This post is one of a series of posts wherein Dr. Bossypants explores that final task we all face: Dying.Consider yourselves warned: Being mortal is challenging, and death is a stressful topic. No doubt you will read these posts with some degree of sadness, despair, and denial. However, Dr. Bossypants sincerely hopes readers will consider such matters thoughtfully, and when the time comes to face our own death or that of a loved one, Dr. Bossypants hopes we can act with wisdom, compassion, acceptance, and bravery.
One of the reasons we are so reluctant to endorse the compassionate ending of life is that many who choose to kill themselves do so impulsively and/or violently. Guns are a terrible way to end it all, but that’s what 23,000 people in the United States chose last year. Over a thousand were children and teens. The horrifying scenes that family and first responders face are inexcusably cruel.
Hanging, leaping from high places, slitting wrists, or disemboweling are also means that leave behind horrifying, tragic scenes, sometimes with an aggressive edge; sometimes with abject hopelessness. No matter what laws we enact, it will always be possible to commit suicide “at” someone, and determined humans can find ways to die. The best ways to reduce these aggressive or despair-driven options are:
- Make the means less immediately available.
- Make other options and assistance far more available.
This is not a blog series about preventing these tragic events, though Dr. Bossypants helped write a book about suicide prevention recently. But it’s worth noting that these types of suicide gets lumped together with carefully considered wishes to gently end one’s life. The effect is muddled thinking, shame, over-reaching laws, and ironically, more secretive, rash, violent suicides than would otherwise occur.
Thoughtfully ending one’s own life must be a secretive act only when the dominant culture and/or loved ones force it to be. Being able to openly consider a chosen death allows people to avoid the precipitous acts that leave behind such damage. In some cases, alternatives can be found so that death is no longer the choice. In other situations, such open discussions might help provide a graceful exit, rather than days, weeks, or years of unconsciousness, pain, or enduring the agonizing wait for the end. Nothing takes away the sting of mortality or the deep sadness of the final farewell, but a planned death can alleviate suffering, some of the indignities most of us want to avoid, and sometimes, enormous expense.
This blog and the next drag readers from the philosophical to the acutely uncomfortable. People have been known to say, “Please just shoot me when the time comes.” This is glib, unrealistic, and ultimately not funny. For many of us, the time actually will come. We will become demented, disoriented by pain medications, artificially made “happy” by anti-depressant medications we would otherwise not agree to take, buoyed by false hope, or caught in the grip of denial because we are sad and angry that we have to die. When we think of our deaths, many of us hope we do not have to lie in a bed, having people change our diapers, feed us, roll our bodies around to avoid bed sores and listen to open-mouth snoring as our bodies slowly shut down. The truth is this: everyone has the right to specify their wishes. You can ask that you be kept alive at all costs and in all conditions, and unless your family runs out of money, your wishes will be honored. You can also specify your wish to have your life end in certain conditions. But right now, you cannot legally have that happen in most states. That is why, at least for now, it is important to know what options DO exist. Having someone shoot you is neither likely nor ideal.
Most of us are at least vaguely aware that overdosing on certain drugs will harm or kill us. However, it is less common for people to know the exact dosage, how to administer it, and what the risks are. If we had a sane and compassionate culture, we could talk these matters over with a trusted medical expert, comparing costs, risks, and availability. As things sit now, this information is reserved for suffering animals.
When our dog, Timber, became so incapacitated that she could no longer walk, we lifted her into the cab of her beloved pick-up and drove to our vet. Instead of carrying Timber into a smelly, scary place, the vet came out to the cab with the injection, and we took a slow drive, petting Timber while she drifted off peacefully. It was a beautifully orchestrated end to suffering, and it is the death I wish for myself. Unfortunately, our vet refuses to sign on.
Short of veterinarian assistance, what’s available? As of this writing, in a minority of states, you are legally able to access medical assistance for a lethal dosage of the right drugs to end your life. There are lots of restrictions and paperwork, but some limited options exist. This landscape will continue to shift, depending on the mood of elected officials.
Death is capricious. Medically we have many ways to extend the life of the body but far fewer ways to extend the life of the conscious mind. This is one reason to use your mind NOW while you can specify the conditions under which you want to be kept alive or helped to die. Dr. Sandra Bem, a famous psychologist in New York, knew she had Alzheimer’s disease. She wanted to stay alive just past the time she could still sequence her actions enough to end her life, but she didn’t dare wait that long. She didn’t want her family members to risk a murder charge, so she had to die a bit earlier than her real wishes. It is a moving story—one available online to those with a search engine.
