At the age of ninety-three and a half, my mother went for 30-minute walks. Then she took a turn for the worse. We went to the doctor. “Doctor,” she said, “I would like to die. Can you help me?” “No,” said the doctor, “and don’t ask me again.” After that, she frequently asked family members to help her die. She suggested going to Switzerland.1 We were concerned, but no one did anything.
She walked more slowly, then she needed a walker, then a wheelchair. She was often sleepy. She got a lung infection and was sent to the hospital. She refused to be admitted, went home with enough analgesic to keep her dopey and, three days later, died. The decline took seven months.
We die differently now, and we haven’t recognized it.
In How We Die: Reflections on Life’s Final Chapter,2 Sherwin B. Nuland describes the autopsies of people who died at 85 and older. Their death certificates had reported cause of death as heart attack, stroke, cancer or infection – those were the big ones – but in every case the autopsy found that they were dying of other things at the same time. Their entire system was collapsing. In other words, they were at the end of their life span.
A Galapagos land tortoise lives to 190. A very healthy grey squirrel barely makes it to 20. Those are life spans. The human life span is about 90, and that hasn’t changed for thousands of years. What has changed, for humans, is life expectancy. In 1900, Canadians could expect to live to 50. Now we can expect to live into our eighties.
This is a key point: in the rich countries today – as a result of sanitation, vaccination, diet and antibiotics – human life expectancy is very close to the human life span.
In 1900, your typical person got sick – at 7 or 37 or 67 – and died at home a few days later. Today, most of us die in a hospital. And we don’t get sick – we just get old. Pneumonia used to be called the “friend of the aged”; now it’s easily cured, so we linger. Our increased longevity has demographic implications: the longer people live, the higher the percentage of old people. People blame it on the baby boom, but if those post–World War II babies died at 50, there would be no boom in old people now.
So given the unprecedented millions of us who will be lingering for months or years, the current interest in euthanasia or assisted suicide is not surprising. Current polls show that 84 per cent of Canadians support assisted dying.3
My mother was no social pioneer, but on this she was ahead of her time. Twenty years ago, at the age of 75, her major activities included going to funerals and visiting hospitals and “long-term care facilities.” She’d say, “I believe in euthanasia. When someone is miserable and they make everyone else miserable, they should be killed. When I get old, you won’t have to beg me.” She was right. She had to beg us.
The irony is that virtually none of the current discussion is about the aged. The most discussed cases involve youngish people suffering from great pain and a terminal disease:
- Sue Rodriguez was 43 when Canada’s Supreme Court decided against her in 1992. She had ALS.
- Susan Griffiths suffered from multiple system atrophy, a rare degenerative neurological disease. She was 72 when she “went to Switzerland” in 2013.
- Donald Low was 68 when he made his famous video. He died of a brain tumour in early 2013.
- Gloria Taylor and Kay Carter are the women whose cases were recently decided, posthumously, by the Supreme Court. Taylor was 61 when diagnosed with ALS. Carter was the exception: she was 89 years old. Confined to a wheelchair as a result of a degenerative disease, she went to Switzerland in 2010.
Quebec’s legislation and the recent Supreme Court decision were guided by legislation and experience in Belgium, the Netherlands and the U.S. states of Oregon and Washington. The focus of all of these is on people, like those above, who are in great pain and dying of a terminal illness.
The Supreme Court ruled that the Criminal Code’s prohibitions on assisted suicide no longer apply “to the extent that they prohibit physician-assisted death for a competent adult person who … has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”4
Québécois aspirants for assisted death “must suffer from an incurable serious illness” and “suffer from constant and unbearable physical or psychological pain.”5
Quebec’s legislation and the Supreme Court’s decision are humane and important steps, but they would likely have been of no use to my mother and won’t much help the vast majority of people who in the years to come will suffer lingering deterioration. When we talk about assisted dying, we need to distinguish between the young and the old, between early death from disease and the death that comes at the end of a proper lifespan.
