Suicide … Acceptable in the Case of Alzheimer’s?
Last week, I wrote a post asking my readers: “Alzheimer’s … How Soon Do You Really Want to Know?” My comment section quickly filled with a myriad of opinions, personal stories, and even a few questions and statements regarding the possibility of planning an “exit” … if, when, and how …
Dr. Schwab introduced the idea in his comment, and some of the commenters picked up on his question, pro and con …
The following comments will tell the story:
Sid Schwab Says:
August 3rd, 2006 at 6:45 pmTimely. I just got a call from my brother, asking if there were such a test. He and I are watching our mom descend through the disease, and it seems he’s had the same thought as I: if you could tell it was coming, and if you could find the perfect time to intervene on your own behalf (putting it as delicately as possible), would you? That’s the impossible part: seeing your future and picking a time….
(Emphasis by Moof)
It’s me, T.J. Says:
August 3rd, 2006 at 11:54 pmI am sorry for the pain and suffering.
Is there an easy answer?
No.
I believe that I would find myself praying to God, asking him to lead me and guide me through it all.
Because there is no way, in my simple wisdom, that I would know the right things to do, or not to do.
We aren’t strong enough, or wise enough, to hold the fate of a human life in the palm of our hands.
To ponder such things seems difficult enough.
later…
wolfbaby Says:
August 4th, 2006 at 12:20 amI don’t believe I would want to know if my candle were flickering
Certainly not if it were going out
surprise me.
Take me in the middle of the night with no warning…Julie Says:
August 5th, 2006 at 2:42 amThis disease is so difficult for everyone concerned. My mother-in-law had Alzheimer’s at the same time as lung cancer metastasized to the brain. She was in grief for her cancer over and over again because she forgot she had it. We were fortunate that her demise was swift.
My husband saw another person with the end stage disease and decided that if he ever learned he had the disease he would not want to go on living. I am not so certain as he is.
[...]
scan man Says:
August 6th, 2006 at 11:41 amMoof, You have this great gift of coming up with posts with some moral / ethical dilemma at the core.
I sympathize with all of those above who have experienced first-hand what Alzheimer’s does to loved ones.
In spite of all the legal / moral / ethical / religious issues, I believe I would opt to go out on my terms while I was still being me.‘Cogito ergo sum.’
‘Non-cogito ergo zero.’
In an email exchange with Dr. Schwab, I asked if he would be willing to answer his own question. He not only graciously did so, he also later gave me permission to use parts of our email exchanges. Here is Dr. Schwab’s answer to “If you could tell it was coming, and if you could find the perfect time to intervene on your own behalf (putting it as delicately as possible), would you?”
As to me, well, I think about it a lot. In theory, I’d want to be able to pick the right time and go for the exit. I’ve thought about how. I’ve thought about whether it’s possible to find the perfect window of opportunity: if you see it coming but don’t feel ready, you may lose you chance to be able to make such a decision: you have to jump off the down escalator at the perfect moment. Or error on the side of jumping too soon, because too late is too late.
I wasn’t expecting to see the issue come up in the Alzheimer’s comments, and I was surprised by how many people referenced it. So - let’s explore this a bit: if you could tell it was coming, and if you could find the perfect time to intervene on your own behalf, would you?
What are the moral, social and religious implications?
If you do think suicide would be acceptable, do you believe physicians should be allowed to “help?” Perhaps that would obviate the need for timing?
If you feel that it’s not acceptable, would you be willing to share why you feel that way?
I want to thank Dr. Schwab for all of his input.
August 10th, 2006 at 11:22 am
Many people mistakenly believe that, because I’m a psychiatric nurse, I am against suicide. I believe that people with terminal or debilitating illnesses should have the right die. Alzheimer’s Disease is a monster. I watched several family members with Alzheimer’s wither away. It’s ugly to watch, and I know I don’t want to go like that.
Personally, I don’t want to know if I’m going to get Alzheimer’s. If I knew there was a ticking time bomb lurking in the wings, I wouldn’t be able to enjoy my life.
Moof, thank you for your posts. I enjoy your blog, and I’ve added you to my blogroll.
