if I would help them plan a strategy for proactively ending his life. I told them that I would be happy to offer them whatever information I had.
On this first visit with them I tried to assess the situation; to get a feel for the level of commitment that each person was bringing to this endeavor. There was no doubt about it, Jeffery was actively dying, his doctor confirmed the dementia diagnosis, and so time was of the essence.
I asked, “Have you guys done your homework?”
“If you mean, have we squirreled away enough medications to do the trick, the answer is no. We never gave this eventuality a thought until recently and now there’s not enough time to do that.”
“Will your doctor assist you with a prescription for a lethal dose of, let’s say, a barbiturate?”
“Doubt it. We’ve never talked to her about this. I don’t even know where she stands on the issue.”
“Well, then, how were you going to make this happen?”
“We were thinking about using street drugs, you know, coke and heroin. I also have some oral morphine left over from a friend who died last year.”
‘That’s it? That’s your plan? What if you mess up on the dosage or something else goes wrong? I’ve seen it happen. You could be in worse shape than you are now and still be alive. Do you have a Plan B?”
Jeffery responded; “Alex and I talked about it some and Alex promised that he wouldn’t let me suffer.”
“But what does that mean? Alex, do you know what it is you are promising?”
The three of us talked for hours about their half-baked scheme. I tried to get them to see how implausible their plan was and how serious the consequences would be if there was a miscalculation. They would have none of it. Their love for each other and Alex’s blind commitment to Jeffery to preserve him from any more suffering was all there was to know. Alex would be as resourceful as necessary, even if it meant he had to suffocate Jeffery in the end.
Ten days later I was invited to their home again. I didn’t realize it at first, but earlier that day they had set their plan in motion. Alex had scored some cocaine, freebased it, and watched as Jeffery shot up. Both of these guys had had a long history with intravenous drug use so all of this was familiar territory. Unfortunately, Jeffery’s history with drug use complicated matters considerably. He had built up a tolerance to the drug and even though he was nothing more than skin and bones, the dose was not lethal. This is the situation as I found it. Jeffery was comatose and appeared near death, and Alex was at his wit’s end.
“He’s been like that for hours. I thought for sure he’d be dead by now. I think we’ve screwed up. What am I gonna do now?”
“I’m afraid I can’t advise you. I can only help you weigh your options.”
As I saw it, Alex had two options. He could call the paramedics and have them try to revive Jeffery with all the trauma that would involve, or he could honor the commitment he made to Jeffery and complete the plan they rehearsed.
Then there was Earl and his wife Christina. Earl was in the final stages of lung cancer. He was a hard, difficult man, plagued by many personal demons. Even when he was well, people used to say that he was an acquired taste, and if you ask me, that was being generous. The sicker he got, the more difficult he became. He alienated just about everyone – his sons, his friends, even the people from hospice. No one could tolerate his fury. In the end there was only Christina.
Some weeks before he died, Earl demanded that Christina call me over for a visit. I wasn’t inclined to accept the summons because I hated to see how he treated her, but Christina sounded so defeated on the phone that I relented and made plans to stop by the following day. Nothing had changed in the eight months since my last visit. Despite being a mere shadow of his former self, Earl was as abusive as ever. How had Christina been able to stand it all this time, I wondered.
“I want to die! I want this to be over now. I can’t get decent care. All these fuckin’ doctors and nurses make me sick. They don’t know what they’re doing.”
“He doesn’t mean that, Richard,” Christina interjected. “He gets good care.”
“Pipe down! I’m doing the talking. What do you know about it anyway? She don’t know nothin’ about what it’s like for me. Listen, Richard, I want to die. I want to end it right now, but I need help. I’m sick of this.”
“What kind of help do you need?” I asked.
“I read Final Exit, you know. I know how to do it. I got all these pills I can take.” Earl pointed to the cache of pill bottles in the nightstand drawer. “But I don’t want any slip-ups. I need someone to help me with the plastic bag at the right time, and she won’t help me.” He nodded in the direction of his long-suffering wife.
It was true. Christina absolutely refused to help. When I asked her why, she could only sheepishly shrug her shoulders. There was clearly much more to this than what was on the surface.
Earl then turned his attention to me. “You got to help me. You’re the only one left.”
“Earl, I won’t and can’t. It’s not that your request is out of line. It’s because I’m a stranger here. In all the years that we’ve known each other, you’ve never once invited even the most casual of friendships to form between us. You’ve always kept me out. You can’t ask me to overlook that now. You’re asking me to participate in one of the most intimate experiences two people can have in life and, I’m afraid, there just isn’t any foundation for that here. I’m sorry.”
“You’re a fuckin’ coward, just like everybody else. So you can just get the hell out and leave me alone. Damn you all!”
I hated to leave Christina alone with him, but I did as he demanded. Christina showed me to the door.
“Why won’t you help him?” I asked, when she and I were alone. “It would be the end of your misery.”
“That’s exactly why I won’t. After all these years, I couldn’t be sure whether helping him die would be an act of compassion, which would end his suffering, or an act of violence, which would end mine.”
These two scenarios provide a blueprint of what not to do if you are seriously considering having someone assist you to die. If you expect heroics from the people who attend you, even if it doesn’t include hastening your death, you’d be well advised to treat your attendants as heroes. Mutual respect and consideration, honor and compassion should be the hallmarks of your relationship with them.
You also have to have a well-thought out plan. And a “Plan B.” There’s no substitute for meticulous attention to detail. Who, what, when, where, and how. Do your homework!