Dying Like A Dog: We Say That Like It's A Bad Thing
There's one door I can't look at at the vet -- and try not to look at especially if the door is open and people are in there with their pet.
I think of it as "The Death Room," because it's the place where they put my dear little late Yorkie, Lucy, to sleep after I saw (most heartbreakingly) that she couldn't stand up anymore early one morning.
The vet gave her an injection and she died in my arms -- very peacefully just drifting off into a drug-induced forever sleep. I was bereft, of course, but I was also very mindful that I didn't want her to suffer -- to cross over into the point where the suffering and disability took over.
Joseph Pierre, a UCLA prof of psychiatry, makes a point I've made before -- that we give our dogs a better death than we give ourselves. He asks why at Aeon, mentioning his wife, a vet:
When we were dating in the years before we got married, my wife would often come home from a long day at work and say: 'I killed my patient today.' This, I came to understand, was a kind of self-reproachful statement of defeat as well as a starkly factual statement that reflected how she'd actually administered the medications that ended a dog or cat's life that day, typically with tearful owners and their bawling children huddled around.This strange admixture of guilt from failing to save a life, along with the resolve to be the agent that takes it, comes with the territory in a veterinary clinic where euthanasia is a daily occurrence. Although euthanasia literally means 'good death', it was totally foreign to me in my training as a physician. Human doctors might feel guilty losing a patient in the end, but that guilt is almost always tempered by the reassurance that while we might have lost the battle to cancer, nature, God or whatever, we did everything we could in the process. Being a physician means that doctors must sometimes admit defeat, but in doing so, we don't go on to be the hand of death.
...In 2009, US legislation that would have allowed physicians to be compensated by Medicare for providing voluntary counselling to patients about options for end-of-life care was defeated due to political uproar over 'death panels'. And yet, as I discuss in the World Journal of Psychiatry in 2015, human euthanasia is being increasingly considered and sanctioned both in the US and abroad. As life-extending medical advances over the past 50 years have fuelled growing concerns about prolongation of suffering and loss of autonomy, the euthanasia movement of the 1930s has gained momentum, evolving into the modern 'right to die' and 'death with dignity' movements that challenge us to consider what constitutes a 'good death'. Today, some form of voluntary active euthanasia - death by administration of a lethal dose of medication to avoid pain and suffering - is legal in several states in the US, as well as in Japan and parts of Europe including Belgium, Luxembourg, Switzerland and the Netherlands.
Still, if the historical divide between our attitudes towards euthanasia for humans and for animals is narrowing, the devil in the details of cultural sanctioning involves who can actually administer, or is willing to administer, the medications that end life. With existing legislation to date, the sanctioned individual - whether a physician, family member, some neutral third party, or the person seeking to end their own life themselves - varies by jurisdiction. Although 'death with dignity' is increasingly supported in many parts of the world, often neither doctors nor patients seeking death want to 'push the plunger' and take responsibility for being the hand of death. In this sense, euthanasia remains a hot-potato issue in human medicine.
Consequently, we now find ourselves debating a range of possible end-of-life care options, including passive euthanasia (withholding life-sustaining interventions including food or water), physician-assisted suicide (providing the means for a patient to end their own life), and active voluntary euthanasia (administering a lethal medication to a patient). Palliative sedation is an increasingly popular option within medicine, which involves administering medications that are intended to relieve suffering through sedation and pain control to the point of possible unconsciousness. Although death is a potential side effect, palliative sedation avoids the moral objections of suicide and euthanasia through the ethics of the so-called 'double effect', which argues that death is an acceptable outcome if unintended and in the primary service of relieving suffering among the terminally ill. Pushing the envelope of what it means to die a 'good death' for humans even further, my colleagues at the University of California, Los Angeles have been investigating the use of psychedelic drugs such as psilocybin to relieve anxiety and depressive symptoms and to find meaning at life's end.
I think our lives must be our own -- which means that we should get to choose our death: how we die, when we die.
