Euthanasia
Euthanasia comes from the Greek eu meaning well or good and thanatos meaning death – a good death. An animal may be euthanized in any state in the country, but for persons in extremis, a self-chosen end of pain and of life is permitted in only ten states and the District of Columbia. Granted, one may argue that there is a fine line between assisted suicide and homicide, thus four-fifths of the states have maintained its illegality.
Colorado is one of the permitting ten. In 2016, Colorado voters approved the “Access to Medical Aid in Dying” proposition, which allows a terminally ill individual with a prognosis of six months or less to live to request and self-administer medical aid-in-dying medication in order to voluntarily end his or her life. It authorizes a physician to prescribe medical aid-in-dying medication to that terminally ill individual, and creates criminal penalties for tampering with a person's request for medical aid-in-dying medication or for knowingly coercing a person with a terminal illness to request the medication.
I
I have been present at two euthanasia events. The first involved a member of Temple in his early 50s who had suffered from Amyotrophic Lateral Sclerosis (ALS), and after several years had lost control over all but his mind, hearing, vision, and an ability to blink. He was hooked up to oxygen through a tracheotomy, he had a feeding tube, a colostomy bag, he had nothing left of his dignity, his personality, nor his will to be. For him life had lost its meaning in the present and he had no expectation of regeneration in the future. He wanted out now.
Using his only means of communication, he blinked his desire to his wife and physician that they help relieve him of the burden of being. He requested that only the two of them and me, his Rabbi, be present. He had one last request – that it take place on the night of his daughter’s senior prom. He wanted to see her come down the stairs in her prom dress and to watch her date come in to pick her up for the dance.
I got to the house about an hour earlier to speak with his dear wife who had been such a rock of support through his transition from hope to despair, from activity to immobility, from independence to tubing tethers. I spent some time with him, asking several times if this is what he wanted now. He blinked ‘yes’ with as much determination as he could evince each time. I read the Vidui – the confession said before death, asking forgiveness on his behalf from any whom he might have offended and that his life be a healing memory and a source of comfort for all who have known and loved him. I recited the Shema for him as he blinked in affirmation.
The doctor arrived a few minutes before the appointed time. The three of us spoke together and then he went in to see his patient. The doorbell rang. A nice looking teen dressed in a black tuxedo and carrying a small box containing a white and purple orchid entered the living room. We all greeted one another. He was here to collect his date for the prom. He was led into the kitchen. His date had another date first, a last date with her father. From his bed in the den, he saw the young man enter. From there he had a clear view of the staircase, and as his beautiful teenage daughter descended slowly, his eyes fairly shone with love and joy. She entered his room and smiled — the smile of one greeting a dearly beloved whose train is about to leave the station. She sat beside his bed with a handwritten page and began to read. I left the room. She was with him for many minutes. She had much to tell her Dad, all of which led to the question that just then occurred to me, whose voice would you or I want to hear in our last moments?
Now sporting the orchid on her wrist, the young couple said their good-byes and left. His daughter knew what was imminent; her date had no inkling. We gathered at his bedside. His wife whispered an affectionate good-bye, and then kissed him tenderly on the forehead. The doctor asked if he was ready. He blinked ‘yes.’ He asked again. ‘Yes.’ A tranquilizing shot was administered. He fell into a deep sleep. The doctor looked at the wife. She sighed, nodded, and closed her eyes in resignation. He turned off the oxygen. A few moments later, the doctor listened for a heart beat … and shook his head.
Baruch Dayan HaEmet.
[Blessed be the True Judge, the words traditionally spoken by family or dear ones upon first hearing of or seeing a death.]
II
She also was a valued friend and Temple member. She founded our preschool and directed it for many years. A Sisterhood leader. A Board member. She was a constant participant for years in our four decade long trek through Torah one or two verses each week, translating the Hebrew, reading the commentaries, searching for ancient meaning and current ramifications, looking at the remez – the connections of this verse to others that came before it, and perhaps digging a bit deeper even to find the spiritual implications in a session’s verses. She looked in particular for the moral implications of a verse, the how to live a better life and how to live life as a better person. She was a role model of good and virtue to so very many.
She had told me a year earlier about the fatal diagnosis, lung cancer, too far advanced for surgery, not much hope for a cure. For the time being, there were a few drugs to stem the pain and keep air passages open. Palliative treatments, of course, leading to stronger drugs ... until the medicines would become ineffective. Her husband had passed away a few years earlier of the same condition. She did not want to go through what he had endured. She did not want to be in a drug induced coma. She did not want to be on a ventilator. She was an independent person, self-aware and self-directed, a woman of spirit and vitality. That was the only way she would live.
