John Holzmann
04-09-2010, 09:52 PM
Several weeks ago, I read the "Last Word" in my favorite news magazine, The Week (http://johnscorner.blogspot.com/2010/04/free-magazine-offer.html) (link goes to a little article I wrote about why I enjoy the magazine . . . and a free trial offer). The article was titled Assisting in my parents' suicides (http://www.theweek.com/article/index/106897/Assisting_in_my_parents_suicides), and was adapted from the book The Last Goodnights (http://www.amazon.com/gp/product/158243557X?ie=UTF8&tag=johnscornblog-20&linkCode=as2&camp=1789&creative=390957&creativeASIN=158243557X) by John West. [Note: At the time of this writing, I can't find the article in its original location. But it is still available via Google cache (http://webcache.googleusercontent.com/search?q=cache:4vEukGMC_dsJ:mobile.theweek.com/article/index/106897/Assisting_in_my_parents_suicides).]
At first, it really bothered me. The author told how his father, "a world-renowned psychiatrist, age 74," and dying from a newly-discovered but aggressive cancer, asked him to "step into his bedroom for a private chat."I sat in the big leather chair by the bookshelves, prepared to wait. Whenever Jolly talked to me about something important, he approached it in a roundabout way.
But not this time. Straight away he said, “John, I need your help.”
This startled me: He was asking for help. Jolly never asked for help. His voice was measured and smooth; he sat squarely on the edge of his bed, leaning forward with hands clasped; he looked straight at me.
“I’m dying,” he said. “That’s no secret—everyone knows it. I don’t have more than a few months, at most. But I do have something that is very important to me. I have options about how and when my death will occur.” He paused to let this sink in. “At some point,” he continued, “not too long from now, I will decide that enough is enough. By that time I will be full of all sorts of drugs, particularly the morphine that I’m already taking for pain. A little extra of that should do the trick, without anyone having to know and get upset. . . .
“My body is full of cancer. If I knock off a little ahead of schedule, nobody’s going to know the difference, and I’ll have saved myself a h*ll of a lot of pain.”
Then he looked straight at me. “But I’ll need you on board, to help me."
I read that and thought, How unfair! Why did he have to say anything to his son? If he wanted to kill himself, why didn't he just do it quietly? . . . Now he was placing this horrible burden on his son.
Despite my frustration, I read the entire article and, over the next few days, found myself thinking new thoughts.
Some of the pieces of data that floated into my mind:
A significant--significant--fraction of people's lifetime healthcare costs accrue in the last few months of their lives.
According to a National Institutes of Health study (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1464043/), "From 1992 to 1996, mean annual medical expenditures (1996 dollars) for persons aged 65 and older were $37,581 during the last year of life versus $7,365 for non-terminal years. Mean total last-year-of-life expenditures did not differ greatly by age at death. . . . Last-year-of-life expenses constituted 22 percent of all medical, 26 percent of Medicare, 18 percent of all non-Medicare expenditures, and 25 percent of Medicaid expenditures."
According to the Canadian Institute of Actuaries (http://findarticles.com/p/articles/mi_m0LVZ/is_8_17/ai_84895863/), "30 to 50 per cent of total lifetime health care expenditures occur in the last six months of life."
I could go on, but I'm sure you get the picture.
We have to be careful when looking at such statistics. I think there can be no doubt: Some of the reason costs are so high at those points in people's lives is because many people die of traumas or injuries or illnesses in which there is good hope that they might survive . . . "if only." But the "if only's" don't always come.
If only intervention could have begun five minutes earlier, or an hour.
If only the medical staff had noticed this one additional complicating factor.
If only . . .
So it's not as if the medical staff or the patients' families expected them to die. In fact, they did not; or, at least, they had good reasons for hope that the patients would survive.HOWEVER, I thought . . . What if I were in the position of John West's dad? I mean, the prognosis was truly hopeless. Yes, the doctors could imagine I might linger for another few months if enough resources were directed my way. But . . .
No one sees me "coming back" to real health.
My life, such as it would be, will consist primarily of lying in bed, half-conscious/semi-comatose, possibly in great pain.
"What if I didn't have major medical insurance?" I asked myself. "What if I didn't have a million-dollar health policy behind me (but I did have several hundred thousand dollars, say, that I could spend on my healthcare if I wanted). Would I really want my family to invest all that money in my care to keep me alive for a few extra weeks--or even months?
And I thought, "No. I wouldn't. Why would I? Why should I? Wouldn't I want the living to enjoy the benefits of that money rather than me simply 'hanging on' for a few extra days or weeks or even months?"
I don't think I would want someone to take active measures to end my life. But it seems to me not unreasonable at some point to say, "Y'know. You really don't have to take any extraordinary measures to 'keep me alive.' . . ."