Of course, there can be abuses, and of course, not every doctor is going to be willing to participate in an assisted death. But the fact that there are abuses is reason to guard against them, not reason to force a person to endure what they feel is unendurable suffering (if they are not able to take their own life).
via @briandavidearp
Great post. I've often asked this question. We put down our pets, but allow fellow humans to suffer. My first wife is dying of Alzheimer's. Her mind has rotted away, and she's being kept in a nursing facility at taxpayer expense. She's a complete vegetable by now, and would not have wanted to die like this. Her late husband was a doctor, and I phoned him one evening and suggested that he take measures to end her suffering. He told me I was the only one to have made that suggestion to him. I still don't have any idea what he meant by that. Were I still married to her, this is not the route she'd have taken. A pillow over the head or some ground-up Nembutal in a milkshake would have ended her suffering. I honestly believe that this happens far more often than we're led to believe, and that much of the medical establishment passively allows it. I suspect the average coroner knows when a death has been "hastened", but says nothing when told about the Alzheimer's. There's no dignity in dying of stomach cancer or Alzheimer's or ALS.
roadge at May 19, 2018 10:30 PM
Yep, death is often painful and messy. Just like many ostensibly life saving proceedures.
This is not an issue I want legislated. I want assisted suicide to stay under the table.
Sanitzing it makes it too clean and easy. I always remember that Star Trek epidsode about what one planet did to avoid fighting a war.
Isab at May 20, 2018 12:02 AM
The right to die will--guaranteed--become the duty to die, as defined by the State.
Ezekiel Emmanual, Rahm's brother and a physician, said that should be at age seventy-five.
Richard Aubrey at May 20, 2018 3:21 AM
The right to die will--guaranteed--become the duty to die,
So much this.
dee nile at May 20, 2018 5:23 AM
Doctors need not be involved. I have no wish to do harm to First, do no harm.
Besides, it doesn't take a super rigorous multi-year course of study to be able to inject someone with a toxin that will kill them relatively painlessly.
I'm pretty sure I can brew you a nice cup of hemlock tea without a lick of training.
That said, Richard Aubrey is spot on. Not only will it become a duty, it will be your patriotic duty.
Hats off to Amy. She's solved the Social Security and underfunded pensions problem in one fell swoop.
I R A Darth Aggie at May 20, 2018 6:12 AM
"I want assisted suicide to stay under the table."
This means someone can be tried for murder for acceding to helping their suffering loved one die.
Amy Alkon at May 20, 2018 6:31 AM
The Oregon Death with Dignity Act was passed in 1997. The 20th annual report shows 143 deaths in 2017 from taking medications prescribed under the act. The program works fine, and has been notable for not making much news. No bad scary things happening.
To be honest, the reports are a bit dull and repetitive. Read more here:
http://www.oregon.gov/oha/PH/ProviderPartnerResources/Evaluationresearch/deathwithdignityact/Pages/index.aspx
Steve Gerrard at May 20, 2018 10:42 AM
A very thoughtful post, Amy. Roadge, I'm sorry about your first wife. That's a terrible situation.
I think the at-home, self-administered morphine pump (or other painkiller) fits into this, especially when a medical professional cautions against using it over a certain level. It's not a warning; it's a recipe.
Kevin at May 20, 2018 11:20 AM
This means someone can be tried for murder for acceding to helping their suffering loved one die.
Amy Alkon at May 20, 2018 6:31 AM
Hard choices make bad law. I dont think you have really thought through all the ways assisted suicide policy can go terribly wrong.
By the time most people are ill enough and despondent enough to want to kill themselves, they are past the point where they can make a rational decision. Neither can their emotionally compromised loved ones.
Kind of ironic that as pallative care gets better and better and hospice gets more available there are still people pushing for the last inch of perceived control over suffering and death by attempting to turn the medical profession into volunteer executioners.
