[cancer] Assisted suicide and the will to live

Yesterday someone asked me why, if I was so miserable, I didn’t go ahead with assisted suicide, as provided for by the Oregon Death With Dignity Act. Voluntary euthanasia has been legal here for many years, the primary criteria being that the patient is mentally competent to request it, the request be made both verbally and in writing, and that the patient be terminally ill with six months or less to live.

While I frankly didn’t appreciate the question very much, on reflection I realized it was a fair one.

The short answer is my will to live. As Lisa Costello has said, if will to live were sufficient for survival, I’d live forever. I can imagine letting go in the very late stages of my terminal decline, if I were overwhelmed by the physical and psychic pain of dying, but not short of that.

The slightly longer answer is that [info]the_child needs me. My lovers, friends and family need me. I need me. Like most people, I dwell in the center of an interwoven tapestry of love and obligation and joy and desire and support, and I don’t want to tear myself out of that place any sooner than I have to.

The more complex answer, as simple as it may be on the surface, is my atheism. Despite thousands of years of wishful thinking and uncountable faith narratives from virtually every human culture, there is not one shred of objective, repeatable evidence for the survival of self beyond the death of the brain. When I die, I will experience personal extinction. That’s not a belief, that’s not a theory; that’s a simple, empirical fact borne out by the experience of every human being who has ever lived and died before me. While I’d love to be an exception, given that basic truth of course I want to hang around the party as long as possible.

One final point: once I’m dead, I won’t know the difference. But many other people I care about will. So for them, I live as long as I can.

18 thoughts on “[cancer] Assisted suicide and the will to live

  1. Laurie Mann says:

    I think that’s the right answer most of the time – fight for life as long as possible. I hope I will never feel the need for assisted suicide, but, depending on a future diagnosis, I’m glad it’s an option (including in Vermont, the state of my birth).

  2. Dave Baker says:

    What a fair-minded response to an inconsiderate (and nihilistic) question!

    I’ve been wondering about something else. This is hopefully a more life-affirming question that speaks to your will to live, and being plugged into the SF community as you are, I’d be surprised if you haven’t heard it before. Have you considered cryonics? I don’t think any reasonable person would say you have good odds of surviving after freezing your body. But it’s at least a chance, however small.

    I don’t mean to second-guess your end-of-life planning, of course. Just curious about your reasons and interested to hear your thoughts.

    1. Jay says:

      Mostly it seems pointless to me. Our current level of medical technology doesn’t provide for freezing without significant cellular damage. I’d hate to wake up a brain damaged idiot in a world where I know no one. Plus I don’t have anything like the money to endow a trust to pay for having me fixed at some future point…

      1. Dave Baker says:

        Makes sense. It’s certainly hard to imagine what sort of future technology could revive a patient preserved using current techniques.

  3. Ron says:

    I don’t see how my question was inconsiderate. I considered the posts that I read and saw nothing in them but anger and suffering. If Jay feels that there is more to his life now than suffering, he should post that more often than complaints about his GI tract, his inability to write or even function cognitively at a level that allows any degree of productivity. I merely made a suggestion and voiced my astonishment. I’m glad that there is something in your life that is keeping you here. Maybe my post said something more about my life than yours. I am not a nihilist. I don’t share the same views that Jay does. I did not consider death in an atheistic point of view, nor in a theistic point of view. I just believe that if suffering and pain are overwhelming, then assisted suicide is not something to scoff at. I apologize for being rude. I would ask that in the future you post more about the positive things that are going so we can all appreciate that, even with your illness, you manage to find some good things to do instead of dwelling on every problem.

    1. Stevie says:

      It is not my experience that Jay only posts about the negatives of his life; I have always regarded his cancer posts as a way of reaching out to all the people suffering horrendous illnesses who lack his ability to communicate.
      The vast majority of people cannot communicate in the way that Jay can; he is working on behalf of all the people who can’t…

    2. Jay says:

      Now I have to make another blog post, darn it.

    3. homa_bird says:

      Then it would be your blog Ron.

    4. Joe Rodgers says:

      Ron, your question has an assumption behind it, that the life that’s not pleasant isn’t worth living. It’s the *unexamined* life that’s not worth living. Jay is examining what’s left of his life in a way that few people are ever able to do. No one is pleased that these are the circumstances, but it’s what it is. If Jay had another 30 years to live and to write, he might will have wanted to be more tactful about the icky. But with time so short, don’t expect anyone to want to cut it any shorter.

    5. Anna says:

      I really don’t think Jay owes it to you to post anything. His blog, from what I understand, is not designed to reassure you or please you. As for being inconsiderate, I would say that blaming a dying man for not being jolly enough for your tastes or get the fuck out is not the most compassionate course of action.
      The time might come when Jay decides that pain and suffering are unbearable and would rather have a way out. That’s his decision to make and his judgement too. I for one am glad that his life is still full of love and joy enough that he feels it is worth persisting.

  4. homa_bird says:

    “…there is not one shred of objective, repeatable evidence for the survival of self beyond the death of the brain.”

    Ok, I’ll bite, I love a good existential blind alley!

    Nor is there any objective, repeatable evidence for love, gravity, or time. But we see the effects and conclude these things are “real”, or “true”. We can’t prove love exists, but we see the effects; people acting in tender, sweet, selfless ways. These “effects” of love give us strong evidence love exists, so we believe in love as “real”, but there is no “proof”, because we can’t see it, taste feel hear touch or measure it.

