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The Observant Immigrant

To be or Not to be…

 Candice Louisa Daquin takes a close look at death and suicide.

The Death of Socrates by Jacques-Louis David (1748-1825) Courtesy: Creative Commons

Recently I’ve been grappling with the imminent death of a very dear friend. She is very young. Maybe her youth or maybe my attachment to her, makes this particularly moving to me. I have dealt with death before and it is never something as simple as going softly into the night. Yet it is something we must all deal with, multiple times, often intimately and up-close-and-personal when it comes to our turn. This may be a macabre subject but, in a way, it shouldn’t be because it’s the one thing we will all are guaranteed to experience. Maybe it’s time to see death and dying differently?

In my friend’s case she wanted passionately to live. She didn’t want to get cancer in her thirties and have the rest of her days taken up with trying to survive. It’s unfair, it’s horrible, it’s what most of us fear. Despite this, her grace leading up to her death, including her time in the Hospice, had been startling for me. I saw a change in her, that I found unexpected and illuminating. One could have argued it was the hand of God touching her, those who do not believe might have mooted for inner peace. As much as I rail against her dying, and wish stupidly something could prevent it, what helps is knowing what I feel and think is nothing compared to what her family is experiencing, and it puts things in perspective and demands that I rein my feelings. By that, I don’t mean ignore the sadness, but put it in a context because everything is a context.

My context is: A few years back my beloved cat died, I was very upset. But I knew he was a cat who lived a long life, and he was ‘just a cat’ versus a human. For me, that context is different (despite ultimately believing us all equal). If my father passed on, it would devastate me more than say, a stranger, and that’s just being honest. When my grandparents died, I was very upset, but I put it in the context of expecting grandparents to die and whilst I still think of them and miss (some) of them, I’m able to cope. I think this is true with my clients, they rationalise by contextualising. It’s how we cope with grief and fear. When we cannot do this, we usually develop some type of imbalance and that can cause us to have unexpected responses like feeling as if it is the end of the world if your pet turtle has passed on. Everything is context-based. While it might seem insensitive to admit this, it’s what keeps us sane.

People can be dismissive of others pain. I have often heard people say things like: “Well her parents died more than a year ago, don’t you think she should be ‘over’ it by now?” Invariably when their time comes to lose their parents, they may finally understand why most people don’t get ‘over’ it when they lose parents, or siblings or their children. Others believe you are weak if you don’t ‘suck it up’ or that there is some time limit on grieving. In the faith I grew up in, we tend to give a year for grieving for parents (or close relatives) which allows the griever to not feel guilty (or guilted) for their emotions – it frees them. On the other hand, it could be negative if say, after a year they feel worse as many do because grief is not linear. Nothing is perfect. The important thing is to have empathy and realise we all process differently and there is nothing that is wrong or right, except for the individual.

If we all die, then we shouldn’t stigmatise illness or fear it but many people do. It is the great unknown. In modern times, a worse fear is suffering. We may not know what happens when we die, but we know suffering and nobody wants to suffer, but increasing numbers of people do. Why? We always suffered to some extent. In wars people would lie on battle fields for long periods of time dying of awful wounds. In modern times we harnessed the power of pain killers and believed ourselves free of pain and thus, suffering. Despite this quite the opposite phenomena has occurred. In some ways people suffer more.

Why? Because with the advent of ways to prolong life, came medication that extended life but it came with a price. When a person gets cancer say, it’s no longer a death sentence. Many recover fully and go on to live long healthy lives. For those who get a late diagnosis however, the cancer might have spread so much so that eventually it will take their life. This is where modern medicine seems to shine. There are a plethora of medications that prolong life. No, not cure but cause remission or sustain life for a period of time.

If you are someone with children or grandchildren, living an extra two years might be worth the astronomical sum it costs (if you can afford it) but at what cost? Many of these drugs cause horrible side-effects and do not reduce suffering, in fact it is the suffering (toward death) that becomes the experience. You could say, we have prolonged suffering in our attempts to give people ‘more time.’ The question then, is it worth more time and what do we mean by more time?

