Short Relief: Going gently should be a choice for the terminally ill

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In his poem “Do not go gentle into that good night,” Dylan Thomas (1914-1953) exhorts his terminally ill father not to give up.

The possibility that he may be disappointed is no reason to despair. All men, wise men, good men, grave men, fail to achieve their ambitions. Like them, he should “rage against the dying of the light.”

In addition to being a poet, Thomas was a Welshman, a wild man, and a heavy drinker. He is widely thought to have drunk himself to death. He wrote the poem in 1947. His father died in 1952. Thomas himself died a year later at the age of 39.

Thomas’ life was a contradiction. He was enormously creative and incredibly self-destructive. He wrote great poetry, urged others not to give up and he did himself in.

My own father died at home, of multiple causes, following an eventful life (albeit not without regrets), after celebrating his 83rd birthday with family and friends. His final days were not free from pain and suffering, but they weren’t devoid of joys and pleasures.

My father-in-law died in the hospital, after a series of visits that began with infections that led to disorientation and falls, which landed him in the emergency room. He was 94, and had a least two full careers, the first as a professional musician and the second in the jewelry business.

Neither man wanted extraordinary measures to prolong life. My sense is that my father got his wish more than my father-in-law. In part, that’s because once my wife’s father was in the hospital, medicine presented us with a slippery slope of incremental decisions. Each individually did not seem to be extraordinary at the time. But in the aggregate, in retrospect, they look inconsistent with his wishes.

What is a good death? A bad one? To die for a worthy cause, a person, an ideal? In service of science? Humanity? To die a peaceful, painless death, surrounded by friends and family, after a long, productive life? To die a senseless death? Alone, in pain, after a dissolute life, or worse, an affirmatively evil one?

How should we approach death? What is a son’s role, a family’s role, society’s role, a doctor’s role? Why are we so conflicted about the issue? How do we do it justice? Five states and the District of Columbia have legalized some form of assisted suicide as a way of ameliorating the pain of death.

Our Legislature recently rejected Sen. Roger Katz’ bill to permit a competent patient with a terminal condition, who follows procedures, to self-administer medicine to hasten death without those actions constituting suicide, assisted suicide, mercy killing or homicide.

The bill would have immunized physicians, health-care facilities, health-care providers and pharmacists who assist the patient, and persons present at death, from professional discipline, civil liability and criminal culpability. It prohibited life insurers from denying benefits to the beneficiaries of a patient who hastens their own death.

The procedures included that the patient be informed of their diagnosis, prognosis, options and those options’ possible results. The patient would have had to obtain a second doctor’s opinion, request the medicine twice orally and once in writing witnessed by two disinterested persons, and be given the opportunity to rescind their request.

All in all, the bill created a framework for a decision to end life that was thoughtful and considered. But the Legislature did not want to legalize people killing themselves. I understand the lawmakers’ reluctance. It seems so antithetical to the purposes of law and medicine and society.

The bill was introduced at a time when the United States’ suicide rate has been increasing. From 1999 to 2014, the rate increased 24 percent, from 10.5 suicides per 100,000 to 13. According to the Centers for Disease Control, there were nearly 43,000 reported suicides in the United States in 2014. Maine’s rate has also climbed in recent years.

A 2015 study published in the Southern Medical Journal compared the rates of suicide before and after states legalized assisted suicide. It found that legalizing assisted suicide was associated with a 6.3 percent increase in total suicides. The increase was greatest, 14.5 percent, in individuals older than 65. Legalizing assisted suicide did not seem to significantly increase the rate of non-assisted suicide.

The purpose of life may be to please God, realize your potential, experience happiness and love, achieve wisdom, be virtuous, or it may be to further some other purpose. Whatever its goal, we are unlikely to achieve it. Even so, as long as we are alive, there is the possibility of advancing one of those purposes.

Conversely, it is hard to imagine a purpose for death. It seems so final and negative that we should blindly oppose it. It may be that death gives meaning to life by limiting it. If life is limited, then what you do with it, including how you end it, matters in a way that it wouldn’t if life were infinite.

The challenge is to make the best of it. That requires having choices and control. Most of the time, it means not giving up, not going gently. But there is no one, best way.

At the end of life, law and medicine may be able to make a protracted and painful death less so. On balance, they should do so. The Legislature should have passed Katz’ bill.

Halsey Frank is a Portland resident, attorney and former chairman of the Republican City Committee.