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One Fatal Rx, Room for Cream?

Why, In Option-Obsessed Nation, Do We Still Have So Few End-Of-Life Choices?


Once upon a time, ordering a cup of joe was a binary decision: Coffee? Or no coffee today? But stand in a Starbucks line today, and it’s clear we’re a nation obsessed with options — from a Grande in a Venti cup with three and a half scoops of nonfat foam to “two inches of room for cream” at exactly 140 degrees. With extra caramel drizzle.

Starshine Roshell

Dripping with cable channels, drowning in apps, we demand choices at every turn and uphold choosiness as a virtue. Ordering coffee now is a public demonstration of meticulous preference — a declaration of druthers, painstakingly hewn. We will have it our way, damn it, or we won’t bother having it at all.

So tell me, then: Why are most of us still dying in the exact way we all dread — in pain, in fear, in open-backed hospital gowns, in metal-sided beds, under fluorescent lights, with tubes protruding from us and machines beeping and ghastly nurses’ shoes squeaking from bustling nearby hallways as a teddy-bear-festooned Get Well! bouquet wilts on a rolling cart beside us? This, my friends, is not the end of a life well chosen.

There are now five states that offer another option for those dying of terminal illness. California recently joined Oregon, Washington, Montana, and Vermont in legalizing “death with dignity” or “physician-aided dying.” (Advocates abhor the terms “assisted suicide” or “euthanasia.”) A 41-year-old Ojai woman with debilitating ALS recently took advantage of the law by inviting her friends and family to a right-to-die party. According to the Associated Press, it was two days of no-tears-allowed celebrating, ending with her swallowing a lethal Rx of morphine, pentobarbital, and chloral hydrate in a canopied hillside bed at sunset. It’s the finale she chose when she had so few choices left.

And earlier this month, according to the Sacramento Bee, a 94-year-old Bay Area man — a former U.S. Marine with heart disease and colon cancer — knocked back a fatal dose of doctor-prescribed barbiturates with a whiskey martini, fell asleep at home, and died peacefully. The way he wanted.

This year, 20 more states are considering right-to-die laws, but it’s a tough sell. Should we be toying with such a profound — and profoundly irreversible — natural phenomenon? Is death supposed to be painless and (it feels rude to even type it) comfortable?? But I can think of no reason why it shouldn’t be. We spend billions testing and producing safety devices like air bags to prevent anyone from having to endure lives of pain and suffering; it’s outrageous we’ve invested so little to prevent deaths of pain and suffering.

Still, there are ethical concerns. Critics worry that disabled and elderly people could feel pressured to exercise their right to die — seeing it more as a duty to die — in order to spare family members the burden of caring for them. Or even that the medical community might one day begin pressuring economically disadvantaged populations to take advantage of the option.

And there are haunting anecdotes about patients who were diagnosed terminal but who chose to fight it and miraculously lived … but there are exponentially more stories about the loved ones we’ve all watched die in extended bouts of pain, and terror, as we stood by, unable to help at all.

Maybe the moment of death isn’t more significant than any other moment in life; in fact, maybe it’s less so, since we don’t get the opportunity to reflect on it, to savor its memory, make meaning of it and weave it into our story.

What matters, then, is probably not how we die but how we anticipate dying. A full third of the people who request and fill these life-ending prescriptions never use them — but their families say it meant all the difference to them to know they had that choice.

No one’s asking for an array of options: no custom order, no room for cream. But we should have a say-so in the ultimate binary decision: Suffer? Or no more suffering today?

Starshine Roshell is the author of Broad Assumptions.



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