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Death vs. Life: One Size Does Not Fit All

Somewhat recently a cardiac arrest survivor I helped to resuscitate was diagnosed with a terminal disease. This brought about the question, is it better to go quickly, not knowing the end is near, or is it better to have extra time on this earth, but know that you and your family may have to endure an end full of potential suffering?
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I am a strong proponent of allowing people to die with dignity when their time comes, or when they so choose. This seems in stark contrast to my life's profession as a resuscitation science researcher and clinician. My area of interest and professional background focuses on cardiac arrest (when your heart stops beating and you are clinically dead), and bringing people back from death; think Lazarus but on a less biblical scale. But having been a critical care nurse for many years, I am also a fierce proponent of allowing people to "die with dignity" and on their own terms. The suffering that can occur for patients and families during those last days, weeks, and months of an illness, to me, can be paramount to cruel and unusual punishment.

In the U.S. over 2,500,000 people die annually, that is more than 7,000 people a day. Yet we, the general public, seem to have a visceral aversion to even the mere thought of death, and will do whatever we can to prevent the inevitable. But as the wise Benjamin Franklin said "In this world nothing can be said to be certain, except death and taxes." Unfortunately my friends, the end is neigh for all of us.

I have some personal experience with the visceral aversion to death. My family on my mother's side are Italian, and not just American-Italian, but "fresh off the boat," straight out of the movies Italian. At funerals, whenever anyone died, it was a like a scene from The Sopranos, but without the police showing up to arrest someone. As a child, watching these scenes unfold, well lets just say I was scarred for life. I vowed to never be the Italian throwing themselves onto the coffin. This is not to take away anything from those who feel this is an acceptable way to grieve the loss of a loved one, but it is definitely not for me. My mother and aunt on the other hand can't even talk about death. The moment you bring it up, it doesn't matter whose impending doom you are speaking of, they spontaneously break into tears and chants of "God forbid," as if that will stop death in its tracks. So, the fact that my professional life centers mainly around death is ironic -- and also makes for an awkward site if I am out with my mother or aunt and talking about work.

Somewhat recently a cardiac arrest survivor I helped to resuscitate was diagnosed with a terminal disease. This brought about the question, is it better to go quickly, not knowing the end is near, or is it better to have extra time on this earth, but know that you and your family may have to endure an end full of potential suffering?

Death is a finite thing, and as such people will do almost anything to keep their loved-ones from it, no matter the cost. I have watched many a family do "whatever it takes" to keep their husband, wife, daughter, son etc. alive, even if it was not what their loved one would have wanted. That is the part so many of my clinician colleagues struggle with the most in these situations -- being the patient's advocate versus adhering to the wishes of the family. On the flip side however -- and there is always a flip side -- is the idea of assisted death, allowing people with terminal illness to make their own decisions about when they will die, before they no longer are able to do so.

The idea of self-harm for the purpose of ending suffering seems like something a competent person would consider. Therefore, the argument that someone is incompetent if they choose to end their own life due to suffering, seems misguided. Those opposed would have us believe that "assisted suicide" is wrong, but I believe the term is wrong. People who are suffering from terminal illness do not want to die, but they are dying. As the 29-year-old, terminally-ill, brain cancer patient Brittany Maynard stated, "I do not want to die, but I am dying. And I want to die on my own terms."

Yet in this country dying on ones own terms is difficult, as death with dignity, or assisted dying, is illegal in most states. The Death with Dignity Act or similar legislation has been passed in only six states: Oregon, Vermont, Washington, Montana, New Mexico, and New Jersey. For those who think this type of legislation will open the flood gates and everyone will be offing themselves, a study published recently examining the Death with Dignity programs in Washington and Oregon found that 40 out of 114 people who inquired, actually used prescribed drugs to hasten their death and die with dignity. Additionally, when looking at the number of people who chose death with dignity since those two states began their programs, just over 1200 people chose death with dignity out of 1700 who obtained a prescription.

Choosing to end ones life due to terminal illness can't be an easy decision to make, and it is only made harder by imposing legal ramifications on healthcare providers or uprooting terminally ill patients to one of a handful of states that allow it, where they most likely will not have the people around them that they need the most during their last days.

Before I continue, I implore everyone reading this to not only discuss your end of life wishes with your family, before there are any medical illnesses or injuries that would prevent these conversations, but to also clearly write down your wishes and have an advanced directive. Let your family and healthcare providers know what your end of life wishes are and if you want to be resuscitated, including cardiopulmonary resuscitation (CPR) if your heart should stop beating. Appoint someone you trust as your power of attorney to speak on your behalf when you can not. Someone who will be calm and reasonable during these most difficult times, and either encourage you to "go toward the light," (because as we know, from the movies, "there is peace and serenity in the light") or advocate on your behalf to continue doing "whatever it takes." Mother, just FYI, you will not be my medical proxy. But please cry and chant away!

Public opinion around this issue is hopefully changing, as the population ages and we live longer, more and more people will be exposed to these choices of life versus death and how we want our loved ones, and ourselves, to die. As a resuscitation and critical care clinician I will continue to save lives from sudden, unexpected, and premature death, but I will also continue to support the rights of terminally ill and suffering patients to die with dignity. Because, as the former American Civil Liberties Union (ACLU) president Nadine Strossen argued when asked about suicide, "The idea of government making determinations about how you end your life, forcing you...could be considered cruel and unusual punishment in certain circumstances...."

You decide!