*****
That's what I was thinking.
The biggest problem with this kind of thinking, it seems to me, has to do with clarifying your thoughts and then expressing them in a precise and concise manner, so someone can interpret your wishes with confidence.
How can you express yourself as being willing to "hold your life loosely," yet not so crazy "loosely" that you wind up being "offed" when you could have been patched up and given several more years of productive time on Earth . . . ?
Any thoughts on this matter? Any input?
At first, it really bothered me. The author told how his father, "a world-renowned psychiatrist, age 74," and dying from a newly-discovered but aggressive cancer, asked him to "step into his bedroom for a private chat."I sat in the big leather chair by the bookshelves, prepared to wait. Whenever Jolly talked to me about something important, he approached it in a roundabout way.
But not this time. Straight away he said, “John, I need your help.”
This startled me: He was asking for help. Jolly never asked for help. His voice was measured and smooth; he sat squarely on the edge of his bed, leaning forward with hands clasped; he looked straight at me.
“I’m dying,” he said. “That’s no secret—everyone knows it. I don’t have more than a few months, at most. But I do have something that is very important to me. I have options about how and when my death will occur.” He paused to let this sink in. “At some point,” he continued, “not too long from now, I will decide that enough is enough. By that time I will be full of all sorts of drugs, particularly the morphine that I’m already taking for pain. A little extra of that should do the trick, without anyone having to know and get upset. . . .
“My body is full of cancer. If I knock off a little ahead of schedule, nobody’s going to know the difference, and I’ll have saved myself a h*ll of a lot of pain.”
Then he looked straight at me. “But I’ll need you on board, to help me."
I read that and thought, How unfair! Why did he have to say anything to his son? If he wanted to kill himself, why didn't he just do it quietly? . . . Now he was placing this horrible burden on his son.
Despite my frustration, I read the entire article and, over the next few days, found myself thinking new thoughts.
Some of the pieces of data that floated into my mind:
A significant--significant--fraction of people's lifetime healthcare costs accrue in the last few months of their lives.
According to a National Institutes of Health study (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1464043/), "From 1992 to 1996, mean annual medical expenditures (1996 dollars) for persons aged 65 and older were $37,581 during the last year of life versus $7,365 for non-terminal years. Mean total last-year-of-life expenditures did not differ greatly by age at death. . . . Last-year-of-life expenses constituted 22 percent of all medical, 26 percent of Medicare, 18 percent of all non-Medicare expenditures, and 25 percent of Medicaid expenditures."
According to the Canadian Institute of Actuaries (http://findarticles.com/p/articles/mi_m0LVZ/is_8_17/ai_84895863/), "30 to 50 per cent of total lifetime health care expenditures occur in the last six months of life."
I could go on, but I'm sure you get the picture.
We have to be careful when looking at such statistics. I think there can be no doubt: Some of the reason costs are so high at those points in people's lives is because many people die of traumas or injuries or illnesses in which there is good hope that they might survive . . . "if only." But the "if only's" don't always come.
If only intervention could have begun five minutes earlier, or an hour.
If only the medical staff had noticed this one additional complicating factor.
If only . . .
So it's not as if the medical staff or the patients' families expected them to die. In fact, they did not; or, at least, they had good reasons for hope that the patients would survive.HOWEVER, I thought . . . What if I were in the position of John West's dad? I mean, the prognosis was truly hopeless. Yes, the doctors could imagine I might linger for another few months if enough resources were directed my way. But . . .
No one sees me "coming back" to real health.
My life, such as it would be, will consist primarily of lying in bed, half-conscious/semi-comatose, possibly in great pain.
"What if I didn't have major medical insurance?" I asked myself. "What if I didn't have a million-dollar health policy behind me (but I did have several hundred thousand dollars, say, that I could spend on my healthcare if I wanted). Would I really want my family to invest all that money in my care to keep me alive for a few extra weeks--or even months?
And I thought, "No. I wouldn't. Why would I? Why should I? Wouldn't I want the living to enjoy the benefits of that money rather than me simply 'hanging on' for a few extra days or weeks or even months?"
I don't think I would want someone to take active measures to end my life. But it seems to me not unreasonable at some point to say, "Y'know. You really don't have to take any extraordinary measures to 'keep me alive.' . . ."
*****
That's what I was thinking.
The biggest problem with this kind of thinking, it seems to me, has to do with clarifying your thoughts and then expressing them in a precise and concise manner, so someone can interpret your wishes with confidence.
How can you express yourself as being willing to "hold your life loosely," yet not so crazy "loosely" that you wind up being "offed" when you could have been patched up and given several more years of productive time on Earth . . . ?
Any thoughts on this matter? Any input?