Caregiving and Assisted Death

Intractable pain
Experiencing pain at the end of life. Getty

 “I want to die, and I want you to help me,” Joyce said to her sister Martha.

Chemotherapy failed to control Joyce’s breast cancer, and palliative medicines couldn’t stop the unbearable pain. Joyce prepared for this moment by saving unused portions of pain medication, until she accumulated a deadly dose. She hoped this day would never arrive.

“How can you ask me to kill you?” Martha said.

“I’m doing it because you love me and you know the pain I’ll experience until I die.”

A Right to Die law had not yet been passed in California, although a bill was winding its way through the state legislature. Martha wasn’t concerned about the illegality of what her sister was asking.  Although she ran various scenarios through her mind about what she would do when this moment came, none had the impact of being faced with the actual plea.

When You’re Asked the Question

Until you are asked to help someone in intractable pain to die, everything is conjecture.  You may think sets of values—either secular or religious—will guide your decision. I thought the same thing during my first month as a hospice volunteer.

“Shoot me please,” my patient said.

I thought he was joking until I saw his tears and expression. While the palliative medicine controlled his physical pain, the narcotic had no effect on the guilt he experienced believing his son’s death was his fault.

As someone new to hospice and having very little experience with people who were dying, I took the easy way out and said, “I can’t do that,” relying on the hospice’s policies.

The encounter happened twelve years ago, and memories of it resurface whenever I discuss, write or speak about death-and-dying issues.

When a Loved One Asks You to Help in Their Death

As a caregiver, there is a small possibility you will face the dilemma Martha and I did. But what would you do if it happens?

When the Affordable Care Act was proposed, the right to die issue was assailed by demagogues such as Sarah Palin and Senator Grassley. Their “death panel” nonsense frightened many elderly people who thought the government was plotting to end their lives. The assault also came from the Catholic church whose bishops vowed to excommunicate anyone supporting the Affordable Care Act since they wrongly believed the act allowed for assisted death.  The irrationality of politicians and religious figures resulted in the cessation of most intelligent conversations on the right to die and harmed the hospice movement that never was associated with the assisted death controversy.

How Do You Choose?

When a theoretical question is tested by a real situation, an interesting thing happens: theories dissolve in the face of reality. I’ve spoken with many people who were caregivers to someone in intense pain not amenable to palliative treatment. Although I never asked if they assisted in the death of the person experiencing the pain, all maintained witnessing the intense pain of a loved one led them to or reaffirmed their belief in assisted dying.

The religious and spiritual values about death should be respected. Convictions may emanate from Catholic sanctity of life doctrines, the Buddhist belief adversity is important for preparing oneself for the next life, or the decision of a dying person to determine when his or her life should end.

But it is disingenuous for someone to question the beliefs of a person who is dying or their caregivers. The next time someone offers an opinion regarding how everyone should face death, ask two questions, “Are you dying?” and “Have you witnessed intractable pain?”

Continue Reading