Monday, July 12, 2010

It's Not O.K. to Call It 'Suicide'

I want to write about something today that is controversial and deeply touching.  It’s a subject that grows more important as many factors in our death-defying culture spin further away from rationality and toward fear-mongering and greed.  I’m talking about people in severely challenging and terminal health situations who want to preserve their right to refuse “heroic” (invasive) medical procedures which would essentially prolong their suffering.   I want to use the preferred and correct terminology for this, “ Aid in Dying”,  contrasted with the term that the media likes to use…the one that grabs everyone’s attention: “Assisted Suicide”.
I found these words contrasting the two from
Dr. James Lieberman in Psychiatric News, a publication of the American Psychiatric Association: He refers to Oregon’s Death With Dignity Act as DWDA.
  1. “The suicidal patient has no terminal illness but wants to die; the DWDA patient has a terminal illness and wants to live.
  2. Typical suicides bring shock and tragedy to families and friends; DWDA deaths are peaceful and supported by loved ones.
  3. Typical suicides are secretive and often impulsive and violent. Death in DWDA is planned; it changes only timing in a minor way, but adds control in a major and socially approved way.
  4. Suicide is an expression of despair and futility; DWDA is a form of affirmation and empowerment.”
  Barbara Coombs Lee sums it up in her blog:  “…suicide is the self-destructive impulse of a person who has every reason and ability to live. Aid in dying is the self-affirming decision of a person who cannot choose to live, and can only choose the manner of an imminent death.”

Against the Law?
In the 1970’s, the laws about suicide, which used to be illegal, changed.  This was both because of advances in psychiatry and psychology, and a reasonable desire to update wording  to reflect America’s independence from ‘the crown’. (two hundred years late!)  (Citizens were ‘owned’ by the King and the crime was destruction of property.)  
  As a young person in the 60’s, the idea of suicide being against the law always puzzled  me…you couldn’t put someone in jail who had already taken their own life so why was it a crime?  Who would be punished?
In religious terms, it was clearly against the faith I was brought up in, and made a little more sense to me from a logical standpoint.  Since I was brought up to believe that a person had a soul, which persisted after death and which was aimed toward heaven, I could see a chain of consequences there.   If committing suicide was a mortal sin, it would prevent someone from going to heaven.  ( I didn’t think it was fair, but that’s another article…)
  Socially, I was most aware of a deep sense of shamefulness around this subject.  It certainly wasn’t the ubiquitous topic of conversation back then as it is (sadly) now.  But it did happen, and when I overheard my mother or other adults talking about someone who taken their own life, it was in hushed and secret tones…and there was shamefulness connected with it.  It was confusing…but I knew I wasn’t supposed to  ask about it so I didn’t.

The Hemlock Society
The legal changes were a progressive step for the time…but there were people who saw more deeply into potential issues that the updated law still did not address.  Derek Humphry founded the Hemlock Society in 1980, 5 years after the death of his first wife from inoperable bone cancer. He helped her to end her life when the pain and indignity of her illness became too much for her to bear. 
  He wrote a book about this experience and formed the Society which was dedicated to informing, assisting and supporting people with the same kind of painful dilemma, supporting their Right to Die.  His work is directly responsible for the current law we have here in Oregon which allows for Physician’s Aid in Dying.   The Hemlock Society merged twice with other groups and all of them are now merged into the Oregon based “Compassion and Choices” headed by Barbara Coombs Lee.   (
Visit the Compassion and Choices website).  They are an excellent resource for information, support and legal advocacy around end-of-life choices. I am proud to give financially to their efforts (Donate to Compassion and Choices)
Seeking Ethical Progress

So much has happened, socially, legally and spiritually over the last 2 to 3 decades.  People are thinking deeply about this, and now there is more compassionate and intelligent dialogue about it.  Buddhists, Christians, Pagans, Muslims and more—no matter who we are, there is a good chance we will have some exposure to this kind of choice and it will move us into uncomfortable, yet growth producing conversations, arguments and decisions. 
  Medicine has ‘advanced’ to the degree that procedures can be implemented which will ‘save the body’ or ‘prevent death’ more than ever before.  But the problem is that these procedures too often do not  enhance life.  Oregon recognizes a person’s right to plan for a dignified death when the circumstances would unduly prolong suffering. The media feeds us sensational stories and persists in calling this dignified procedure 'suicide'.    This is why I want to share those contrasting words with you.
  I feel concern when I hear more and more stories of people, mainly elders, who, despite their best efforts to be clear and informed, have somehow ended up in exactly the positions they tried so hard to avoid:  a stroke, heart attack, or sometimes even a doctor’s appointment which requires communication among several specialists who don’t take the time to act as a team with the family. Any of these situations can result in a spouse or family member caring for someone who is no longer able to do the most basic self care, is in unremitting pain, has no hope of recovery, whose quality of life is extremely poor, whose medical care consists of one painful, egregiously invasive procedure after another.  Often there is horrifying financial expense.   This is so much a product of our denial of death, along with the culture of corporate greed that has grown up around medicine. 
  The times we live in and the choices and experiences available to us seem to have outstripped the capacity of many of our spiritual teachings to address them.
How About You?
  Where does this leave us?  It’s an interesting and fruitful edge for inquiry; and there are no easy answers.   But I want to throw in a word from a dear friend of mine that helps put a little perspective into the conversation.  She said to me one day, “You know, Marian,  Death isn’t the worst thing that can happen to a person!”  
Until next time…
What do you think about this?
I welcome your comments. 

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Nancy Ward said...

Thank you for your thoughtful insight on this subject. My father committed suicide and my mother, who wanted to live, chose to stop medical intervention in order to prolong her uncomfortable life. I learned the difference through experience.


Marian said...

Oh Nancy thank you for sharing so deeply from your experience. Blessings to you.