A Self-Made Death

By Monica Mehta, AlterNet. Posted July 26, 2005.

Death. It's a topic most people shy away from. Try starting a conversation about it and you'll be labeled morbid or depressing. Talk about planning it and people will refer you to a therapist or a life insurance plan. People love to talk about love, sex, babies -- all life-affirming topics. Not death.

Bob Stern wanted to die on his terms.

The vast majority of the health care system's expenses are incurred taking care of individuals in the last few weeks of their life. This figure partially illustrates that for most families, it's hard to let go of a dying member; they pull out all the stops and pursue every possible treatment, because not to do so would seem inhumane. Even with the terminally ill, family members don't have a plan for what to do in the end; they just continue medical care until the patient dies. They agree to resuscitate 80- and 90-year old parents; they sign forms for countless procedures. There is often a great deal of pain associated with these treatments, and in the current health care system, there are very few ways to die old with dignity.

Most doctors know when enough is enough, and when it would be better to let a patient return home to die among her loved ones, or even when it might be better to hasten death after all but palliative treatment has already ceased and the pain is unbearable. The problem is, most families don't know how to say goodbye. And most people haven't discussed with their families when they'd like the treatments to stop and the goodbyes to begin. There's also the issue that in western culture, death in old age is not seen as an inevitable next stage; it's a grievous defeat that should be battled at all costs. "Do not go gentle into that good night," the poet Dylan Thomas writes. "Old age should burn and rave at close of day; Rage, rage against the dying of the light."

But most elderly, if asked, would prefer the option to go gently, and painlessly. The Hemlock Society, now known as End-of-Life Choices, advocates for the legal right of Americans to have such options. They say they do not support suicide; they are advocating for patients to have the right to have their doctors hasten death for them with the use of lethal drug doses. The recent Academy Award-winning Million-Dollar Baby brought the issue of euthanasia into the national spotlight. Susan Stern's documentary takes it a step further, addressing it on a personal level.

On the eve of his decision whether or not to end his life, a perfectly sane-looking Bob Stern makes a home video for his daughters. "I am seriously considering whether ... I can put an end to this very nice life which you girls have been a part of for many, many years," he tells the camera. He talks about wanting to avoid the unhappiness of loved ones that goes along with caring for a terminally ill patient. The "memories of the [sick] person are changed by virtue of this agony," he says. He uses a "cost benefit ratio" to weigh the pros and cons. But what he doesn't say is that he endured four long, painful years caring for his own dying mother. That experience may have made the decision for him.

Regardless of how we feel about the right to choose when to die, we can make a few choices about how we want to die. It's called an advance directive, and it helps generate decisions about whether we'd rather rage, or go gently. It also teaches us how to talk with our loved ones about death. That's something we should have learned about along with the birds and the bees.

Monica Mehta is an associate editor at AlterNet.