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08/21/2014

Suicide and Terminal Diseases: A Personal Choice and Rational Approach

by Craig Klugman, Ph.D.

My spouse and I have an ongoing conversation, really more of an argument, about one end-of-life scenario. I have stated on several occasions that being in my middle-40s, if I was struck by a serious disease (usually the disease in the scenario is cancer) with a less than 50 percent chance of survival (remission), and a course of treatment that is prolonged and painful, then I would choose not to receive treatment. Instead, I would do a lot of traveling (if able), visit with friends (if able), and then die comfortably.

I say this as a healthy, able-bodied person and as he is quick to point out, I can’t know how I would feel if I’m ever in such a situation. I grant him that, but I have seen enough of people undergoing such treatment, talked to families about dying, have a strong sense over the distribution of societal resources, and have no one dependent on me for their existence. I also have good insurance, good social support, and an above average understanding of the culture and language of medicine.

I do not bring this up because of the recent suicide of Robin Williams, which may have been spurred by his diagnosis of Parkinson’s. Recently, I read the story of Gillian Bennett, a retired clinical psychotherapist and wife of a philosopher who at age 85 took her own life rather than suffer the increasing indignities of her dementia. On a sunny day before noon in British Columbia, Bennett and her husband brought a foam mattress to a hillside with a beautiful view. Laying next to her husband, Bennett ingested whiskey and Nembutal and drifted off to that permanent sleep. Bennett made her case for her suicide on a website she created, deadatnoon.com.

On this website, Bennett discusses her experience of living with dementia for 3 years, the options for her future care, the cost to her family and society for that care, the effect the disease has on her family, and the burdens on society of an increasingly growing aged population. She goes on to urge everyone over the age of 50 to complete a “living will.” Bennett says that the making of such a document should be compulsory. She also believes that the “medical profession, the Law, and the Church will challenge and fight any transformative change.”

Bennett ends her 4-page note with loving thoughts about her life and her family. She talks about how she plans to die and says that her husband had no part in her death (an important point guarding the illegality of assisting in a suicide in her province). Although she would love to have had her children with her when she dies, she has told them to be far away so that no legal suspicion should fall upon them. Her family created a video after her death, telling their story and talking about their mother’s good death.

There are many who will say that Bennett was a coward, that she was selfish, that she must have been depressed, and that she made a decision that should only be made by a deity. I am sure that criticisms will also be directed toward her husband and her family. But for me, I think she was brave. This was not a spur-of-the-moment decision. She thought through her quality of life, her future life, her effects on those around her, and made the choice that was right for her. This does not mean that people should be encouraged to make a choice of rational suicide when faced with a severe terminal illness. This does not mean that as a society we should put people in a position where they feel suicide is the best (or only) option because of the lack of available affordable care. This does not mean that everyone in the same position should make the decision. This does mean it was the right decision for Bennett and her family.

End-of-life decisions are intimate and personal. They should be made in long conversations with loved ones and should be consistent with one’s beliefs and life choices. They should not be coerced (to end a life, or to keep living a life). Many of us will have the unfortunate reality of having to face similar decisions. The thought processes of my current able-bodied and able-minded self may change. Perhaps these suicides are a call to change the way we view dealing with tragic disease, or a call that we change how we treat people faced with horrible choices. I believe that rational suicide can be an acceptable alternative for people like Bennett who were not clinically depressed, who had carefully considered her choices over a long period of time, and who had the backing of her family. For her, a good death was one on her terms, on her timeline, by her hand, and while holding the hand of the love of her life.

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