Whilst doctors want to offer hope, they do so more out of a stubborn desire to ‘try anything’ rather than because the six months they may give a dying person, is really beneficial when you consider the sheer backbreaking cost (bankruptcy from medical costs being the #1 reason) and very small gains (six months more of life and you have spent all your money on a treatment which only benefits Big Pharma, according to Dr. Azra Raza in her ground breaking book about death and dying, The First Cell). The unwillingness of doctors to give up, is admirable and very human (who wants to tell someone there is no hope?) but it brings with it, a false promise.

In the modern world, people have smaller families by and large, and as such, many of us when we get older and more likely to die, may have less obvious incentives to live if we get sick. It’s not so much a wish to die, but a pragmatism about death and dying. Easy in theory, perhaps less so in practice, we must all eventually deal with this issue. Better to consider it before the time comes, hence the increase of living wills, whereby we inform doctors and loved ones, what we want to happen should we get sick. Again, macabre maybe, but imminently sensible, and useful when doctors are not mind-readers and cannot predict what a patient coming into Emergency may wish by way of life sustaining treatment.

Speaking of life sustaining, one debate long held relates to dementia. Right now, if you were to write in a living will that should you get dementia you do not want any life sustaining treatment that would only include if something actually happened to you, such as a heart attack or your kidneys shutting down. For many with dementia though, it is the day-to-day living that is hard, both on the individual whom on some level knows they are not themselves, and on those who care for them. Whilst it seems inhumane to some, to consider letting people with dementia die, those lucid enough to know they have dementia will often wish to die rather than live, without any hope of recovery and the mental state of a child without any chance of growing up. Since dementia is so common place and we’re all living longer, this is a real issue and yet little is done to combat the increase in dementia patients who may often have nobody to look after them and no funds for full time care. What should be done?

Clients of mine with parents suffering from dementia will often describe the agonising decision to put them in care if they have the financial wherewithal or take care of them at home, often at great expense (loss of job, career). Some wish nothing more than the opportunity to care for their parents or loved ones, whilst others feel guilty for wishing it were anyone but them looking after their dementia patient. Both perspectives are understandable. For some there is a redemptive quality to caring, and it comes naturally. For others, financial or emotional reasons may make being a person who cares for others, incredibly hard. It is not surprising that older carers such as the husband of a woman with Alzheimer’s, often dies before the wife. The actual act of caring is exhausting as it may be redemptive, and nobody should be blamed for being unable to do it. Sometimes however, there is no choice, with rising costs for elder care, especially with dementia. It makes me wonder what will happen if the predicted number of elderly develop dementia. Will it be common place to see them walking the streets without anyone to look after them? Take me for example, should my father develop dementia and I live in a different continent, what would I do? This is something many of my client’s fear and yet little is done to resolve this issue by world Governments.

Some people believe dementia patients should be allowed to access euthanasia. As of now, all countries with some degree of access to euthanasia ask that the patient be ‘sound of mind’ – which would not apply to someone with dementia. But even if you write a living will stipulating that you wish to have euthanasia if you get dementia, this is a tricky situation because by the time that would apply, you would not be sound of mind, so it negates the ability to have euthanasia. Furthermore, what of unscrupulous relatives or friends, jockeying for inheritance or to financial gains? How can this be stopped from being misused? How can we gauge whether someone with full blown dementia really wants to die? The reason this matters, is by the time a woman is 80 she has a 1/3 chance of dementia of some kind and by the time she’s 90 that chance is 1/2. This is and is going to affect a huge swath of the population and as such, these conversations need to be had. The only way we do this is to consider what end of life means and how best to end life.

End of life conversations are common in therapy. Clients may be bereaved. They may have a partner dying of a terminal illness, they may have lost a child, parent, friend. Perhaps it is a relief to have counselors because many people don’t want to ‘go there’ and talk about death and dying as if it is contagious. It’s a hard subject, a sad subject, and difficult to put a positive spin on it. Life can be tough enough, without considering dying before it’s time, but that’s exactly what we should do to protect ourselves.

The other subject not discussed in depth is suicide. It’s one thing for us to die of disease, we know that’s a possibility but we’ve always struggled with the idea of suicide. For most of history, suicide has been variously unsanctioned by society-en-mass, but the question is why? Is it an ancient fear of the ‘unnatural’ impulse to die? That we work so hard to stay alive, it seems absolutely wrong to wish to die? Or something else? Whilst Emile Durkheim (1858-1917) wrote on suicide and many have questioned this, no one person that I’m aware of, has managed to figure out what our collective horror is in relation to suicide.

