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End-of-life choices

By Patricia Clarke

His name is Legion. Or John. He is 85. His wife is dead; so are most of his friends. He doesn’t see very well so he can’t read. He used to argue politics but he can no longer speak coherently and anyway there’s no one to listen. He’s had heart attacks and he’s had cancer but thanks to the ministrations of seven doctors and their eight different daily medications, he lives on. As far as I know, no one has asked him whether he wants to.

Her name is Legion, too. Or Mary. At 72, physically healthy, she is locked in an institution. All day she babbles incomprehensibly. Sometimes she gets angry and throws things. She spits and scratches at the attendants, so they tie her hands to her chair. She would be better off, her husband admits, if she could die. But she can’t.

Then there’s Tom. He’s alive, if you can call it that, only because machines keep his lungs breathing and his heart pumping. The doctors say it’s hopeless. His family insists: somehow, someone, somewhere can save Dad.

You probably know people like this. I do. As the baby boomers reach their 80s, their numbers will double, some with dementia, others with ailments that once took our lives, but with modern medicine we live on. And that’s a good thing. Isn’t it?

The mythical Tithonus didn’t think so. The gods gave him eternal life but inadvertently also eternal old age. In Tennyson’s poem, he begs the gods to take back their gift: “happy men that have the power to die.”

Rev. Don Matheson often meets Tithonus in his work with long-term care patients at a Toronto seniors’ home. “So many say to me, ‘I wish I could just die.’” To have that power when life becomes a burden is not possible now. Whether it should be possible is an issue, Matheson thinks, that will soon be as contentious as abortion.

Medical technology has outrun our ethics. When is enough, enough? What kind of care can we provide when there are twice as many Marys with dementia? If medical treatment has to be rationed, can I buy my way to the head of the line so my husband can live another month, while my neighbour’s husband dies on the waiting list? Are we willing to pay enough taxes to provide immediate, unlimited medical service to everyone no matter the cost? If not, where do we draw the line, and who draws it?

These are public policy decisions, but policy-makers need guidance. We need to talk to them now about the value of life and the meaning of death. Is life, prolonged at any cost, the ultimate value?

Two generations ago, when most people died at home, death was no stranger and sometimes a welcome friend. Now death comes, mostly, to hospitals and nursing homes, out of sight, out of mind. Maybe that makes it harder to accept it as a natural, inevitable part of life. As Rev. Rob Fennell of the Atlantic School of Theology says, ours has become a death-defying, death-denying culture.

And yet, Fennell reminds us, “Death isn’t the end of the story.” We don’t know what is, but as a wise Maritime minister, Rev. Flemming Holm, said on his deathbed, “Let God surprise me.”

Patricia Clarke is a writer and editor in Toronto.

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