A year ago, when a doctor finally diagnosed the brain disease that had been making it harder for her to walk without falling, Rona Zelniker told her son and daughter that she was going to end her life while she still could, before complete disability set in.
Her children were grateful for the way she prepared them, and for the time they had together at the end. “I must have cried 150 times in the last year,” said Keith Zelniker, 32, her son. He scheduled off the week she was planning to die, writing on his work calendar, “bereavement time.”
Zelniker felt anxiety about how she would end her life. She didn’t want to swallow pills, only to wake up even worse off, with brain damage. A gun was out of the question.
[i]Jerry Dincin, 78, a retired psychiatrist in Chicago and acting president of the Final Exit Network, said the struggle to allow people to control how and when they die will become “the human-rights issue of the 21st century.”[/i]
[i]Keith [Zehlniker] worried his mother wouldn’t have the strength to drag the helium tanks from the laundry room to the spare bedroom, and he had visions of her ending her life on the laundry room floor. This made him angry. “Things are so taboo,” he said, “you have to do this backroom. This is like an abortion before Roe v. Wade.”[/i]
These two statements speak volumes. It is much easier to make a case to the non-Christian public for the right to life in the case of the unborn than in the example cited here (not that there isn’t one). Yes, one can speak to the cases where a non-terminally ill person is allowed to believe that death is the best way out and where the elderly have convinced themselves that they are too much of a burden, but how does one address those persons – particularly those without faith – who cry out for the means to end interminable suffering? It is easy to profess the inherent value of life, but if you’re not experiencing that condition such a profession can ring a trifle hollow.
Anyone out there working in terminal care with answers?
I have a genuine question here, not a snide one. Is there a well-developed hospice movement in the US? Can a terminally ill person be cared for in a good professional environment without crippling costs? Here in the UK we are blessed with an excellent network of hospices. They will also take the terminally ill for respite care to give families a break – you do not have to be literally dying to be admitted. Most are charities with strong local support but also backing from businesses and trusts. In the Netherlands, by contrast, hospices are (I believe) rare and hence euthanasia widely accepted. Hospice care has helped many people make a decision to die well by knowing that they can let nature take its course but that at ever step of the way there will be excellent analgesia, counselling, enabling of family and friends to be present and active, and respect for each person’s faith. For those who wish to die at home there are the Macmillan nurses, who look after cancer patients in their homes and are very highly regarded in the community, which again raises funds for the charity which provides the nurses.
Jeremy – I agree with you. It is remarkable how much flows from Roe v. Wade – this being one case. (Another area one thing begets further consequences is homosexual ‘rights’ and ‘marriage’ – as this brings polygamous marriage, bisexual ‘rights’ and even ‘pedophilia’ to being next in line.)
The one argument to be made to a non-Christian is that this becomes a very slippery slope – if we can assist the competent in ending their days, why not the elderly [i]in[/i]competent, framed also as an act of mercy; then, what about the elderly who are using so many financial/medical resources and are terminal; next, what about the mentally disabled who are much younger…? As a society, we have this tendency to discount the ‘slippery slope’ arguments, but the older I get the more I see them used in the legal arena (and the church areana).
Two books by Michael O’Brien – [b]Father Elijah[/b] and [b]Islands of the World[/b] – are good parables about the awful reality of the ‘slippery slope’. Horrifyingly, the latter book is a true story.
#2 – there are good hospice programs in most larger communities in the US, as Medicare has paid those programs fairly well (though many are charitable nevertheless). Great question.
Terry Tee, yes. I had two aunts and two uncles who died in hospice care, one in a hospice center, by her choice, and the other three at home. The care is outstanding.
My father passed away peacefully at home, and he was able to spend his last few days with friends and family due to the excellent hospice care he received.
With the coming national health care, you know what will come next: your cancer/ALS/place your terminal disease here, will be too expensive to waste on treatments that would only extend your life by ` – 3 years, but we will gladly pay the $200 for the suicide pills. I believe this actually happened in Oregon where the “right to die” is legal. There was a person with terminal cancer, and they wanted to have a treatment that could extend their life by another 18 months. Oregon denied it, too expensive, but let them know that they would pay for their “right to die” Rx.
As a hospice chaplain, this story saddens me. What hits me most is the spiritual issue of “needing to be in control.” I see it quite often with my patients and their families. Some people have a very hard time letting go and accepting what life (including death) is giving to them. Others embrace it with grace and find ways to continue to live while they are dying. Of course it is not either/or. We all tend to operating with varying levels of grasping for control of our lives or releasing our grip and receiving what will come.
Jeremy Bonner’s (#1) reflection upon the difference it makes to be someone facing such suffering personally is important. As I sit by the side of my patients, it is easier for me to accept their condition than to think about myself lying there in that same condition. And so I do what I can to let those people know that they are still people of worth, still worth my time to be with them. It is my hope that there will be people around me who will do the same for me.
