I never thought much about terminal illness and the morality of assisted suicide in the first 70 plus years of my life but aging brings with it the unbidden concerns of end of life care.  Modern medicine has given us the ability to extend life far beyond what our ancestors of even a handful of generations ago imagined was even possible.  That medical miracle exposes a deeper question of the difference between life and living.

I’m old enough and I also do have cirrhosis, a frequently terminal illness, so time and tides force me to consider the end of life as a real thing.  I remember well as a young person the feeling that old age was so far away as to be only a curiosity.  I’m reminded of thinking that 60 years old was ancient and not comprehensible to me.  I looked with some discomfort on old people.  I remember thinking that my grandmother was impossibly old and though I loved her truly she seemed like an odd creature with her wrinkles and infirmities.  There was a moment of clarity in my adult life when I realized that my Grandmother was in her 50’s when I had those feelings as a child.

I find myself recalling the New Testament imagery of death as the rider of the pale horse.  Those thoughts have come recently when I reflect on being a caregiver for a terminal patient. I’ve seen others, my mother in particular, do it for loved ones without really understanding the price they paid.  I never internalized what it actually means to stand as the last guardian of a valued life as the pale horse of death comes ever closer.

With modern medicine dying may be less painful than in ages past but it is much longer. The results of our technology have outpaced our ability to bear the burden of end stage disease in a humane way.  The result is that we have a crisis of care for terminally ill patients.