If you are wealthy and can imagine coping with international travel, you can fly to certain compassionate nations where professionals will help you end your life with dignity. This is what 104-year-old Australian, David Goodall, chose to do. He was in good health and of sound mind. He was also able to afford this decision, and he was ready to die. He was indignant and sad that he did not have the right to choose to die at home, with local medical support. It is, indeed, a sad thing that we deny such individual freedom, causing undue suffering, forcing duplicity and isolation.
In general, a large dose of a major tranquilizer combined with sleeping pills and alcohol is lethal. But obtaining the right substances at the right time can be challenging. A friend with terminal cancer planned ahead and found a way to order lethal drugs so that he could end his life at home. Family members traveled thousands of miles to be with him at his planned death. The drug order was delayed and his ability to swallow diminished. By the time the package arrived, he was unable to swallow well enough to get the drugs down.
Hospice was called in to manage his pain, but of course, hospice cannot provide lethal drugs or injections. He was kept mostly unconscious but was in both physical and psychological pain when awake. His family members had to return to their homes. The cancer finally killed him three weeks later.
Contrast this with this excerpt written by a loving son who was able to be present as his father died: My father passed away peacefully less than an hour ago. Thanks to Oregon’s “Death with Dignity” law, he exercised his “cosmic right” to end his life on his terms, not cancer’s. He passed on in a grassy field in the Ashland hills, under a tree and shining sun, next to an organic garden, and with Buddhist Monk chanting playing in the background. His very last words were “Wow. Amazing.”
At a recent social gathering, a physician friend and I were bemoaning the topics Dr. Bossypants is addressing in this blog. I asked her if she would provide me with a prescription for lethal drugs (with a long shelf-life) so I could end things if I needed to. Like our vet, she declined, citing the fact that she would like to continue to practice rather than spend her golden years incarcerate. She went on to say that she’d worked out an even better plan for herself: Her car, in her garage, running the exhaust in through a tube, with good wine, good music, and a blanket.
The plan has some appeal, but I am aware of others who made such choices and were either found before death, or had to put all the pieces in place, inform others, and then die alone. Some of my clients and family members would prefer to die alone, but many would rather have loved ones close by. Short of gas masks for those in attendance, monoxide could be a lonely death. Also, it requires planning, tools, and privacy—all of which may not be available to a demented or very ill person.
Starvation and Restricting Fluids
A dear and wise colleague of mine was diagnosed with early Alzheimer’s disease a few years ago. She acted quickly, entrusting her final days to friends. Her choice was to stop eating, but she knew she might forget her own choice, so she put the pieces in place that would allow trusted friends to help her starve herself to death. She was in good company. There are many historic accounts of voluntary starvation, both intended to bring about death, and/or intended to bring about political change by being willing to die for a cause.
Starvation, or fluid restriction, or both are ways to end one’s life that are entirely legal and within your control, assuming you retain your cognitive capacities and/or have supportive friends or family involved. For some people, in some situations, this might be ideal. Dr. Bossypants likes to eat, so voluntary starvation is not among her top choices, but things change. It is good to know this option exists.
Like starvation, hypothermia can bring about a chosen death. To involve others would require a kind of orchestration that seems daunting, but as a way to end one’s life alone, it has some appeal to a certain curmudgeonly set of folks. If you’re serious, do your research. If this were the only option for Dr. Bossypants, it would involve serious inebriation beforehand.
In his best-selling book, Final Exit, Derek Humphry describes a combination of sleeping pills and a clever way to asphyxiate yourself after falling asleep. This is a gentle and efficient way to end your life. I won’t repeat the steps here, but I encourage people to get a copy of this book. His tone is brusque and businesslike, but the information is invaluable. There are other books, organizations, and sources for this important information. Dr. Bossypants will list those in upcoming blogs.
Information is not the Obstacle
Dr. Bossypants wrote this particular blog more to rattle people than to actually spell out the steps necessary for a gentle, well-planned death. This explicit information is readily available, although some of the kindest, most appealing means are not. To move from a distant philosophical position to an active, prepared position is far harder than anyone imagines. The previous blogs explain some of the reasons we are so reluctant and afraid. But bottom line: it is unethical and cruel to inflict unnecessary suffering on sentient beings. This includes one’s pets, one’s loved ones, and oneself. Bodily autonomy—the most basic of freedoms—means it is ethically permissible and sometimes wise and humane to gently bring an end to one’s own life on earth. Further, we should have the right to ask for assistance when necessary.
Thus ends a difficult blog.