Let’s play devils advocate for a moment. What is it about the decision of another wishing to take their life that causes people to react so strongly? Is it the same as abortion? Pro-life over Pro-choice? Or the visceral horror we all have about dying? If the latter, why does it matter so much to us what others do? What right do we have to intervene? Yet we do, societally and individually. One might say we’re just trying to save lives, but do we put as much passion into feeding the starving or rescuing women from abusive relationships as we do banning abortion and making suicide illegal or socially frowned upon? When it’s not illegal, it’s considered ‘weak’ and a ‘cop out’ (to use an American term). The only society where suicide was really ‘embraced’ if such a thing can exist, is Japan, and nobody really knows why that singular country took the notion of suicide to such an artform.

Suicide bombers today may be Muslim fundamentalists protesting against the tyranny of an oppressive country. They are sold on the idea the after life will be a paradise, and much of what they are told is not from the Koran but from the machinations of those who impel them toward acts of terror. When a young person blows themselves up to destroy others, this is not the suicide we think we understand, but an act of anger, revenge, justice or ignorance. Suicide in its more common form is less about revenge or justice but can be about ignorance or anger. Ignorance in that many young people kill themselves almost upon an impulse, with little pre-thought or planning, just in a reactionary ‘of the moment’ way, that shocks loved ones who didn’t see it coming because it may not have been (coming). There is an element of ignorance to this act, they may be copying others, or reacting abruptly, and had they known more in that moment, they would possibly have looked back on the act and regretted it. As such the impulsive element of the act could be viewed as ignorance/nativity.

Anger is a very common reason for suicide, although probably the one everyone is most familiar with is despair (depression). Ironically anger is as much as incentive for suicide as despair, because of the heightened tendency to react with both those emotions. It is in that heightened state that many attempt or complete suicide and those who survive, often realize there were other options they wish they had taken. For the committed, then suicide is a personal decision, perhaps based on a terminal illness diagnosis or long-term suffering. Despite this people intervene and tell anyone who wishes to die rather than linger and suffer, that they are weak for taking this option. I have always found that fascinating and awful, because I see it exactly the way I would putting my cat to sleep. I did it out of mercy and love. I did not want my cat to suffer. A human being is not a cat but the same emotion applies. Where is the true difference?

The difference lies in religion. People who condemn people for taking their lives are not universally religious but many are. The tenants of a religion might dictate that someone should not take their life. I have always wondered why, because I believe most religions were written and created by humans and so it begs the question, why were they so intent on stopping people from taking their own lives? I can understand that if a God exists and says we should not take our lives, this would give pause to many. But it also creates a challenge, because what God would wish someone to suffer terribly?

This is a very personal decision and that’s my final word on whether someone should choose suicide if they are suffering. To some extent it should be the right of the individual and never anyone else, what they do with their life and death. I recall Brittany Maynard (1984-2014), a young woman with a terminal cancer in her 20’s talking of her right to end her life rather than brutally suffer and I felt then, even if I did believe in God, I would not strip her of that right, because I did not want her to suffer and I could not believe any God or human would. Again, if we have tools in place to deal with these issues, then people who are suffering terribly, do not have to battle through this, at their most vulnerable.

Many of us may not know this but suicide if we’re talking technically suicide, is incredibly common. Old people often stop eating and will themselves to die when they have had enough of life. Technically that’s suicide even if they do not see it that way. Maybe it’s more natural than we imagined? Likewise, hospices and long-term care facilities will medicate terminal patients at the end to hasten their death and relieve some of the suffering. Effectively causing a person to die before their ‘time’ if we think in God-given terms. I do not begrudge this because these carers are seeing people suffer in ways few of us can imagine, if there is not a mercy to ending a life of agony, then I don’t know what mercy really is.

The stigma of suicide is incredibly pervasive. Just like mental illness, suicide is seen as ‘not right in the head’ and a weakness. How sad that society believes judging those during their worst times is the right thing to do? How is that going to help someone choose anything else? And what of their right to end their suffering? This begs the question: Is it right to die before your time? And by right, what do we mean? Who is the judge of what is right and wrong? For some, it’s easy, it’s God and most Gods say suicide is ‘wrong’ but again, why? And at what cost? For those of us without God, then right and wrong become moral principles that we try to adhere to. Is there a downside to morality being the choice of humans rather than something more than us? Absolutely. We are flawed and liable to influence, but sometimes trying our best is all we can do. I would like to think I would be merciful before judging if someone I loved dearly wished to end their life. It would of course depend upon the circumstances, as it should.

