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A Good Death?

A friend recently told me her father had died. He was 102.

When he was 96 and in a nursing home, he shared a room with his wife, who was 93 and no longer knew who he was. He confided to his daughter that he wished she could die, and that he wanted to die, too.

"It's been long enough," she recalled him saying. "But they won't let me go."

He was frail and crippled, but he wasn't in acute pain and didn't have a terminal illness. He was simply tired of living. He had enough presence of mind to know where he was, why he was there, and what the future held. All of it was damn bleak.

He wanted to choose, but it wasn't his choice to make.

Should it have been? We have some control and independence over how we live. Should we not also have some control over how we die?

More to the point, should physicians be allowed to help us exercise that control?

This is not an easy question, either in the abstract or the particular. For some, it is utterly and morally wrong to assist in another's death, no matter what the circumstances. Advanced directives, pain management, holistic hospice care, yes. A lethal dose of pills to hasten a certain death, no.

Surely my friend's father could have taken antidepressants to smooth the rough edges. For all I know, maybe he did. He had family support, adequate finances, decent around-the-clock care. Just take these pills, Dad. You'll feel better, wait and see.

For others, escape from pain and a sense of hopelessness is not the point. One doesn't want a palliative, one wants a choice, a measure of control and independence in choosing how and when to die.

Which is more virtuous: the grace and dignity thought to accrue from an acceptance of the natural forces of decay -- and the laws of the state -- or the grace and dignity thought to accrue from the embrace of reason and the freedom to choose?

As my father told me after refusing pain medication until the very end of his bout with cancer, "I want to be aware of what I'm leaving behind."

I don't think there is any such thing as a good death. There is only a good life, which is a measure of the choices we make within the circumstances that both expand and limit those choices. My nephew died of a brain tumor when he was 26. It was a horrible twist of fate; it should never have happened. But it did, and in his last days he was remarkably serene and resigned to his fate. As his brother described it at his memorial service, "Greg taught us how we should live. He showed us grace and courage."

My nephew lived a short but good life. His death was one indication of it.

It's interesting to note that in Oregon, where a Death with Dignity Act has been in existence for five years, there hasn't been a rush to physician-assisted suicide. In fact, more Oregonians die in a hospice program (36 percent) than in the rest of the country (25 percent). The Act has actually prodded physicians to make efforts to improve care for the terminally ill; they grant only one in six requests for assisted suicide. Although various studies indicate that anywhere between 10 percent and 52 percent of people with AIDS or cancer have an interest in assisted suicide, only 0.1 percent of people in Oregon actually die this way.

But Oregonians can choose. That's no small thing.

I've often told my wife and children that if I ever get to the point where I'm babbling incoherently and don't know where I am, just take me out in the back yard and shoot me. Like the Vikings, when my time comes I would rather drift out into the great ice floe, spear in hand, than suffer the ignominies of a choiceless life, no matter how caring the environment.

But who knows how it will go, and how we will feel when it arrives. I've learned through experience not to confuse my desires with sound public policy. The issue of physician-assisted suicide is fraught with all sorts of minefields, and until there's a sea change in our culture's attitude toward death and dying, it's not going to sweep through the states anytime soon.

I'm not planning on a good death. I'm planning on a good life in the time that's allotted to me; and when the end comes, I hope to have a choice, and to have someone there to help me make it.