August 10th, 2006 at 1:18 pm
You sure do ask the hard questions. What is a living will? Choices a person makes whether or not to prolong there life in the event of a dibilatating situation… DNR orders? all of that is, in lite of current technology the equvalent of commiting sucide in some peoples opinion. In my opinion it is knowing when to conceide the battle gracefully and acknowledge the war is lost. Alot of it is a matter of perspective. And personal experiences and choices. Each person is allowed to live there live how they see fit, and to make there own choices. I personally do not believe that putting a knife to my wrist is an option, however, it is not for me to make that choice, nor inforce my will upon another. But I also believe it is ok to interfer with technology and allow mother nature to take her course. If you know that your life will not be of good quality and that it will be a “ghost life” then I firmly believe it is your choice to not prolong it with further treatments. Im not even sure if that is along the same lines as to what you were thinking but those are my thoughts such as they are.
August 10th, 2006 at 2:10 pm
I always hesitate to post what may be a controversial stance, especially in the presence of esteemed physicians and other healthcare professionals. But, I explored this topic in a biomedical ethics class I took in college, and I would like to share what conclusion I came to personally.
I think we are such an arrogant race of human beings to think we are entitled to the final say in our own lives. God has the final say. When we cross the line and usurp that authority from Him, we have made a poor choice. A choice nonetheless, and one that is individual. Our life is in our hands from early on (by design), by the choices we make about diet, exersize, and lifestyle. I contend we are allowed to make this choice. In fact, biblicaly, Christians are told they are given the choice of life or death and are admonished to choose life. The choice is ours, but so then are the repercussions to ourselves and others.
As a student, I always find it a difficult challenge to look at these dilemas w/o my own spirtuality tinting the glasses through which I look. As a nurse, and eventually an NP, I know I will need to learn to take the glasses off sometimes. I am interested in reading the discussion to this and learning a thing or two.
August 10th, 2006 at 5:31 pm
“If you could tell it was coming and could find the perfect time to intervene on your own behalf, would you?”
Well, Moof, I personally don’t think I would have the courage to end my own life. It is hard to say, unless one is actually in the situation what one would ACTUALLY do. Talking about this when I do not have a debilitating disease, it is easy to say “Oh yes, I would end my own life” or “No way, I would never do that.” Never say never, I always say. However, even though I don’t think I would be able to end my own life if I had Alzheimer’s or another terminal illness, I do believe the right should exist for those who do. If there is someone who is living with excessive, chronic pain and is living a life where their illness is progressing to a point of losing dignity and quality of life, I think it is Ok for them to end it. Why should someone be forced to stay alive? I think it is cruel and inhumane to postpone death to someone who is living a painful existence. We treat our animals better when we euthanize them. Granted, I know the social implications are far more complex in humans and I am not trying to minimize the issue here. I just believe in the right to end suffering.
August 10th, 2006 at 9:08 pm
This could turn into a slippery slope argument really quick.
Yes, we do treat our animals better, but only some of the time.
There are many times whenever an animal should be euthanized but are left to do die an agonizing death because the owners refuse to have them humanely put to sleep.
But there are many more instances where owners come in and have their animals euthanized because of 1. finances and 2. convenience.
With that being said, I think that you could plainly see where this viewpoint could go if the tables were turned, and we were speaking about a human patient.
Oh the rich lawyers that we would create as the battles rage on in court.
From this viewpoint I could see the “can of worms” that would be created, and thus the slippery slope that I think could actually occur.
From a spiritual viewpoint…
Man has a soul. And God has given strict instruction about taking your own life. I suppose that one could technically avoid this spiritual complication by having a hired killer do the deed. But I think that God would view it from a compliance point of view.
Since God has been here from the beginning, and He definitely knows the ending, I am only left with one option on this issue. That is to “trust in the Lord with all my might”.
Our point of views are definitely self-centric, and as a general rule, none of us enjoy discomfort of any kind. Many of us can’t even tolerate the current heat wave with dignity and grace…
But then I look at the sacrifice that my Lord has given me so that I could have eternal life with Him…
And all He asks me to do is to follow a few directions that He has given me.
I pray that I am never in such a situation as many others have found themselves… Their bodies racked with pain, living miserable existences.
But I believe that God will give me the grace to get through it, if only I ask.
