The Blog

Dare to Be 100: To Be or Not to Be

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This core issue addressed by Mr. Hamlet in his famous tortured self debate concerns the right of self determination. Today's headlines in California news outlets detail the bill pending the governor's signature on "physician assisted suicide". Our estimable governor, Jerry Brown, once teetered on entering into the priesthood. He is currently conflicted by this issue. On the one hand he is aware of the encyclical issued by Pope John Paul II in 1995 which forbade Catholics from any effort that might be construed as support for "physician-assisted suicide". On the other hand, however he is surely aware of the overwhelming support of this bill by the public and the legislature. The original encyclical prompted a surrounding discussion that the attending physician is not strictly prohibited from providing what are commonly termed as "comfort measures."

The current moment is a part of a slippery slope that has been around for some time now. My main job description as a geriatrician put me in direct relation to the act of dying, when?, where?, and how? I wrote a paper "The Trajectory of Dying" on this topic. My attention was constantly on the alert to the too frequent grotesque aberrations that sometimes occurred at the moment of my patient's dying. Despite what I had perceived that every reasonable construction about advance directives etc. was in place my patients found themselves in the ICU with tubes in every orifice. The family was furious. I was furious. It all happened because the beleaguered 2 AM nurse in the nursing home when confronted with the reality of the agonal moment panicked and called 911, which precipitated the sirened trip to the hospital and what Dan Callahan termed "a wild death". The nursing home's paranoia was generated by their fear of punitive action by the state for neglect, despite all elaborate instructions to the contrary. This sequence was too common.

I was so involved in this issue that I testified to the legislature in Sacramento about my perception. We all recognize that bureaucracy has its limits, and some of the lower echelons of the attendant group are grievously ill equipped.

To me this was an example of what is commonly termed "structural lag", that period in which prior habit is no longer consonant with the reality of today. With much personal gratification I identify that this issue has matured. Our lag has largely disappeared. We as a species are slowly learning how to die with dignity and rationality. Renée Dubos's term of "medicated survival" is consigned to past history.

Learning how to die is a precious errand. I fervently hope that our governor is up to speed and signs the bill.