The issue of maintaining one’s dignity is an interesting one. My thought as I read this account was that dying with a bag over your head doesn’t sound very dignified to me. Rona Zelniker apparently felt that it was more dignified than having to get around in a wheelchair and have other people take care of her. This seems to view dignity as defined by one’s own values. But it seems to me that dignity can also be given by others even when we think we have lost our dignity.
I first worked in hospice in Oregon around the time that the assisted suicide law was passed. The members of our hospice team were simply not comfortable with assisted suicide. I suppose it has something to do with an affirmation of life and of the individuals even when they become helpless in the face of death. Hospice is fundamentally about living even in the face of death.
Orthodox Jews, Christians, Muslims, Buddhists, Hindus all have an absolute prohibition in their religions against suicide to help them with decision-making. Secularized religious people and those of no faith do not have this support. I wonder where we should draw the line in American civil society on this matter. As to some kind of “right” for one to demand that the State pay for medical life-extension as In Texas #6 mentioned, I can’t see any compelling reason to do so in terminal cases. Medical life-extension is as much playing God as preemptive life-termination.
One of my best friends died in a local hospice center. She got beautiful care with emotional, physical, spiritual support all around. She knew she was terminal but expected to live a couple of weeks there. She died–peacefully–within two days. I think it was because she was so loved and cared for–she was treated with ULTIMATE dignity–that she was allowed to slip from this life into the next. I still weep at the joy she expressed.
Hospice is well established in many places. I would hope it would be a ministry for all Christians.
We recently had a vet put our thirteen year old 100 pound Airedale to sleep at home on his pillow. He had congestive heart failure and cancer. He was unable to stand and had not eaten for three days. I don’t know if there is a Human/Dog comparison and I have some guilt about our decision. It seemed that to let him die of starvation would unnecessarily prolong his suffering. I guess grief for me was cumulative since his death brought more tears than my own parents. I’m also not saying this would be the right approach for a human. I’m still not sure it was the right approach for a pet.
Jeremy (#1)
As a Christian and former hospice nurse, I have often wrestled with this topic – though, admittedly, it’s been primarily on a theoretical level, as I’ve not personally encountered any patients who have actively hastened their own deaths. However, I HAVE had patients in chronic renal failure, for example, who decided “enough is enough” and elected to stop dialysis. Would that be considered “passive” suicide? When you get down to brass tacks, are all suicides “equal” in the eyes of God? I just don’t know…
As others here have noted, hospice (or “palliative care”) offers a holistic approach to meeting a patient’s end-of-life needs, including a whole arsenal of pain control measures, thus minimizing the physical suffering. It also includes chaplains, social workers, bereavement counselors (for both patients and families), nursing services and any needed medical equipment. Thus, all the “bases” would seemingly be covered…except, perhaps, that whole “dignity thing.” And therein lies my struggle: I’ve assured countless numbers of patients that it is [b]OK[b] when they’ve lost control of their bodily functions…there’s nothing to be ashamed of…they are NOT a burden, regardless of how many times they need to be cleaned and their beds changed…that I considered it a privilege to be able to do that for them. And I’ve [i]really[/i] meant it (although, I must confess that I have mucus issues). In many respects, that aspect of hospice nursing was what was most rewarding for me, because it was very much a “foot-washing” experience. And yet, I would fervently pray that I never end up like [i]that[/i] – not dissimilar from the exchange between Jesus and Peter that Thursday night two millenia ago…Conversely,the most difficult aspect of hospice nursing was caring for patients who were vehement atheists. I was always surprised when I encountered such patients…and I would pray hard that God would whisper in their ears while there was still time. Though each of us is just a breath away from eternity, caring for a dying, atheistic hospice patient is like watching a slow-motion car wreck – you know how it’s going to turn out, but all you can do is watch and pray from the sidelines.
While this article – and the ensuing discussion – addresses suicide by the terminally ill, I would be very interested in hearing everyone’s perspective (as Christians) regarding suicide in general. I ask, because my brother committed suicide in 2002. In our subsequent meeting with the priest to iron out the details of his burial liturgy, I requested that Psalm 139 be read. This has long been among my favorite Psalms, but I was thunderstruck when we reached verse 16: “All my days were appointed for me before one came to be…”
I have chewed and ruminated over this verse for the last seven years. To me, the operative word in this verse is “ALL” – not “some;” not “most;” but ALL. Thus, my question is: did my brother have any more appointed days? Is the method by which we enter eternity appointed for us? If my brother had not reached the bottom point in his life on that day – and subsequently overdosed on demerol – would that day still have been his last appointed day? Would he have entered eternity by some other means? Car accident? Heart attack? Food poisoning? I am genuinely interested in hearing everyone’s thoughts!