As she knew it would, the disease progressed. The drugs keeping her somewhat comfortable enough to make it through the day were increasing in size and frequency. During one of our conversations, she told me that her greatest fear was that her lungs would become filled with fluids and that she would strangle. “That could happen soon, my dear Rabbi, and I can’t let that happen. I have always been afraid of drowning, and so ... I have invited Hospice nurses to take over my daily care and ultimately to do what they can help me do ... ultimately.”
Hospice usually enters a case when they think a person has less than six months to live. I was surprised. She was still actively involved in our Torah study sessions. She was walking, even entertaining friends, engaged energetically in discussions. Too vital for a six month diagnosis? And, yet, about three months later, she called to invite me to her home in three weeks for her “final evening.”
I chewed on that a lot over the following days. Rikki and I talked about what it must be like to plan a final evening, to know for certain what the rabbis in Mishnah said we cannot know.* Mishnah does not say that we must not know, that it’s forbidden to know, only that under most circumstances we will not know. But for one in constant pain, whose death because of illness is immanent, that wait may involve too much suffering. It may be just be a road too far and too painful to travel.
[* (Pirkei Avot 2:13) Rabbi Eliezer said, “Repent one day before your death.” But since we cannot know the day of our death, it is incumbent upon us to repent every day.]
I went to the house at 6:30 on that final evening. Her children, their spouses, and her grandchildren were all there. They had just finished supper together and were clearing the table. She had left the table a few minutes before I entered. I greeted all of the family members. They told me that she wanted to see me. We spoke for 30 or so minutes – holding hands, lots of reminiscing about Temple, about our family times together, about what had been. Finality makes no plans for the future. We recited the Vidui together and said the Shema. I kissed her hand. She laughed. “All these years, my dear rabbi and friend, and I get a kiss on the hand?” I leaned over and kissed her forehead. “That’s more like it.”
Once I left her room, the grandchildren entered one at a time, youngest to the oldest. Each sat next to her on the large bed. She hugged each and talked to them about ... them, what they could become and what she wished for them. It was her version of an Ethical Will, a custom she had learned from her father. Fifteen minutes for each or twenty. And then the sons-in-law went in one at a time, and then her children – three daughters, went in together. They had been with Mom all that day and every day that week.
It was 9:00pm. She made a phone call to a cousin who could not travel, then to an in-law to say good-bye. She had originally planned to finish the evening at nine, but seeing as how the little talks had taken a bit longer, she moved the time up to ten.
The Hospice nurse was with alone with her for a few moments and then asked everyone to come back into the large bedroom. The grandchildren had all been taken home by now. They didn’t need to be here. She was sitting up. Her daughters were sitting on the bed with her. They started singing songs that she used to sing to them as infants. They were all laughing. A few funny comments. It was a party mood. Unexpected, but in a way quite lovely. The songs were a paean of praise to a mother who had been their heroine, their firm rock, their model of parenthood. Death as release, as relief, as a welcome to the alternative, need not be somber. This last hour was certainly not.
The daughters led a few reminiscences – this trip, that experience, this one’s wedding, the day that grandchild was born, when you and Dad went here or there, and with each she filled in the missing parts. She had not coughed all evening, but a slight wheeze followed by a shortness of breath and then momentary panic that was quickly hidden.
At 9:40 a young colleague, an exceptional rabbi from another congregation who had become a dear friend to her and had been there all evening, read a story that contained a poignant meaning for all, and recited a prayer for her and for her family. Her doctor stood in back with the nurse ... observing. It occurred to me that the only person here who had a reason to be sad was the doctor. The rest were helping this lovely lady do what she wanted to do. He alone could not fulfill his reason for being – to heal, to cure.
We each in turn praised a value, a cause, a strength that she exemplified for us. She was delighted. She gave her thanks and words of praise in return. Perceptive. Generous. Gracious.
At five minutes to ten, she asked one of her daughters to go and mix the potion. At one minute before the hour, the daughter returned with the glass of clear liquid. With her legs dangling off the side of the bed, the dear lady lifted the glass as if for all to see. She looked around and wished everyone many years of health and love, of success and fulfillment, and of happy memories. The clock on her night stand reached ten exactly.
She raised the glass, and said, “L’chaim, to your health,” and drank it. She blew us all a kiss. Put her feet back on the bed and pulled up the covers. Add courage to the qualities she exemplified.
We all stood there for minutes. The nurse came over to check her pulse. She was now in a deepening sleep. It would take a while yet. Most went back (ironically) to the living room. My colleague and I remained with the doctor. The nurse left. He stayed to pronounce.
It was well over an hour. She had died peacefully. Euthanasia .... hopefully, that qualifies as a good death.