Isab at May 20, 2018 11:42 AM
Amy: But the fact that there are abuses is reason to guard against them, not reason to force a person to endure what they feel is unendurable suffering
Guarding against abuses is, of course, both wise and necessary. However, guarding will not achieve 100% prevention so it comes down to the question: If some unknown (but likely small) number of people may die as the result of abuses, is saving their lives worth the suffering inflicted on so many others by preventing legal assisted suicide? I suspect most Americans would say yes.
JD at May 20, 2018 12:19 PM
In TX at least, terminally ill people have the legal right to adequate pain relief, even if it hastens their death. Ergo, morphine overdose is technically legal.
I've taken care of far, far, far too many people whose brain is gone, whose body is rotting slowly, to ever be against legal euthanasia. If we have the right to choose to end a life growing in us, we ought to have the right to end our own life. If and when the time comes for my mom, I will handle it, as she has asked of me, as I will ask my kuds.
Momof4 at May 20, 2018 12:44 PM
The problem with legalized voluntary euthanasia is that people at the end of their lives are not always competent to make such decisions and can often be easily influenced by others, others who may have a vested interest in ending a complicated life early.
And even a living will does not relieve us of the responsibility of making sure the person is competent at the time of execution. If we're going to execute someone, even by their own wish, the person should be competent to okay such an act at the time of it.
According to the aforementioned Ezekiel Emanuel, extreme pain is a motivator in only about a third of assisted suicide cases. In a 1997 article in The Atlantic Emanuel stated, "The Remmelink Report found that among Dutch patients the leading reason for requesting euthanasia was a perceived loss of dignity. The study of Washington State physicians found that the leading factors driving requests were fear of a loss of control or of dignity, of being a burden, and of being dependent. Among the New York HIV-infected patients the leading factors were depression, hopelessness, and having few -- and poor-quality -- social supports."
I don't know if he's changed his mind since then, but his concerns about being careless in legalizing euthanasia are worth considering.
Careless legalization of euthanasia could also lead to an ethical "slippery slope" which would make it easier for medical care providers to rationalize euthanasia when it would save them expense and work, as well as decrease support for palliative and hospice care.
Unintended consequences can plague even the most well-intentioned of laws and, if we're going to advocate legalized euthanasia, we need to be aware that it's not always as black-and-white as "death with dignity" proponents portray it.
Conan the Grammarian at May 20, 2018 12:56 PM
Conan: it's not always black-and-white as "death with dignity" proponents portray it.
Do they, in fact, portray it that way? Or are you just characterizing their position that way?
Careless legalization of euthanasia...
Implicit in that term is that there is -- or could be -- careful legalization. I think that those who are adamantly opposed to legalization would probably argue that there is no "careful" that is sufficient enough to warrant legalization so that, by its very nature, any legalization is careless.
JD at May 20, 2018 2:30 PM
> This means someone can be tried
> for murder for acceding to helping
> their suffering loved one die.
Totally worth it.
We want the entirety of medicine, in practice and regulation, to focus towards living.
First, because you are going to die anyway, and no elaborate efforts or procedures are required to bring this about.
Secondly, because modern medicine is treasure of treasures. With its shapely twin sister nutrition, it's given recovery and longevity to formerly tormented people in nearly every corner of the globe and nearly every economic position.
In fact...
I think medicine has become so good that you no longer see it clearly. Civilization's howling, incessant attack on illness has been so effective, so comforting in some of the most personal contexts imaginable, that the imagination is stoked towards even greater rewards: Personalized fulfillment! Paradise!
But nature wins... That's how that goes. This is not a new problem. You've known your whole life that this is coming, and you've had the whole time to prepare to defend yourself from an unpleasant exit. You can't make every part of your life into someone else's problem, especially at the risk of despoiling our blessings. And I promise— If we make room for killing as a mundane corner of medicine, it will attract some of the ugliest and least-competent exemplars of human nature. (Those TSA fuckweasels who molest us were always in our culture, but for the first four decades of my life, their enthusiasms were denigrated and useless... And then our government decided to pretend they were respectable. They are not.)