Switzerland is the only country in the world where you can elect euthanasia for no specific reason. In America in the ten states that permit some degree of euthanasia, you need to be close to death and have a terminal illness.

Why is death sad?

Switzerland is testing a 3-D-printed pod that its creator says can painlessly end someone’s life in a matter of minutes. The device is called ‘Sarco’ and users can potentially end their lives at the push of a button. The advantage of this system is he pod becomes filled with nitrogen gas, which lowers oxygen in a person, until they fall unconscious and this occurs fast, within a minute. The idea of a truly painless death by euthanasia is why this was invented and users do not Sacro suffocate they die fast of oxygen deprivation after they’ve fallen asleep.

Some have argued a machine like this could glamorise suicide (although how, is not explained) and that it may be overly appealing to a mentally ill person seeking death. I don’t really agree. If there are checks and balances in place that work effectively, this won’t be an issue. The real issue is who wants to consider people taking their lives when death is sad? And how do we access without bias, who is ‘eligible’ for euthanasia and who can be helped another way, that doesn’t involve a premature death? After all, someone in the throes of depression, may wish legitimately to die, but what if a year later they are well enough to be glad they didn’t die? Those kinds of grey areas must be resolved before euthanasia could ever be expanded or wide-spread.

The Netherlands and Belgium permit assisted suicide for patients with unbearable physical or psychological suffering. Which differs from the USA where it can only be for terminal end stage physical illness. Switzerland has less qualms, making it a destination for ‘suicide tourism’ which again, is very sad, but perhaps what is sadder, is that they have to resort to this and what about those who don’t have the means? People assume those who are pro-euthanasia must be eugenicists or simply not care about others, but often the extreme opposite is true, just as it is with Pro-Choice advocates, who believe choice is freedom and the basic right of any woman.

Should we be able to die because we’re simply ‘tired of life’ or should we be expected to carry on to the ‘bitter’ end? This is such a cultural dilemma and maybe suicide became more acceptable in Japan because they reframed the concept of death, making it honourable to commit suicide (or as a means of regaining honor) just as suicide bombers find honour in the act. Should we need honour or some justification to believe suicide needs to be part of any argument about end of life? Maybe this is also connected to concepts of the death penalty. It is believed by many that America will not have the death penalty in years to come, that it’s a faded system that doesn’t work and scapegoats the most vulnerable. I see the death penalty as very different (a consequence for a bad act) than legally assisted suicide (to end suffering) and thus, when I consider arguments about end of life with clients, my considerations are about their quality of life and not, the myriad ways we can consider forms of dying.

In an ideal scenario nobody would wish to die, perhaps. Why? Because so much can be found in living and those who love us would not wish to lose us. Realistically however, people get sick, people get tired, people suffer. As long as we recognise this in ourselves and others, then debates about what end of life represents, will be part of a larger conversation and a necessary one. Perhaps if we cannot see anything positive in this, we can at least not shun it until it is too late. Likewise, we could consider that death is not the worst thing to happen to us, though suffering might be (or the suffering of those we love) and ways of alleviating suffering that are compassionate, should be part of the conversation.

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Candice Louisa Daquin is a Psychotherapist and Editor, having worked in Europe, Canada and the USA. Daquins own work is also published widely, she has written five books of poetry, the last published by Finishing Line Press called Pinch the Lock. Her website is www thefeatheredsleep.com

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PLEASE NOTE: ARTICLES CAN ONLY BE REPRODUCED IN OTHER SITES WITH DUE ACKNOWLEDGEMENT TO BORDERLESS JOURNAL.

2 replies on “To be or Not to be…”

Running through our beliefs and debates and feelings about death, there is that question; When is it “someone’s time”, and who decides? It is easy to understand that some want to answer that God decides, and no one else. But then, I have to ask how that god makes it’s decision known. There might be many ways.

Roman officers had a tradition in case of dishonor, to have a friend hold their sword so that they could run onto it, thus dying with the wound on their front, as in combat. It is interesting that they and the Japanese came to similar answers.

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