Caring Advocates Blog & News

Grappling with final questions that have no easy answers

by Janet Silver Ghent

During my father’s protracted battle with cancer, my mother made her own wishes clear. When her time came she didn’t want to suffer. She didn’t want her family inconvenienced. In a New York minute, she wanted Jack Kevorkian.

But when her time did come, the death doctor was out of commission, in a Coldwater, Mich., correctional facility, and my mother was confined to a hospital bed in her New York apartment. Neither I nor my brother nor the hospice workers would comply when she asked us to toss her out the window or give her a shot to end it all. The best we could say was that we would make her as comfortable as we could, keeping her out of pain.

But that wasn’t good enough. Administering morphine every few hours didn’t quell my mother’s anxiety attacks. Those last days were grueling. By the time the hospice nurse put my mother on Ativan, it was a bit late in the game.

There was another alternative, but my brother and I didn’t know about it. After my April column describing my mother’s last days, I received an email from Dr. Stanley Terman, a San Diego psychiatrist:
“I am sorry for your mother’s prolonged final ordeal,” he wrote. “What I do not understand is why no physician offered palliative sedation (sometimes called terminal sedation). That is what she wanted, and needed, and would NOT have hastened her dying, so it would not have broken any religious or secular laws. Can you explain why this was not offered?”

The explanation was that I didn’t know about it.

Terman referred me to his Web sites — www.caringadvocates.org and www.thebestgoodbye.com — which discuss legal end-of-life choices. Among them: Palliative sedation, which involves alleviating extreme suffering and agitation through medication that makes the patient unconscious. It is not lethal. In addition, those who are terminally ill can opt to refuse food and fluids. Ironically, my mother, who wanted to die, was calling out for ice chips and sherbet at all hours.

Months later, I attended a Palo Alto symposium on assisted suicide and personal choices at Congregation Etz Chayim. I listened to social psychologist and medical ethicist Stephen Jamison, California director for Compassion and Choices, address the right to die. I also heard Dr. Ellen Brown, medical director of Pathways Hospice, and Dr. Bruce Feldstein, director of The Jewish Chaplaincy at Stanford University Medical Center, address some alternatives.

I learned that in Oregon, only one in 1,000 who sign assisted-suicide directives actually implement them, according to Jamison. But filling out those directives gives patients “the right to talk” when they really need to be heard, he said.

Brown said she has those conversations all the time. When a patient says, “Help me die,” one needs to look at what’s behind the request, including fear. The answer may be better hospice care. She also discussed the possibility of palliative sedation, which is legal in California. Unlike assisted suicide, it doesn’t violate Jewish law, Feldstein added.

Addressing the Jewish perspective, Feldstein said while many Americans feel they have the right to commit suicide, “Jewish tradition has a different set of assumptions.” Among them: “The body does not belong to us, but to God or to life itself.” Because the body is “on loan to us … we’re caretakers.” Suicide is “murder of oneself” and it is prohibited, he said, as is assisted suicide.

However, he added, placing impediments to dying also violates Jewish tradition: “We can and should do everything to relieve suffering, including giving medication that may hasten death.”

Looking back at that dark February, I thought of what my brother and I did and did not do. Do I wish we had used palliative sedation? Yes, but my brother reminded me that because my mother was conscious, we were able to be present with her until she slipped away.

Could I have administered a lethal injection, which was what my mother would have wanted? The answer is still no. But then again, there are no easy answers.

Janet Silver Ghent, former senior editor of j., is a freelance writer/editor living in Palo Alto. She can be reached at ghentwriter@gmail.com.

J. The Jewish news weekly

http://www.jewishsf.com/content/2-0-/module/displaystory/story_id/30781/format/html/displaystory.html