Jeri Elliott has her life—and her death—well under control. A social work professor at Toronto’s Ryerson Polytechnical Institute, she unabashedly enjoys the good life—a fulfilling career, financial security and a childless and happy marriage with Tom, a guidance counsellor. Self-assured and still in her mid-40s, she has every reason to appreciate today and be optimistic about the future. But, after several years as a medical social worker at Mount Sinai Hospital in Toronto, she is no stranger to illness and death. That experience, along with the recent death of her father, has prompted her to consider very deeply the terms of her own unavoidable death—and declare them unacceptable. “I can’t bear the thought of terrible pain,” she says, echoing a fear of millions of Canadians, “and I won’t be dependent on others for things in death that I’ve taken for granted in life. If I’m faced with a prolonged terminal illness, I’ll commit suicide with carbon monoxide.”
While shocking and unacceptable to most of her acquaintances, including her husband, Elliott’s attitude is shared by a growing number of people. Called “rational suicide,” this radical response to terminal illness has made recent headlines in Britain and North America. Early this summer, Lady June Spencer Churchill, widowed daughterin-law of Sir Winston, killed herself by heroin overdose. The coroner explained that she was suffering great pain from bone cancer and was afraid of becoming dependent on others. About a month earlier, a small storm followed the U.S. television broadcast of videotaped events leading up to the carefully orchestrated suicide of New York artist Jo Roman. In their deaths both women, the one quiet the other flamboyant, made a deliberate statement about the way we die, fuelling a moral debate that has all the loaded language and polarized emotional positions associated with the abortion issue. One side argues from the Judeo-Christian tradition that holds all life sacred, a gift from God that cannot be returned when no longer useful. The other side is perhaps best expressed by the title of the Broadway play Whose Life is it, Anyway? As the debate gathers force, the abortion bat-
tle cry of “It’s my body” is giving way to cries of “It’s my life.”
Nowhere has the issue surfaced more dramatically than in Britain, where EXIT—The Society for the Right to Die with Dignity attempted in July to publish a 30-page suicide manual called A Guide to Self Deliverance. Its purpose was to provide information to members on pain-free and fail-safe alternatives to messy old favorites like wrist-slashing. Outraged protests and
threats of litigation prevented publication (as in Canada, suicide is now legal in England but counselling or aiding in a suicide is punishable by up to 14 years in prison), but not before Sheila Aitkenhead, a 38-year-old mother of four dying of cancer, went on television to plead for publication. “What I’m proposing isn’t illegal,” she said. “I intend to take my own life but I can’t get any help to do it.”
As EXIT stopped publication, the U.S.-
based Hemlock Society took up Aitkenhead’s cause, saying it would publish its own manual and, last month, the Edinburgh branch of EXIT announced its intention to publish the original English guide, since aiding and counselling suicide are not crimes in Scotland. Meanwhile, the U.S. Society for the Right to Die refused to distribute the manual or to take a position on rational suicide. “We are not a suicide advocacy group,” said Executive Director Alice Mehling. Her concern, and the concern of much of the British and Canadian euthanasia movement, remains focused on ensuring against forced artificial prolongation of life.
It was precisely the argument against prolongation of life that was used by Jo Roman in her videotaped documentary. Jeri Elliott, who watched it with her husband, found it “moving and sensitive” while Tom (who leaves the room
when his wife discusses the subject) found it “manipulative and self-indulgent.” His aversion was shared by many viewers and mental and health care professionals, including nurse-sociologist Mary Vachonof Toronto’sClarkelnstitute of Psychiatry. “She wasn’t accepting death. She was attempting to snatch immortality by dramatizing her death and calling it ‘art.’ My 10-yearold watched the film and he could see the manipulation, the pain to family
and friends who didn’t want her to do it.” Admittedly, Roman’s public gesture was extraordinary, but thousands of ordinary people have written to EXIT in the past few months requesting the suicide guide and EXIT membership has risen from a few hundred to nearly 10,000. Experts agree that few of the new members are dying. What they want, like Elliott and Aitkenhead, is a hedge against the future.
