Okay, maybe you were looking for an upbeat happy-faced Thanksgiving post from me? Well, I have advised clients and written in blog posts that it is a great time to have “the conversation” about end of life wishes when family members gather for holidays like. . . Thanksgiving! So here is the themed post for this year’s holiday: grief is part of life and so, part of death – whether it is grief around a life change like a loss of a relationship or status or the loss of a loved one’s or the prospect of losing one’s own life.
Why is this so difficult to talk about? No, I don’t mean this as a rhetorical question, rather as a question to ask each other and ourselves – to discuss individually and collectively in our communities. The time is right for this. Medical technology has extended our longevity such that some are now seriously questioning the purpose of such longevity. I’m thinking of my first Dementia and Memory post of Oct. 1, 2014, where I cite the article “Why I Hope to Die at 75” by Dr. Ezekiel Emanuel. The obvious answer to the question is that death is a great beyond, an unknown for the vast majority of us. Reminds me of an observation by my favorite ancient Greek philosopher, Heraclitus:
Whoever cannot seek
The unforeseen sees nothing,
For the known way
Is an impasse.
Fragments, #7 at 7, Brooks Haxton, trans. (2001: Penguin).
Is it because the fear of death is nearly universal? Ernest Becker, the late anthropologist and author of the 1973 groundbreaking book The Denial of Death, seemed to think so! This fear is based on the “problem” of the body, how to manage our physical existence and its limitations. There responses to this come in a myriad of forms: religious, spiritual, moral (philosophy), and ethical – just to name a few.
I would submit that we (as in post-modern American culture) are at an impasse in the debate about death, its meaning and the prospect of suffering as part of the dying process. Evidence of this is clear from the recent death, via means of doctor assistance, of twenty-nine year old Brittany Maynard. I find it interesting that the subjects of these types of debate are all young women: Karen Ann Quinlan was 22 when she ingested alcohol with the tranquilizer; Nancy Cruzan was 24 when she was in the auto crash that left her in a “vegetative state;” while Terri Schiavo was 26 when she suffered the heart attack which deprived her brain of oxygen for several minutes. These are some of the women whose fates have informed the course of development of the law concerning advance medical directives. What impact will Brittany Maynard’s death have on the state of upheaval surrounding the quality of medical care? Is this question one that applies across the board to us regardless of our age as adults?
In his article in response to Ms. Maynard and the rising calls for doctor-assisted end of life measures, “Doctor-Assisted Suicide Is Unethical and Dangerous,” Dr. Ira Byock observes
American health care is undergoing tumultuous changes and showing signs of strain. A recent Institute of Medicine report attests to persistent deficiencies in care and social support that seriously ill people and their families experience. Witnessing the suffering of our relatives, friends and, for clinicians, our patients, gives rise to moral distress. It is not surprising that support for physician-assisted suicide is also rising. The age-old dictum that doctors must not kill patients can appear antiquated, out of touch with hard realities, and even heartless.
One way to look at the euthanasia is as some kind of triumph over the tyranny of death, in that means can be selected to hasten its progress so as to minimize suffering. But this really begs the question – it is the challenge of meaning, in how we live our lives as well as how we choose to die.
We even speak about death in physical terms – as a wall, a door or a window. Is our imaginative vocabulary so limited? Why is it we have such a difficult time in grappling with the question of meaning in our life – is it because we do not wish to contemplate it in light of its physical end, our mortality? Or is the question backwards? I find an observation by Miguel de Unamuno in The Tragic Sense of Life helpful here:
In the most secret recess of the spirit of the man who believes that death will put an end to his personal consciousness and even to his memory forever, in that inner recess, even without his knowing it perhaps, a shadow hovers, a vague shadow lurks, a shadow of the shadow of uncertainty, and, while he tells himself: “There’s nothing for it but to live this passing life, for there is no other!” at the same time he hears, in this most secret recess, his own doubt murmur: “Who knows? . . . . ” He is not sure he hears aright, but he hears.
It seems that a major strand of euthanasia seems to presuppose that there is no meaning in the dying process, that it is simply needless suffering. This is the question that is not addressed by euthanasia, this is the fear that is laid bare and yet still rejected.
And what if true mastery is not based upon the art of living fully, deliberately and mindfully – but rather on the art of dying well? Indeed, I would say that is an excellent topic for another blog post. So if you think gratitude is an important expression of being in the world, whether through your heart or your mind or both – I wish you a Happy Thanksgiving!
©Barbara Cashman 2014 www.DenverElderLaw.org