I wrote the following in 2008. It was published in The Denver Post.
Our old dog, Tanner, of mixed parentage, passed away this month, the same week we saw Marley and Me. He was over thirteen years old. He died peacefully during the night, alone. He did not seem to be in pain when I last saw him earlier that evening. He did not whine, but he was not eating. I found him the next morning. He looked like he was sleeping but I knew the truth because he did not raise his head to greet me. Tanner is buried in a nice spot on the ranch.
Our old dog, Buck, a Golden Retriever, also died at age thirteen, several years ago, under different circumstances. He was in pain. He could not get up. He was whining. We euthanized him at home with his family petting him and telling him, amid tears, what a good dog he was and how we loved him. Our nice vet came to the ranch and performed the procedure in our presence. He is buried on our ranch, as are many other well-loved pets, in our private cemetery.
Lucy, another family member, her of the Border Collie variety, was also “put to sleep” but when she was only two. Again, the circumstances were different. It was the humane thing to do after she was hit by a motorcycle. She suffered a spinal injury and could not move her back legs. The same vet, Dr. Jung, kindly explained that Lucy would not like to live like that, unable to walk and play, so the merciful thing would be to let her go, much as we loved her, and because we loved her.
Most of us agree that life is precious. We do not seem as united in our views of death, particularly regarding decisions about dying. Obviously, physical suffering is a distinguishing factor. To some, death is an enemy to be fought; to others it is a friend to be embraced.
My mother-in-law is a hospice nurse. She has been with many people as they took their last breaths, some struggling, some at peace. She is a religious woman and shares her Christian faith. She believes and has observed that a dying person’s faith makes a big difference in the way one dies. Tanner and Buck probably had similar relationships with God, both being wise old souls. I have my doubts about Lucy’s spiritual life yet I don’t doubt God often smiled at her antics.
Regarding faith in God and a confidence about eternal life in heaven, even those of us who hold those beliefs can bitterly differ about decisions to end life on earth. Some positions seem inconsistent to me. For example, people who oppose the death penalty for convicted murderers but support the abortion of innocent babies seem inconsistent. To me, it is more consistent to be both anti-abortion and anti-death penalty, as are many Roman Catholics At least those two positions are consistently pro-life.
I must confess that I, personally, am not consistently pro-life. Life is precious to me, yet, in many circumstances, such as assisting in Buck and Lucy being “put to sleep,” as well as “putting down” a number of horses for equally humane reasons, I viewed death as an escape from suffering and made these choices as an advocate for these voiceless animals.. I realize that people are not the same as pets regarding how those choices are made, but I view the criteria with a consistency. That is, I don’t think it is kind to keep someone alive when the quality of life is full of unbearable physical pain, especially when the person has left instructions to not keep him or her alive by artificial means if there is no reasonable hope of recovery. I don’t want to suffer in hopelessness myself and, per the Golden Rule, I respect the wishes of others who wish to be allowed to die.
My own father had signed a document called a Living Will, which left instructions to not keep him alive by artificial means if there is no reasonable chance of recovery of a quality of life. He has also expressed in conversation after visiting his cousin who had become fairly helpless and bedridden and no longer himself mentally, “Please don’t let me be like that.”
However, when Dad suffered a severe stroke which paralyzed his right side and left him unable to speak and unable to even swallow, let alone eat, despite the Living Will, and despite his clear instructions to not let him be like his cousin, he was given a feeding tube and lived twenty more months before dying of pneumonia, known as “the friend of the elderly.” Why did we who loved him allow him to live that way for so long?
Well, I will explain, with some guilt and some blaming of others. Those Living Will instructions were subject to interpretation. One doctor at the hospital told us, as my mother and other family members were discussing the suggestion of the feeding tube, “Honor your father, as it says in the Old Testament.” He knew of the Living Will, he knew my mother was saying, “I know what Johnny said about not wanting to be artificially kept alive.” That was his advice and it turned out to be good advice. However, there was another doctor who looked at the Living Will and said, “This says ‘if there is no reasonable chance of recovery.’ I can’t say there is no reasonable chance. He might get his swallow back. But if we don’t put in the feeding tube, he will starve in a few days.”
So we let them put in the feeding tube. My father, a very tough and determined man, tried to get back as many of his abilities as he could. It did not take him long, with the help of therapists, to regain his ability to walk, at least with a walker. He would wave away help and insist on walking on his own. A former college athlete, he was proud of his come-back and we were proud of him. If the therapists told him to lift his arm ten times, he would do it one hundred, just to hasten his recovery by trying his best. He worked for hours moving balls from one container to the other and then back again. One therapist said to me, “They don’t make guys like that anymore.” He did his best, but he could not will himself to swallow because that is an involuntary neurological function. He never got his swallow back.
And he could not speak other than in rote ways. For example, the therapist helped him learn to say, “Hi, Honey,” as a surprise for my mother when she came to visit, as she did daily all day long. But due to something called perseveration, he might say the same thing to the guy who cleaned the toilet, because he was stuck on saying that re-learned phrase. People would suggest, “If he can’t talk, can’t he still write what he wants to say?” He couldn’t due to brain damage called aphasia. He seemed to understand what was said to him, but it was a one-way information highway; he could not make himself understood. It was sad to see this proud, smart, accomplished, athletic man reduced to the post-stroke circumstances. I can only imagine what he was thinking. Did he regret that he was kept alive by the feeding tube?
If he did regret and resent the decision to put in that tube, he did not act like that. He did not seem depressed. He could still smile. He could still enjoy being around people. He could even read and watch TV. It would be too boring to fake that he was following the stories but he couldn’t be tested on the content.
So, did we do the right thing or did we dishonor him? I don’t know. When Dad said he wouldn’t want to be like his cousin was, and he didn’t want his life extended by artificial means, he was healthy and strong. Being healthy and strong, of course he did not like the thought of being otherwise. Neither do I. Right at this moment, I don’t have a pain in my body. I am enjoying life. Of course, I don’t want a life in pain or without my faculties. That is what we think and say when we are healthy. When Dad lost his health, he still tried to live. The fact that he did not give up makes me think that maybe he changed his mind about not extending his life by artificial means. He still loved and knew he was loved. He had a quality of life because he was conscious and, therefore, conscious of love.
What about Terry Schiavo? As I recall, she was not conscious. Did she want to live? Who can say? I see a distinction between her being in a coma for many years and my father walking and reading and loving, even without eating and speaking.
My mother-in-law, the hospice nurse, wears on a necklace a silver medal with an emblem and the initials, “D.N.R.” which means “Do not resuscitate.” I wonder if her wishes will be honored. I wonder if her wishes will change. I wonder who will decide.
Shakespeare wrote, “To be or not to be, that is the question.” There are other questions too, such as what it means to be alive, when does life begin, and when should it end. Theology and medical ethics study and debate such things, but all of us experience them.
Life is precious – and each life is unique, and so is each death. Dying in my sleep, like Tanner, at a ripe old age, sounds good to me, but I probably won’t get to choose how I die. Choosing how we live, while we can, is precious indeed.