End-of-Life Choice, Palliative Care and Counseling

Hobsons Choiceby Barbara

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Today family, friends and neighbors who loved Joan and Thomas Vanacore are grieving their tragic deaths and wondering how it might have been different. The Vanacores, known by the community of North Haven, Connecticut as decent and loving people, died violently — because our society is dysfunctional around death. Our laws are cruel. Connecticut law denied them the peaceful, humane choices they deserved as their exemplary lives drew to a close. Compassion & Choices is working hard to change that and the sadness of this case only increases our determination to succeed.

Both the Vanacores had terminal illnesses. Thomas, 73, had advanced cancer and Joan, 70, was dying of Alzheimers. We can’t know for certain what Thomas was thinking when he shot his beloved wife of 38 years in the head and turned the gun on himself in the sunroom of their home. But as their story unfolds, it repeats a pattern and illuminates truths all too familiar to those who fight for dignity and choices at the end of life.

Here is that truth in a nutshell: Many people with terminal illness want desperately to meet death on their own terms. Facing imminent disintegration of body and mind, they wish their passing to reflect the values and beliefs of a lifetime and avoid prolonged, needless suffering. The laws of most states prevent them from planning a peaceful, intended death, so they resort to violent means. Some jump from balconies and some drive into highway abutments. But most turn to America’s icon — the gun.

Shame, shame on a society that forces such a Hobson’s choice. These are our elders, the generation that fought the war for democracy and freedom and they deserve better. Their actions reflect values that form the very backbone of America. Among these are a deep sense of responsibility for themselves and others, courage to face the hard facts of a tough situation, and the practical ability to take charge of their fate. Many also act from extreme altruism and desire to spare their families the burden of a long and difficult demise. Courage, altruism, responsibility — those who would condemn the Vanacores don’t appreciate the force of these bedrock American values.

The Vanacores join a line of decent, distinguished couples whose character led them to similar actions at the end of their lives. World War II Admiral Chester Nimitz, Jr. and his wife planned their death together and left loving notes for their family. In 1975 world famous theological scholar Henry van Dusen and his wife faced declining health and took overdoses of sleeping pills to end their lives. A letter for their three sons and said they had led happy lives, and were not afraid to die. Van Dusen’s successor as President of Union Theological Seminary commented that “He had a very strong belief in immortality. His attitude was that, when your time is up, when you have lived out the possibilities, it is all right to stop, and to go on to the next life.”

Why doesn’t society allow people who share Van Dusen’s conviction to pursue it openly and die in peace with medication prescribed by their doctor? Forcing people to plan in secret and act alone prevents a careful medical evaluation and the opportunity for palliation and probably shortens their lives even further. As Nobel laureate Percy Williams Bridgman, dying of cancer, wrote about his own self-inflicted gunshot, “It isn’t decent for society to make a man do this thing himself. Probably this is the last day I will be able to do it myself.”

When I think of the character of such people I always recall the story told by a woman from the little town of Sedro Woolley in Washington State. She described her husband as a person who “took care” of whatever needed doing. He took care of their rural home, and he took care of her. Dying of cancer and suffering excruciating pain, he still looked out for her needs. The day he died he spent the morning sharpening all her kitchen knives. Then he embraced her tenderly, went out to the yard and shot himself there, so it wouldn’t make a mess in the house.

The people who take pride in “taking care” deserve better from us. They deserve real choices and permission to die in peace and comfort, with the same honor and decency with which they lived their lives.

Aid in dying, the opportunity for the terminally ill and mentally competent to have the choice of life-ending medication prescribed by their doctors, is legal only in Oregon, Washington and Montana. Connecticut should turn the tragedy of the Vanacore case into hope and comfort for those who follow. The case in litigation, Blick v. Connecticut, takes the first step toward that hope.