The Dignity of Final Choice

The medical model for dealing with death is expensive, degrading, and unnatural.  In the matter of leaving this life how did nature provide?

Edvard Munch,  Death


Notwithstanding the serenity of deathbed scenes in the movies, the actual process of dying is not pleasant.  In addition to the intrinsic horror of it, compounded by our cultural fear of death, the modern Hippocratic inclination to preserve life by any technological means all too often results in a gruesome attack upon the dignity of the dying and the sensibilities of their loved ones.

I once had a beautiful Irish Setter.  She had the delicate grace of a doe, and I loved her beyond all reason.  In our many expeditions into the wilds of the California Coast, she taught me how to fulfill my longing to return to nature.  As she grew old, tumors appeared on her body, and the muscles in her hind legs became so weak she could not get up after she relieved herself.  This was a devastating spectacle, but when I was told I should “put her to sleep”, I could not bring myself to take responsibility for extinguishing her bright spirit.  The very next day she disappeared.  Shortly thereafter, we found her body in a small clearing in the brush.  It became clear that she had taken herself into seclusion, deprived herself of any food or drink and died in her own peace.  I then discovered that animals are inclined to do this naturally.  This innate gesture of dignity, a form of nature’s grace, was her last teaching to me.

When the dying process reaches a certain critical point, appetite and thirst cease.  The organism itself is choosing to die. The desire to stop eating and drinking becomes a drive in its own right.  This radically hastens death.  I am told that ending life in this way is painless and appropriate, as it facilitates the body in shutting down all its functions.   Choosing to die by this natural means is the final dignity.  It is appropriate suicide.

I began to notice how people in our culture die.  What I discovered was that technology can prolong the process almost indefinitely and that this sometimes leads to situations verging on the gruesome.  There is no choice in the matter.  In an effort to restore choice, we have begun to write Living Wills, to assure that at the crucial time, our life will not be technologically prolonged. Nevertheless, grisly last ditch efforts, such as tracheotomies and feeding tubes, are common practice.  The emotional cost for the dying and their loved ones is enormous.  People are kept alive, though they are not really living.  Even when Living Wills have been in place, the tendency at the end to force feed water and nutrition, by the staff or by family who cling to the life of the beloved, supercedes this subtle but definitive message on the part of the dying.  In the case of both my parents, there was a moment when each indicated that they wanted to stop.  In each case it was contravened.

As in so many ways, the innate wisdom of nature is trumped by the intervention of technology compounding the fear of death and loss.  This display of technical virtuosity is not only blind and cruel, it is also expensive.  The medical cost of keeping people alive after the time when they would naturally die is staggering into the billions and mounts sharply every year.

Death in our culture is very complicated.  The dying process is extreme and emotionally fraught.  After all, for the living, death is the worst possibility. There are many angles. Sometimes medical people are in a hurry to remove technology from a patient’s support because the death process is in place and they have no patience for it. Or, if patients refuse food and drink, are they really dying or just wishing they could?  Very often the forced feeding is decided by the family, who cannot countenance allowing their loved one to starve to death.

Therefore, what I am proposing is a change in our collective understanding and customs around dying — that, by common agreement and official custom, we restore this natural practice of choosing to stop eating or drinking as the signal that a person wishes to end life.  At this point, all heroic efforts should cease.  This practice should be broadcast as the legitimate and responsible right of each individual to complete their process of dying.  Until we are educated to accept it as custom, it should be a proviso in any formal Living Will.

I am told that this insight has been integrated into the practice and procedure of Hospice, which more and more handles the process of dying in the United States.  But the option needs to come further into the public awareness. You yourself can begin by becoming aware of it, observing it in nature, and committing to making this choice when it occurs naturally to you.  Let it be understood, by agreement with loved ones and stated in your Living Will, that when you stop wanting to eat or drink, you do not want to be forced to receive nutrition.

Ultimately, this gesture on the part of the dying should be honored as the universal sign — the choice of the dying — to cease all efforts to extend life artificially.  This means that the practice must be elevated to the status of a custom and that each individual understand that this final act is a natural and inalienable right to choose the end of life.

Ceasing to take sustenance is nature’s own way of combining the freedom of choice with the legitimate ending of life.