And if my mind is gone, ruined by a disease such as Alzheimer’s, God knows the desires of my heart.
later…
August 10th, 2006 at 10:23 pm
Moof. In our many discusssions, assisted suicide has come up and you are well aware that I support it under very specific circumstances. Sad as it is, Alzheimer’s produces a problem that does not apply to other fatal diseases. Assisted suicide can occur only with the decision made by a fully mentally alert patient.
If a patient were to learn by testing that he would die from the disease, no law or religion would permit suicide of the currently healthy patient with years of life to come.
In view of the strong opposition to assisted suicide by a large segment of our population,it will be many years, before laws would permit death performed by a loving relative.
August 11th, 2006 at 5:38 am
Boy Moof, you do ask hard questions..My answers may shock you since you know what I went through with my mom.
Frist, no one should ever have to suffer with Alzheimer’s. No child should have to watch while their parents minds are being destroyed day by day for years on end by this horrible illess.
But, as far as Drs. being involved in assisted suicide, I don’t think we have the right to ask that of a medical professional. There job is to heal and save lives. To me that sounds like we would be very self important to ask a physician to do that. Also, I’m not strong enough to commit suicide. Alzheimer’s, being the beast it is, is not reason enough to kill ourselves. I think there are some pains in life equal to and even more more emotionally painful than Alzheimers. Such as losing a child. I have often thought if I lost either of my children I would kill myself. I honestly don’t know how one lives through that. But, we don’t encourage those people to end their lives or expect physicians to assist them in doing so.
In many ways I believe Alz. is harder on the family caregivers than on the patient. That is my big worry and believe me when I say I worry about it. No way do I want my kids or my grandkids having those memories after I am gone. I never want to look at one of my kids and call them these horrible names that I heard so much from my Mom. I don’t want them years later still remembering and being effected by this disease.
I have taken steps to ensure that will not ever happen with my kids. They will not be my caregivers and they will not have those memories. If Alz. happens to me then there are people who know what I want, but suicide isn’t it. There are papers signed, notorized, filed and ready to go when the time comes.
Good topic Moof….:)
August 11th, 2006 at 11:42 am
What’s apparent in many of the comments is that one’s religious view enters heavily into this. Fair enough. But, as care-givers, and given that for any religious view you might personally hold there are literally billions on Earth who differ from you, the question is to what extent we ought to rise above our personal views in regard to ourselves, and render the care that’s best for the patient.
August 11th, 2006 at 12:11 pm
Also, and this is just my opinion only and noone needs agree with it but it’s how I feel. I think if medical professionals really want to help patients now and the ones that will come in the future they should put their energy where it can make a bigger difference than for just oneself. Put your energy with that of other professionals and help find better treatment or a cure for this illness.
Also and I know this was about what the patients themself want. But, if we start doing that, then I imagine it would be only one more step until family members who have medical power of attorney could ask for assistance, in puting their family members out of their misery. Then it becomes who are we really doing it for? Are we commiting murder? Are we doing it because family members don’t want to see their loved ones go through this? Many times where that patient themself is at, may not be as bad on them as it is on you…This is a can of worms.
August 11th, 2006 at 12:55 pm
“render the care thats best for the patient” - hmm, that gave me pause, a new twist to my opinion, as Im aware I can not put my own opinions on others, especially those seeking my healthcare skills in such a vulnerable way. However, who decides what is best for the pt? If the pt decides, that easy, because if you disagree then you may refuse. If the hc provider decides what is best, from where are they given the authority to do so? The pt perhaps?
August 11th, 2006 at 1:05 pm
Please allow me to interject a question … because I see some very interesting statements in the comments, and I’d like to see the ideas explored further, if anyone is willing to tackle them.
In his comment, Dr. Schwab stated:
Cathy replied with:
The question I’d like to ask is: Who would suicide (or mercy killing) be helping?
1) If, like Dr. Schwab says, it’s the patient, then how? Since there’s no associated unmanageable pain to prevent, it would have to be psychologically helpful. How would that be different from suicide for an emotional reason, like depression?
2) If, as Cathy implies, the suicide, or “mercy killing” would only be helpful to those who “don’t want to see their loved ones go through” end stage dementia, then does it rise to the level of murder when done with help; or when done alone, are we condoning a loved one’s suicide to save ourselves an emotional burden?