Pain is the major terror. With medical triumphs over infectious diseases such as typhoid and pneumonia, the big killers are the degenerative diseases. People know that a diagnosis of cardiovascular problems or cancer can mean a slow, painful and expensive death. But while this is the reality, it needn’t be, according to Dr. John Scott, director of St. Michael’s Hospital palliative care service in Toronto. He says that many physicians are both unaware of the advanced pain technology now available
and unskilled in its use. “It’s not that they don’t care, they just don’t understand the needs of the terminally ill.” Scott, a specialist in pain control, insists that no one today need suffer uncontrollable pain. “We can’t control the confusion, the weakness, but we can insure a pain-free and lucid illness with the patient in control.”
Control is exactly what rational suicide advocates want. John Thomas, a philosophy professor at Hamilton’s McMaster University and author of two books on biomedical ethics, emphasizes the patient’s right “to choose his time of death.” He argues that rational suicide should be an option for those who “not in the throes of depression, but in full cognitive control, feel they can no longer cope and want to end their own lives.” He does not see rational suicide as the answer to the needs of the terminally ill but he does add a warning: “With the loss of meaning in our so-
ciety, mass suicide may not be too far removed. We need ideas that will give our lives and our deaths some meaning and dignity.”
“Meaning and dignity” are more than catchwords to thousands of senior citizens. Suicide, rational or irrational, sanctioned or unsanctioned, is on the rise among the elderly and it is loneliness, along with pain, that is the major problem. The Ontario Senior Citizens Advisory Council, headed by Kingston geriatrician Dr. George Merry, is preparing a layman’s guide to the process of dying and is backing legislation that will prevent artificial prolongation of life. If passed, the legislation would do away with the need for “living wills” like the one tacked up in Jeri Elliott’s kitchen advising physicians to take no heroic measures to prolong her life if she is unable to direct the doctor herself. Although such documents are not recognized legally, many Canadians
have signed them and advised relatives and friends to follow their directions. Most physicians believe such documents are unnecessary and continue to regard suicide as a response to depression.
Regardless of motivation, a person who decides on suicide faces legal complications that can turn last plans into last problems. A Toronto businessman with advanced terminal cancer recently “died in his sleep” after meticulously planning his suicide with the help of his wife, who supported his decision and wanted to be with him when he died. The couple agonized over the difficulties for weeks until the wife simply announced that if “discovered” she would take the consequences. Such fears are not without foundation. After EXIT announced its plans, Scotland Yard launched an investigation into 200 “nat-
ural” deaths to see if suicide and relatives were responsible. In Toronto recently, a Chinese student was convicted and given a short sentence for assisting his father to commit suicide and then, because an inheritance was involved, camouflaging the death to appear as a murder. While the case was highly unusual, the student’s plight highlighted the difficulties faced by many Canadians from countries such as China and Japan where suicide is considered a correct and honorable response to many situations.
The Canadian medical establishment remains unalterably opposed to relaxation of the laws against aiding suicide. Geriatrician Dr. Rory Fisher, head of the extended care unit at Toronto’s Sunnybrook Medical Centre, sees relaxation as a “Nazi-like” opening of the door to the killing of the old, the infirm and anyone else who doesn’t suit society’s needs. For doctors like Fisher, the answer to rational suicide is to make improved care for the aged and the terminally ill available everywhere, not just on the random basis that now exists. Dr. Balfour Mount, chief of Montreal’s Royal VictoriaHospital palliative care unit, points out that the goals of the medical system —“diagnosis, investigation, prolongation and cure”—are “meaningless” to the terminally ill. But they reflect society’s general rejection of death. “We must accept the fact that we’re not infinite.”
Mount’s pleas for a societal effort for decent death equivalent to the effort against poverty and racism fab on too few ears. The dying need personal attention, not technology, not miracles. At the 700-bed St. Michael’s Hospital in Toronto, just two full-time staff members—Dr. John Scott and nurse Joan Foy—specialize in the care and counselling of all of the terminally ill and their families. Needless to say, not everyone can benefit from their special kind of care. Sometimes workers in their position have little choice but to stand by and wring their hands. If the rational suicide
If nothing else, the rational suicide advocates will release those wringing hands. By forcing fears of pain, loneliness and dependency to surface, they have become the unwitting allies of health care professionals who see rational suicide as a moral and social evil. The medical system has failed, yes, but perhaps the real failure is more deeply rooted in a society that is narcissistic and death-denying, one which ghettoizes the old and hides the dying. Until Canadians take Mount’s crusade seriously, Jeri Elliott and a lot of other ordinary people will continue to favor rational suicide. No amount of care and caring will ever prevent death, but it can go a long way toward easing the inevitable process.
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