How do you feel about assisted suicide?  Would you choose it for yourself?  Would you choose it for a family member?   What would be your criteria for making such a decision?

Two cases from my early days as a paramedic immediately come to mind about this subject, and though seemingly tangential, they have served to form my opinions.

The first was a woman who had jumped in front of a train and had been brought to the ER for pronouncement.  Her body was so mangled that it was only from identification papers that we discovered her age and gender.  Her suicide was very hard on all of us – even for my battle-hardened friends from the fire department.  I remember mentally asking, “Why didn’t you just come to see us?”

The second case involved a middle-aged man who had suffered a severe heart attack and subsequent cardiac arrest.  Three of us did CPR on him for the longest time while physicians decided how extensive the damage to his heart had been and how best to treat him.  Our CPR was so effective that the patient was conscious and aware of his surrounding and nearby conversations.

One doctor quite callously entered the room and told us to stop CPR because the damage to his heart was too extensive for him to live without an immediate transplant.  I was doing CPR at the time.  The man looked desperately at me and shook his head “NO” in terror.  The only thing I could do for him was to ease up on my compressions.  One of the respiratory therapists slowly reduced the amount of oxygen he was receiving, but we did not stop resuscitation attempts until the man was unconscious.  Again, the effect on the three of us was substantial, only this time we were able to talk a bit about the experience and vent our frustrations.  I believe the experience was more difficult for us because we each had a hand in letting him slip into unconsciousness so CPR could be stopped.

I’ve seen a lot of people die over the years, and tried to comfort countless relatives and co-workers.  One thing I am completely convinced of is that death, regardless of prognosis, is never easily accepted by sane individuals.  From the grief of a spouse who had sat patiently by the bedside watching a slow slide towards death, to the son or daughter whose flight didn’t arrive in time to say goodbye, death remains a highly painful catastrophe.

Today we can add to this painful transition with physician assisted suicide.  How many relatives have and will feel unrelenting guilt for not being able to talk someone out of suicide?  How many medical workers will be permanently impacted by decisions to withhold food and water from patients deemed too sick to recover?

One of my co-workers had an anacephalic daughter that lived until the age of twelve.  As her mother, she dutifully cared for her every day, often reading to her as she sat by her bedside.  When she finally succumbed to pneumonia, my friend was of course heartbroken, but comforted by the knowledge that she had done everything possible for her daughter.  This knowledge allowed her the freedom to grieve with a minimum of guilt, and I believe she was able to carry on afterwards only because of her ability to choose whatever life was possible for her daughter.

Recently, my husband’s elderly aunt underwent surgery to replace a heart valve, but suffered a massive stroke in the process.  Her physicians decided to withhold food and water.  It took her two weeks to die.  Aside from the questionability of performing this kind of surgery on a woman who was not bothered overmuch by symptoms, the added agony of watching a relative die slowly at the hands of people trusted as healers was too much for some in the family to bear.

Our family has traditionally cared for our sick and dying at home.  My parents moved into the basement of our home to accommodate Dad’s mother and father.  My brother also moved to the basement when my Mom’s father came to live with us.  Because of my medical training, I was left upstairs to care for all of them if they needed help during the night.  Mom took care of them during the day.  It was an arduous task.  My father took care of my mother when she was dying, and now my father has come to live with us.

As difficult as all this has been, and even with the emotional and physical repercussions of being a long-term caregiver, my relatives were afforded as much life as possible.  The price has been heavy, but my life is richer in many regards for the experiences.

Most importantly, there is an absence of gnawing guilt.  We did not abandon our family members to emotionally sterile medical environments.  They died at home with familiar surroundings and loved ones nearby.  Their ability to function within a family was maintained.  Their dignity was preserved.  Both my paternal grandfather and my mother decided at the very end to not struggle against death anymore, and each refused things that could have prolonged their lives.  They were free to make the last decision of their lives, and the family respected their wishes.

I believe we must retain the right to make this final decision.  For those like my co-worker with the anacephalic daughter, the family must have the right to make life decisions for those incapable of deciding or verbalizing their choices, and the community must respect their wishes.

If our society had not devolved into a legalistic monster, we would not be faced with such issues as euthanasia or assisted suicide.  Families and individuals would most likely decide on courses of action with regard to their physicians, communities, churches, and deeply held beliefs.  In times past, physicians sent their patients home with enough medication to ease pain.  I’m certain that more than a few times a patient was given a little extra morphine – just enough to put them “out of their misery”, and nothing more was ever said.

However, these considerations may be moot with proposed healthcare reform and the rationing of services.  More than likely, all individuals above the age of 50 (unless they are one of our esteemed and honorable lawmakers) will get nothing more than palliative care.

So tell me, have you seen the movie Logan’s Run?