August 11th, 2006 at 6:35 pm
I used to be the marketing director for an assisted living which specialized in the care of the “memory impaired.” One of the things I was shocked to learn was that the pt does experience moments of lucidity when they realize what is happening to them. As the process progresses, these episodes become less and less frequent and the pt can seem “blissfully unaware” of the state they are in.
So I would say this act of mercy killing is helpful to those around the pt. Even if the the pt stated ahead of time they did not want to live like that, the fact may be they wouldn’t know they were living like that, so it cancels out their need to not live like that. ??make sense?
In depression, it seems an awareness of the debilitation does exist for the pt, and its successfuly treatable in a much higher percentage than with Alz. That would be the only difference.
For no. 2, I am currently very interested in learning all I can about what happened in New Orleans and why the ENT doc appears to have taken the life of patients that were merely unable to be moved out of the hospital. Was this done because the doc couldnt live with the emotional burden of knowing the pt would have drowned, died from heat exhaustion, or died otherwise from neglect? Cathy brings up a very interesting point I have never considered. If your life is taken and you didnt get an express vote or say in the matter (taken by an active act of killing vs. a disease process) then it has to be murder, or we have to re-define murder.
August 11th, 2006 at 8:31 pm
I think the playing field has subtly shifted here: at first, we were talking about suicide; now we’re talking about euthanasia. Euthanasia, as I see it, doesn’t apply to an Alzheimer’s patient, because a requirement (legally; but also logically) is that the patient is fully competent to make the decision. So let’s not get confused about what we’re talking about. We started on a rhetorical plane: would I (for example) choose suicide if I saw Alzheimer’s coming. As to euthanasia — that’s an entirely different issue. Cathy suggested that to intervene is to interfere with God’s will. Which, of course, is also true if I take out an appendix, isn’t it? We can’t be selective in assigning a condition to God’s will. If He has plans in giving a person cancer, and wouldn’t want us to speed that person’s death, than how can it be that He doesn’t have plans in giving a person appendicitis? Why — to put it another way — is it a miracle when one kid lives through the crash of a school bus? If God saved the kid, then it must follow logically that He also chose not to save the others. So why is the death of the other kids no less a miracle than the survival of the first? Each — logically — is God’s will. Each is an action of God. It must be so; or neither is. My point is that when we try to ascertain God’s will, we are interjecting personal views. So, to me, it’s not an argument against euthanasia to say it’s interfering with God’s plan. There may be other good arguments pro and con, but to me, that’s not one of them. The idea of euthanasia has pitfalls. It’s also true that in Oregon, where it’s legal in certain situations (hair-splitting: as I understand it, it’s doctor assisted suicide, which is, I suppose a little different from active euthanasia), it’s being used quite rarely. Frankly, as a physician, I wish I had the option, when all else has failed and when the patient rationally and reasonably desires it, to speed him or her to a satisfactory end. And as anyone who works in a hospital knows, such things happen all the time. It’s a challenging topic. One on which very good people disagree. But I think we already have too much of government deciding morality.
August 11th, 2006 at 9:53 pm
ok, so back to suicide. Suicide has always seemed like an act of desperation by someone who is expressing hopelessness and despair with their loss of control over their situation. So if someone committed suicide because of an Alz. diagnosis, my heart would break for them because they felt so helpless and hopeless and I could not relieve that suffering.
August 11th, 2006 at 11:09 pm
The answer is simple, suicide is not an option to be concidered by the patient or the loved ones. I form my opinion on my belief that there is a God, and although the Bible does not speake on mercy killing or suicide, it does speake on murder which these forms of death fall under. My family know my feelings on this so it is never to be an options in my life, but..if someone in the Medical field takes it upon themselves without our knowledge to pull the plug……….I thank them ahead of time and hope like hell they have a dream team when they face the final judgement.
August 11th, 2006 at 11:10 pm
Hi Moof,
You’ve raised some really good questions.
I think every person has the right to their beliefs, whether it be about how they choose to conduct their life, to what they feel about death and ending their life.
Physicians try to relieve suffering. At the bedside of a dying patient, we try our best to make their passing comfortable - as much morphine as they need to appear comfortable. But to ask a physician to take a life before its time is to ask us to play God. It does not seem right.