According to Laura Fraser in a Halifax Chronicle Herald special report, “Academics point to the same European countries as role models for other regions, with Denmark, Sweden and the Netherlands regularly topping their lists as the best places in the world to grow old.”6 Fraser conveniently points out, “Their citizens are the highest-taxed in the European Union.”
In Canada, here is what old people can look forward to: If we have money and a caring family, we will spend our final years at home or in a seniors’ residence with the best care love or money can provide. If we’re poor, we will go into a nursing home (a “long-term-care facility”) and lie in bed until we succumb.
Perhaps that’s an exaggeration. Quality varies. According to a Canadian Institute for Health Information study, “The average nursing home resident in Canada is age 85 or older and faces many challenges, including multiple chronic diseases and problems with mobility, memory and incontinence. Some are completely dependent on nursing home staff for the most basic activities of daily living, such as toileting and eating.”7 Further, according to the same study,
- “The percentage of residents on antipsychotic medications without a related diagnosis ranged from 18% to 50%” (i.e., people were given antipsychotic drugs even when not psychotic);
- 60% suffer from dementia, including Alzheimer’s disease;
- “residents with worsening symptoms of depression ranged from 3% to 40%.”
I’m 64 years old. This is what I would like for my last years. I’d like Canadians to willingly pay high enough taxes so everyone can be humanely cared for as they grow up and as they grow old.
I would also like – let’s deal with the tough one first. Dementia, particularly Alzheimer’s, can wipe out the higher functions of the brain (memory, cognition, emotion, language) but leave the body intact for years. I would like to be able to sign a document today that stipulates that when, for a period of 30 days, I cannot recognize my grandchildren or remember their names, I will be put to death. No country will allow me to sign a request today, when I am (arguably) of sound mind, for euthanasia to be carried out at a later date when I am not.
I hope I have 100 good years. But I’d also like to know that, if I remain of sound mind, I can get help dying, even if I don’t have an incurable disease and am not in unbearable pain. I don’t want to be put in the position of having to kill myself while I am still capable of doing so, but before I want to. Maybe 80 or 85 should be the minimum age. But if I want to die because I’m bedridden and uncomfortable, or don’t want to deplete my children’s inheritance and/or use up large amounts of government funds for little return, that should be sufficient reason.
Finally, I’d like a going-away party. I’ve been to a few wakes recently, and they tend to be fun. I’d like to attend mine. I will lie in bed and people will make funny, affectionate speeches about me. Then someone will fetch barbiturates or hook me up to a canister of helium. I’d rather they didn’t go to jail for doing so.
1 Switzerland is the only country that allows foreigners to travel there for the purpose of ending their own lives. Other than that, Swiss assisted suicide is rarely discussed. According to a Canadian Press summary of right-to-die legislation around the world, in Switzerland “a law passed in 1942 forbade anyone from helping someone kill themselves for selfish reasons. As a result, people arguing that they are assisting with a suicide for unselfish motives are not considered to be committing a crime. Suicides can be assisted by people other than doctors and no medical condition needs to be established” (Winnipeg Free Press, February 6, 2015, retrieved here.
2 New York: Alfred A. Knopf, 1994.
3 Dying with Dignity Canada and Ipsos Reid, Dying with Dignity Public Perception Survey, retrieved here.
4 Sean Fine, “Supreme Court Rules Canadians Have Right to Doctor-Assisted Suicide,” Toronto Globe and Mail, February 6, 2015, retrieved here.
5 Quebec, An Act Respecting End-of-Life Care, Inroads, Summer/Fall 2014, p. 59.
6 Laura Fraser, “A Better Way to Care for the Aging,” Halifax Chronicle Herald, retrieved here.
7 Canadian Institute for Health Information, When a Nursing Home is Home: How Do Canadian Nursing Homes Measure Up on Quality? (Ottawa: Author, 2013), retrieved here.