Just read an angry rant from Scott Adams, creator of Dilbert comic strip, about watching his father die a tortured death and why assisted suicide should be legal.  This blog, because it’s mine, allows me to reflect on everything he said.

I’m not going to get into the assisted suicide discussion.  It’s a moral/ethical/legal conundrum that we are working out, albeit slowly in our democratic republic way.

What I want to talk about is how in the world did we get to this point?  I have thought a lot about this over the years, as a physical therapist working in hospitals, ICUs, and skilled  nursing facilities.  I remember a woman in her 80’s who was on a respirator and a thousand tubes and in ICU for months. She was terribly ill.  She was emaciated.  She was alert.  It was her choice.  For those of us who were working with her, it was mind boggling.  None of us could imagine wanting to live that way.  Her motives were unknown to us, and here’s a case where assisted suicide would have been irrelevant.  It made us angry, honestly.  We often felt as if she was torturing us.  She eventually died in that condition.

Over the years I have come to believe that how we got here was because medical technology moved so quickly we didn’t have time to understand the consequences of prolonging life at any cost.  For previous generations, these medical treatments were miracles, and they are.  The problem became where to stop.  I am on the side of Mr. Adams. Stop before the torture is endless and hopeless.   However I can attest that there are people, and there are families – sons, daughters – who have no problem hanging on to some vague hope in the situation he was in – wanting more and more treatment.  They want “everything” to be done if there is even 1% chance that life could be prolonged.  It becomes a selfish position to hold, but people hold it nevertheless.

I had a woman with cancer once confide in me that she was “done” but that she didn’t want her family to think she hadn’t done everything she could.  A few months after I worked with her in her home she did pass away, but her words have haunted me.  I remember her frightened and hopeful family giving her encouragement and telling her to “fight” when clearly she was ready to let nature take its course.  They were good people.  They didn’t want to torture their mother.  They just didn’t want her to go.

I have had to stand up to sons and daughters and explain to them as they yelled at me that I was incompetent and that I “just need to make them do it” – walk or exercise or eat or whatever – that they were asking me to torture their parent and that I would not do it.  Believe me, that is where the doctors are in a terrible position.  As a PT, I can say “they aren’t progressing, Medicare won’t pay, even if you want to pay privately it would be unethical of me to take your money.”  A doctor cannot say that.  She can and must present the options and let the family make the choice.

One answer is for us to all make sure we have written our advanced directives.  I had a recent conversation about this with friends who are adamant that the significant other would “know what I want.”  I gotta tell you, that’s just not true.  So many factors come in to play.  Dialysis one day a week? OK.  Dialysis four days a week? No thank you.  So what, then, about dialysis three days a week?  Would I want someone to have to wipe my ass if I was clear of mind and could live to see my grandchild’s wedding?  Probably.  Would I want someone to have to wipe my ass if I were demented or comatose? Probably not.  Write it down.

My final comment has to do with a comment on the article page re: assisted suicide about “this is what religion gets you.”  Sigh.  I try not to get into a space where I have to defend my religious support system but sometimes I must.  My mother is a practicing Catholic.  She has an advanced directive.  It does not authorize life at any cost.  It is an advanced directive that is approved by the Catholic Church, based on reason and compassion.  Religion really has nothing to do with whether someone or a family wants to prolong life against all odds.  Many religious people await the progression from this human experience with a sense of joy and anticipation and would never in a million years want to torture ourselves or others.  Many non-religious people would rather be tortured than die.  So can we leave the whole “all religious people are assholes” argument out of this?

It’s so complicated.