No. Do it yourself.
In some podcast recently, someone said "It's better to be a warrior in a garden than a gardener in a war."
Keep your gravediggers out of my surgical theaters. The doctors will find their own path to the soil, as will we all.
Crid at May 20, 2018 2:48 PM
Damn... I still got it.
Crid at May 20, 2018 2:51 PM
Well, to answer your question, I'll leave you with this quote: "Joseph Pierre, a UCLA prof of psychiatry, makes a point I've made before -- that we give our dogs a better death than we give ourselves."
Or, how about this one: "We put down our pets, but allow fellow humans to suffer."
Not a lot of nuance in those sentiments.
Conan the Grammarian at May 20, 2018 4:01 PM
I forgot to mention, and I certainly meant to, that "acceding to helping" is clumsy and troubled language.
I mean, like, indictable.
Crid at May 20, 2018 5:13 PM
Cosh may well be talking about potable water and so forth, but, like, it's the kind of thing I meant by sisterhood.
Crid at May 20, 2018 8:54 PM
Goddess:
I think our lives must be our own
- - - - - - - - - -
How does this lead to allowing people to kill OTHER people?
Medicine has nothing left to offer you? Pull out the IV, go home, and wait to die. Like my wife's grandma did.
Use any means you like to hasten things.
But there is no "personal agency" in legalizing killing - especially when it's done by an impersonal beauracratic functionary who doesn't even know you.
Leave society's safeguards on human life as you found - and enjoyed - them.
Ben David at May 21, 2018 9:48 AM
Maybe it isn't stressed enough here, but in the age of the common busybody and Facebook "expert", someone will make it their business to involve everyone possible in your end-of-life choices, and drag out the trial. It's for your own good, you see.
It's not gonna work like old times, where you would maybe get the family doctor and two sons to work out a dosage of Laudanum to ease Nana on her way.
Radwaste at May 23, 2018 5:10 AM
@Amy:"which means that we should get to choose our death: how we die, when we die."
Why? Where is that written in the fabric of the cosmos? Such broad normative statements seem far too religious to be spoken by an atheist.
Did you get to choose how you were born? How much choice did you have in how you lived? Most of us would, if we had a choice, be born and live rich, beautiful, and healthy. How's that working out for the vast majority? Mom used to ask me where the word "fair" was written on my birth certificate.
Amy and others continually, and justifiably, grouse about millenial snowflakes who feel they should be excused from facing any adversity. How is this attitude about death any different? We watch the movie Braveheart, and wax rhapsodic about the courage of William Wallace, who endured death by torture. What sort of wussified cowards does that make us if we can't bear a less than idyllic passing?
I say grow a pair, cowboy up, and rage against the dying of the light. Or, at least have the stones to 100% DIY it as soon as you're diagnosed, before you lose the ability, like Robin Williams
Also, if one happens to be religious, in pretty much any monotheistic way, what good soldier abandons his post before relieved by his commander, just because it gets tough?
"The program works fine, and has been notable for not making much news. No bad scary things happening."
You mean like the state Medicare authorities telling a woman they wouldn't pay for an experimental new cancer drug, but they'd pay to euthanize her? Like the other guy said - the right to die becomes the duty to die. Old people in the Netherlands are terrified to go anywhere near a hospital and give some administrator an opportunity to permanently eliminate the cost of their single payer healthcare.
"Kind of ironic that as pallative care gets better and better and hospice gets more available there are still people pushing for the last inch of perceived control over suffering and death by attempting to turn the medical profession into volunteer executioners."
It's hard to find a better way than that to put it.
"If we have the right to choose to end a life growing in us, we ought to have the right to end our own life."
The premise of your syllogism is far from being a settled matter.
bw1 at May 23, 2018 6:16 PM
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