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.

Our society faces the very real dilemma of whether life at all costs is a valid strategy.  Our machines can keep a body going far beyond what would have been expected even 20 years ago and the life support procedures will likely continue to improve.  Even if we don’t wish to we will be forced individually and as a society to confront the question of when is it time go.   Remember, no decision is in itself a decision.  We will have many people who will allow the system to choose for them who will linger hopelessly, being kept warm by medical science, after the cognitive ability to choose has gone.

Interestingly, it is not my personal age or situation that leads me to ponder the ethics of assisted suicide.  My mother is a terminal cancer patient.  She lives in a state which legally allows medically assisted suicide.  She has recently come to live with me during the terminal phase of her illness, which will likely claim her this year.  In my state assisted suicide is considered to be murder and people are in jail who helped their loved ones die. 

My mother has expressed a wish not to be forced to suffer the agonal dying associated with metastatic lung cancer and made the first legal inquiry in her home state which began the legal process to allow her to choose that course.  Now, however, we face a different legal system and the decisions fall on her children in a way that is different from her choosing her own path.

I find myself in a web of competing needs and emotions which impose an unexpected weight as reality begins to crush idealistic notions of what is right.  To be or not to be.  Where in that equation does a third party, even a family member, stand?  I am faced with my mother’s desire to control her death and to determine for herself what she will endure.  Because I am now her caregiver, must I act to help her die? That course involves pain I don’t know that I can manage. Or do I violate her wishes and avoid personal responsibility at an unknowable cost to her?  The cancer has metastasized to her brain so it likely will steal her intellect before it grinds her to dust which forces me to choose a path.

To serve her, I must take her back to the legal jurisdiction which will allow her to act according to her wishes which means that I must be, in some measure, the instrument of her death.  To fail in that violates my promise to her that I will care for her to the best of my ability. Duty, loyalty, love, kindness, fear and obligation become a stew of competing imperatives. 

I am not unique as a caregiver facing questions like this. Many states don’t allow assisted suicide so most don’t face this precise choice but end of life choices stand before millions of family members and all have the bitter choice of how much life is too much. Is there a bridge too far in life preservation efforts beyond any hope of improvement?  I am stuck between two minds on the subject as pain awaits no matter the choice.