[b] “As I have need of Thee, send me forth to others who sit with drooping faces at the table of despair – and see Thee not.” [/b] Max Ehrman
Shalom –
JW-M
Sorry about the formatting above (#11). Elves, if you would delete it, I would be grateful.
Jeremy (#1)
As a Christian and former hospice nurse, I have often wrestled with this topic – though, admittedly, it’s been primarily on a theoretical level, as I’ve not personally encountered any patients who have actively hastened their own deaths. However, I HAVE had patients in chronic renal failure, for example, who decided “enough is enough” and elected to stop dialysis. Would that be considered “passive” suicide? When you get down to brass tacks, are all suicides “equal” in the eyes of God? I just don’t know…
As others here have noted, hospice (or “palliative care”) offers a holistic approach to meeting a patient’s end-of-life needs, including a whole arsenal of pain control measures, thus minimizing the physical suffering. It also includes chaplains, social workers, bereavement counselors (for both patients and families), nursing services and any needed medical equipment. Thus, all the “bases” would seemingly be covered…except, perhaps, that whole “dignity thing.”
And therein lies my struggle: I’ve assured countless numbers of patients that it is [b]OK[/b] when they’ve lost control of their bodily functions…there’s nothing to be ashamed of…they are NOT a burden, regardless of how many times they need to be cleaned and their beds changed…that I considered it a privilege to be able to do that for them. And I’ve [i]really[/i] meant it (although, I must confess that I have mucus issues). In many respects, that aspect of hospice nursing was what was most rewarding for me, because it was very much a “foot-washing” experience. And yet, I would fervently pray that I never end up like [i]that[/i] – not dissimilar from the exchange between Jesus and Peter that Thursday night two millenia ago…
Conversely,the most difficult aspect of hospice nursing was caring for patients who were vehement atheists. I was always surprised when I encountered such patients…and I would pray hard that God would whisper in their ears while there was still time. Though each of us is just a breath away from eternity, caring for a dying, atheistic hospice patient is like watching a slow-motion car wreck – you know how it’s going to turn out, but all you can do is watch and pray from the sidelines.
While this article – and the ensuing discussion – addresses suicide by the terminally ill, I would be very interested in hearing everyone’s perspective (as Christians) regarding suicide in general. I ask, because my brother committed suicide in 2002. In our subsequent meeting with the priest to iron out the details of his burial liturgy, I requested that Psalm 139 be read. This has long been among my favorite Psalms, but I was thunderstruck when we reached verse 16: “All my days were appointed for me before one came to be…”
I have chewed and ruminated over this verse for the last seven years. To me, the operative word in this verse is “ALL” – not “some;” not “most;” but ALL. Thus, my question is: did my brother have any more appointed days? Is the method by which we enter eternity appointed for us? If my brother had not reached the bottom point in his life on that day – and subsequently overdosed on demerol – would that day still have been his last appointed day? Would he have entered eternity by some other means? Car accident? Heart attack? Food poisoning? I am genuinely interested in hearing everyone’s thoughts!
[b] “As I have need of Thee, send me forth to others who sit with drooping faces at the table of despair – and see Thee not.” [/b] Max Ehrman
Shalom –
JW-M
ORNurseDude,
Thanks for that. As the spouse of someone in transplant pharmacy, I have some awareness of the struggles involved but you put the situation in very cogent terms from a hospice perspective. I’m not sure that I have an answer for you on the suicide issue at present, but I didn’t want to wait to acknowldege your contribution until I did.
ORNurseDude, I don’t know about your suicide question, other than to say we are in God’s hands, always.
Thank you for what you said about patients who feel they have lost their dignity with their physical control. This happened to my father. His wife (not Mom, she passed away years before) was ugly to him, and told him that the nurses were angry with him when his sheets were wet in the morning. When I got there, I was able to assure him that this was NOT true, and indeed the nurses later told me what a kind and considerate old gentlemen he was in those last three months. You reassure me now, and I thank you for what you did for your hospice patients.
My father-in-law is greatly disabled and became very ill in February. If it had gone to pneumonia, I was sure that he would be gone in days. And so I called and emailed everyone I could think of to pray for him and, praise God, he did recover. Now, his lifestyle is severely limited because of his numerous disabilities, but he is fighting to stay with us as long as possible and I’m grateful for that as my children are very young and I want them to remember him. If it were a matter of convenience and cost, sure if would be “better” if he put a bag over his head, but I am so grateful that he gets up every day and values the life God has given him.
ORNurseDude –
A woman friend of mine suffered for years over her father’s suicide. Rationally, she knew that, being in the end stages of cancer and in terrible pain, he probably wasn’t really culpable for what he did. Yet we aren’t only rational creatures, and so she suffered. Having gone through some depression of my own, I can understand the feeling of wanting to die. It’s always a tragedy, however, which leaves the living a terrible trauma. God bless you with healing.