I would never be able to assist in a suicide. It goes against a core belief, that all life is holy and should be cherished. But given the great diversity among us, there are physicians who may truly believe that they are doing a greater good when participating in euthanasia. After all, principles such as “First, do no harm” are just concepts - the interpretation of them differ greatly from person to person.
In the case of Alzheimer’s disease, I agree with the points raised, that the patient usually does not suffer nearly as much as the caretakers or loved ones. And while we may never find out, it is possible that the quality of life of these patients may not be as bad as we think - after all, we are using our measures of “quality” to judge another’s life, which has been proven inadequate in similar situations (studies on happiness of lottery winners and happiness of paraplegics). Perhaps, we, as a society, should create with more effective ways to help ease the burden of the caretakers, and increase the support for caretakers.
August 12th, 2006 at 11:01 am
First, I havent mentioned anything whatsoever about anything being Gods will? I don’t think God has anything to do with Alz. My views have all been stated from my personal experience, of being the sole cargiver of my Alz. victim mother, for more than a decade. Watching and experiencing ever step, day by day of what Alz does to someone.
My conclusion, is that although it is horrible, it is not reason enough to commit suicide. My fear is that, should suicide one day be allowed, it would eventually lead to euthanasia.
I agree that there should be more, and better, ways to offer help and assistance to caregivers. For the most part mother was quite content with whereever she was at during the course of this illness. Very early stage is when it is harder on the patient. When they are still lucid, but have these periods of confusion or memory loss and they are aware something is wrong. Progressing beyond that they aren’t aware of what is happening to them.
My fear, for my future, is that I also will get it and my kids will see it and experience it. I don’t want to kill myself I just don’t want them to see it.
August 12th, 2006 at 1:53 pm
Sorry. I think I mixed up the comments of Cathy and intelinurse2b. Must be time to move on…
August 12th, 2006 at 2:54 pm
Oh no, its perfectly fine to mix up comments sometimes. I do it often. I knew you must have mixed me up with someone. I actually like these discussions where we all get to state our views and why. I hate the comments that get nasty and abusive but that hasn’t happened. I find everyones views interesting and they give me alot to think about.
August 12th, 2006 at 6:59 pm
My husband is adamant that if he is ever given a diagnosis of Alzheimer’s he will end his life. He says this because of his observation of people who were in the end stage of the disease and does not want to live like that. He helped found the Hemlock Society in Wisconsin. I went with him to the meetings and decided that I do not feel the same way. I decided I could not attend any more of the meetings as I was fundamentally opposed to their basis tenets.
I can only hope that my husband does not ever receive a diagnosis of Alzheimer’s.
Moof asks “What are the moral, social and religious implications?
If you do think suicide would be acceptable, do you believe physicians should be allowed to “help?†Perhaps that would obviate the need for timing?”
I think that people have the moral authority to decide when to end their life. I believe the means are available to end ones life without asking anyone else to help. I don’t believe I could help someone end their life.
To confuse the issue I do believe in withholding life support if that is what the patient wishes. My father had an extremely severe stroke and the neurologist told us that his chance of any recovery was nil. My Mother was aware of his concerns and said he did not want to live under the circumstances he was in. So we agreed to have the feeding tube withdrawn. He died within 2 days so the feeding tube may not have made much difference.
The end of life decisions are often not clear cut.
August 16th, 2006 at 4:54 am
Choice- of course. My personal belief is that I would rather not die in a bed full of pee, not able to understand what is happening. I do not want any religious person to ever make a choice for me.
People talk about doctors as healers and paragons. Not so so much about those who do not follow their Hippocratic Oath to do no harm- there are doctors who deny care on behalf of the insurance companies, doctors who write up policy for insurance companies, and doctors who just plain should not be doctoring. If a patient would like a choice, there ought to be a doctor somewhere who can help. Kind of like helping a woman end a pregnancy. There are some people who think that this is something important and valuable. The point is all doctors are not alike. There are docs who try everything to keep life going, those who are in the middle, and those who would wish that at their patients request they could help end suffering.
Pain and suffering are not noble or necessary conditions for a human. Think of childbirth. It is no longer necessary to bring forth a child in great pain. This is a good thing.
If I had AZ I would seriously think about ending my life. Same as certain cancers and other conditions that would make my being here more difficult and ultimately less pleasurable for all involved.