    Gravity is a similar case: we have yet to discover a gravity “particle”, like a photon, (gravitons are purely hypothetical, invented mediators of the gravitational “force”) we have never witnessed this interaction at an atomic level, don’t really know if gravity is “real”, or if it is a function of acceleration, or what the bleep it is (perhaps it is love between large objects?). Yet we believe in it because we see the repetitive, measurable effects.

    Time: not real either, in a touch, feel, hear see way. But there is evidence of time in graveyards and gray hair, calendars and rusting cars. So we believe in the thing called time, with absolutely no real evidence. (Einstein tote blew this one away with relativity, but we still believe in this phenomenon.)

    Now we come to the proof of immortality of souls/life after death. Again, no way to touch, feel, see or prove the existence of a soul that survives after death, but I argue there is evidence everywhere, evidence as powerful as the physical, spiritual and mental evidence of love, time and gravity.

    Main evidence for consideration; people are born with wildly differing capabilities, proclivities, talents, attractions, emotional landscapes, afflictions and strengths that cannot be explained by environment alone.

    Everyone I know seems to be in the midst of a journey, especially those I know best, including myself. If we are all starting from scratch each time we are born, brand new white pieces of paper with nothing written on them, how/why do some become so wise, while others remain in a rut? Why are some souls so advanced, while others remain bloomin idiots? two children in the same family, twins, even, can have wildly different lives.

    This is, for me, ample evidence (and I agree, not solid proof) that all of us, animals included, are on a journey of souls, at different stages of the process, getting just what we need (some lives are anguishing, some a walk in the park) each time around in order to eventually perfect ourselves.

    Of course, there are huge spiritual implications for this, no way will I broach that.

    1. M.A. says:

      (And, even if you absolutely don’t believe in gravity, you probably
      won’t fall off the planet.)

  5. Joe Rodgers says:

    Breathtaking- and not in a good way. “If you can’t say something nice, don’t say anything at all”- It’s unexamined privilege, I think. The whole reason I find this narrative compelling, is that the author is unashamed to voice the awfulness. If people can’t stand to hear the bad stuff, then what meaning, what contrast is there to compare the things that aren’t awful?

    bearing witness to these things isn’t exactly a pleasant experience, but it helps me remember what I think living should be about. Time spent with you at the con felt all the more valuable because I knew something about how expensive it is on your side.

  6. pelican says:

    I appreciate Jay’s deep honesty. Ugly truth- we’re all walking on that path, he’s just further down the road than most of us. And, the last few miles of that road are not pretty, and it’s really hard to predict how we’ll respond until we get there.

    Thanks as always for sharing what you choose to share, Jay.

  7. Stephanie Harper says:

    As a hospice nurse, it is a pretty common experience to have someone to express a desire to die immediately. Variations on “just pull the plug” are often how it is expressed – sometimes in seeming jest, sometimes in tearful sincerity.
    I am a strong advocate of the right to die, and the right of a person to make that choice. That said, my experience has been that these requests are expressions of suffering, rather than an express desire to die. When I ask “What is it that makes you feel that you want to die right now?” The answer is typically poorly controlled pain, a fear of increasing pain, or the sense that they have become a burden to loved ones. A feeling of powerlessness, of uselessness often underlies these requests.
    Something as simple as good pain control, a plan for future pain control and reassurance that they will not be allowed to suffer -to put them in control of the process and know the options- can greatly reduce suffering and improve quality of life.
    The feeling of uselessness, of being a burden is very common. Grieving the ongoing, continuing losses that comprise illness and the loss of the roles of caregiver, or breadwinner, etc is terribly hard. Sometimes reframing and defining the new roles is helpful. Discussing that the person may now be in a role of teacher. Teaching children or grandchildren how we care for ill family members, how we cope with really difficult decisions and situations, how we live with challenges and restrictions, and eventually how we die. This experience will Shape their attitudes and actions in the future. It is also giving your family or other caregivers the opportunity to BE caregivers. To be someone who does this Very Hard Thing. Because when it is all over, they will be changed by it, and will always be someone who takes care of those they love.
    My most interesting experience was with an academic, who had lost his wife two years previously and was dying of esophageal cancer. He lived alone, no caregiver or family, and explained on my first visit that he did not intend to deal at all with his imminent death.He told me his very well researched plan to kill himself when he could no longer get up the stairs to his room. It was a good plan.
    I offered him an alternative, once I had cleared it with our ethics committee. He was given the option of requesting Palliative sedation rather than using his own plan. He aggreed, and I checked in with him at each of our scheduled visits. The day finally came when he called me and let me know he couldn’t stay home anymore. He was transferred to our facility, made comfortable in his room, and advised that whenever he felt that he was ready for the anaesthesia he could just let the staff know. He spent the remaining weeks of his life very comfortable in our facility, without pain, and never asked for the sedation. The important thing for him was being in control, of knowing that it was there if he needed it.
    This is why I think that knowing that option is available is so very important – because it gives people the autonomy they have lost to disease. And the power to choose not to use it, but knowing that they always have the option.

    1. Anna says:

      Great post. Very reassuring too.

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