As Good As One Could Hope For

In late August, as tropical storm Hillary cloaked Southern California, I shuttled my sister from coastal Orange County, down the I-15 corridor to Menifee. We traveled to visit a long-time family friend – a sort-of second mother to us – who had recently moved to assisted living.

Despite the ominous predictions for the storm, the drive turned out to be non-eventful. Our reservations about assisted living facilities were also quelled. The place was, well, luxurious. Most importantly, our family friend (I will call her Emily) was in good spirits, sharp, present, and hospitable – just as we always remembered her. She had been through months of medical trials and was recovering, a noteworthy feat for someone a couple of years shy of ninety.

While Emily’s sister offered us tea and cakes, Emily recounted her previous months of health concerns. As with most medical issues, the diagnostic phase, and the prolonged period of not knowing, proved to be trying. Early in the process, Emily was told that she may have amyotrophic lateral sclerosis (ALS), an awful prospect. As she described it, “You become trapped in your own body.” She told us that, with the possibility of a life diminished by ALS ahead of her, she’d considered opting out.

As her sister tried not to listen, Emily detailed to us in her polite, midwestern manner, her research into euthanasia. Emily had given the matter ample consideration, she spoke concisely about methods, timing, possible legal hurdles and, most importantly, how the subject was verboten with her family. Fortunately, for Emily, she did not have ALS and she never had to follow through on her research. However, Emily’s frank discussion of the matter, and learning that Emily had even considered euthanasia, was unexpected.

I grew up on a wide suburban street in Riverside, California. My family attended the same Catholic church as Emily and her family. I went to Catholic school with Emily’s children. Catholic doctrine, as I was taught, forbids ending one’s life. Even permitting someone to end your life, or encouraging someone to end your life, is forbidden. The one exception being martyrdom. Martyrs were the stalwarts when it came to faith, and their stubbornness often provoked their slayers. In the case of St. Sebastian, he provoked the pagans and their arrows at least once (perhaps twice?) and not only received special benediction, but also became the subject of fanciful paintings.   

Per Catholic theology, suicide is a sin. However, as we learned in middle school religion class, there are exceptions. Those who lack the capacity to make clear decisions – are not in their right minds – get a free pass. As a legal matter, suicide has been mostly decriminalized. Thankfully so, if only considering the absurdity of such laws. However, euthanasia has historically received a less than eager reception in the U.S. Recall the vilification of Dr. Kevorkian – “Dr. Death” – and the lengths he went to skirt criminal convictions for his work with the terminally ill.

My late mother, a nurse, and a follower of church doctrine always took issue with euthanasia. Life is sacred. However, her views about care for the dying evolved as she grew older. When my grandmother’s cancer became terminal – radiation and chemo no longer even a consideration – my mother was angry about the resistance to providing necessary pain medication. It was hard enough to watch her mother die, but watching her die in pain was horrific. My mother unsuccessfully lobbied the hospital staff to provide my grandmother with more pain medication – anything to make it better. The experience of watching my grandmother die a difficult and painful death inspired my mother to work for hospice, and to become a strong proponent of palliative care. By the time my mother became terminal herself, she was completely on board with taking morphine, whatever it took, she wanted it. This was, of course, a relief for her three children. We were with her in the last days, my mother on a potent cocktail of morphine and lorazepam, resting peacefully until she died. No pain, no anxiety. We were relieved that she was afforded the dignity of a peaceful end.

Obituaries necessarily recount the high points of one’s life – the milestones, the achievements, the follies etc. – with a short mention of the cause of death. Besides the requisite “was in the presence of loved ones” there is little accounting of the actual death. However, when I read obituaries, I often think about what the final days could have brought for the memorialized individual. Anyone who has watched someone die knows the process can be tough if not brutal. It does not have to be. When folks offered condolences for my mother, my sisters and I were quick (and proud!) to report that the process was as good as one could hope for (understanding that we all knew the ending beforehand).

Accepting the need for hospice care, and palliative care takes one down a slippery slope to euthanasia. Give someone enough morphine for pain and, eventually, it may kill them.  However, to my knowledge, hospice is not allowed to administer an overdose, or fatal dose of painkillers. For obvious reasons, our medical system is designed to keep folks alive. No one goes to medical school to learn how to kill people. But the catch is that, whether we like it or not, there is in every case a point when medicine will no longer be successful. This is a difficult consideration for many to reckon with. One may remember when the Affordable Care Act tried to add cost saving measures to end of life care and congressional opponents to the bill began screaming about death panels. That was silly and disconcerting, if emblematic of how we struggle with the process of dying. We have plenty of discussions about life, death, and life after death, but the subject of how we eventually succumb, the final hours, the final mechanism, does not make good cocktail hour chatter. Our failure to acknowledge how death can be unnecessarily brutal has kept euthanasia out of mainstream acceptability.

Things change, however. California passed the End-of-Life Option Act in 2016, which was modeled on Oregon’s Death with Dignity act. The California act became law (after court challenges) in 2018. Brittany Maynard, the brave 29-year-old with terminal cancer, was forced to travel to Oregon to pursue euthanasia. Brittany inspired the California statute. The catch for both the California and Oregon law is that the patient must self-administer the lethal cocktail – No Dr. Death at the bedside. California law also requires the diagnosis of terminal illness.

Which brings me back to Emily. When faced with a possible diagnosis of ALS, I believe she realized she might be diminished to a point where she could not self-administer her own lethal end, and then be trapped in her body, a sort of purgatory.  Emily told us that her research turned up helium as a recommended solution – it is readily available, not a controlled substance, and fatal in sufficient doses. Of course, Emily’s joke was that, after a fatal dose of helium, one’s final words would arrive in ear-piercing frequencies. Death with dignity and hijinks. Donald Duck voice aside, helium renders an image of lightness. There are far worse destinies than taking flight as a balloon. Perhaps the best we can hope for is that eventually we will all be able to simply float away.

David Womack is the author of Mountain Bike! Orange County and The Stand-Up Paddler’s Guide to Southern California. He lives and works in Laguna Beach.