MAR 1996


Therapists Talk 
Shrink Rap 


    Michael E. Holtby, LCSW, BCD

Dignity Dead In Committee

Originally published in Colorado's AIDS Newsletter, Resolute! , March 1996

Not Reproduction  without the permission of the author.

On February 5th, 1996 Rep. Peggy Lamb presented the Dignity in Dying House Bill 1185 before the Health, Environment, Welfare and Institutions Committee. It was voted down 4 to 7, and so for physician-assisted suicide in Colorado will remain a felony in the category of manslaughter.

One person living with AIDS testified in behalf of the bill: Bruce Monett from Niwot, Colorado. He challenged the Committee, saying that he could come into the hearing room with a gun and kill them all and the State would put him to sleep by lethal injection. But he would be denied the same death for just being a PLWA. The Committee seemed unmoved, as a staff member held up the "TIME" sign.

I testified about the client I wrote about in the April 1995 Shrink Rap Column, who smothered his partner of 12 years by sitting on his head with a plastic bag and a pillow, when the pills didn't work. I was trying to make the point that without professional assistance these are ill-considered, ill-conceived decisions often with tragic consequences. "TIME"!

I must be fair to the Committee -- it is typical for people testifying on a bill to have an average of three minutes to state their case. And the hour was late. They didn't even begin hearing our testimony until 7pm, and there were twenty witnesses. And ultimately, it appeared the Committee members had made up their minds before we even started.

There were no questions for those in favor of the bill. However, the Committee had a number of questions for those opposed. They seemed particularly interested contenting themselves that pain can be ameliorated, thereby solving the problem of suffering.

The Committee seemed to miss the point. They reminded me of a client who used to say of his lovers, "I always fall in love with their potential -- not the reality of who they are." Likewise, the Committee fell in love with the potential of pain-free death, rather than the reality that 75% now experience pain -- according to a recently published study. They seemed to overlook the fact that suffering is not just physical pain. Suffering with AIDS can be the indignity of diarrhea and diaper changes. Suffering with AIDS can be the isolation of blindness, and dementia. Suffering with AIDS can mean a one-time Adonis ends up looking like and old man from Auschwitz. Suffering can mean being too weak to lift your head off the pillow. Suffering is primarily fear, not physical pain.

The Committee members may believe that this kind of suffering is not sufficient to warrant helping someone to die. It appeared their criteria required intractable, inescapable pain. Yet who are we to tell a dying person their suffering isn't great enough?

Father Frank Gold, whom some of you know, as he serves as a hospital chaplain for many with AIDS; gave an eloquent argument for ending life without our speeding up the process. He basically was saying that healing can occur -- even near the end.

Of course there is truth to this, and I have written about such instances in a previous Column (June, 1995). However, as Michael Shernoff, another HIV psychotherapist, has written, we die as we have lived -- not all of us healed: Hollywood has pumped us up with a sanitized, sentimental version of death: everyone is gathered around the dying person's bedside and fences are mended, old wounds are patched up, then the dying imparts a last jewel of wisdom before the gentle closing of the eyes. There's no shrieking with fear, no groaning from the intolerable pain, no dying alone in an impersonal hospital bed, no homophobia. In too many AIDS cases, however, families are so full of anti-gay hatred that they can't even offer a kind word to dying son or brother or father... Sadly, we don't always rise to the occasion, even when we're confronted with the finality of death.(1)

Most fundamentally and yet not adequately defended was our right to determine how we die. I believe this is a personal choice, with a highly personal criteria. Only when we are on the doorstep can we say, "The time is now." Many PLWA's say, "If such and such happens to me, then I'll check out." That point comes and they more-often-than-not find their condition is tolerable. However, part of what makes it tolerable is the knowledge that if their situation becomes bad enough they can take their own life. So suffering as fear is alleviated.

A study of vital statistics in Louisiana recently found PWA's had a suicide rate 134.6 times that of the general population. (2) A Cornell Medical Center Study found the rates to be two to three times higher than people with other terminal diseases. The Committee would say the solution is better pain control. And yet of those I have known of who chose suicide were not in pain. Many health care professionals would say it points to the need for better palliative care, and yet I have had clients leave hospice to kill themselves. And many therapists would say its a matter of treating depression. Clinical depression is a cause of suicide, and is very treatable. And yet most individuals who are truly close to dying that I have known personally became less depressed. Allthese solutions assume suicide under any circumstances is bad and to be avoided.

Yet if we don't follow the Hollywood script do we have to hang around? On May 3, 1994 Federal District Court Judge Barbara Rothstein declared the relevant laws of Washington State unconstitutional. In overturning that state's statutes she wrote:

The liberty interest protected by the Fourteenth Amendment is the freedom to make choices according to one's individual conscience about those matters which are essential to a personal autonomy and basic human dignity. There is no more profoundly personal decision, nor one which is closer to the heart of personal liberty, than the choice which a terminally ill person makes to end his or her suffering and hasten an inevitable death.

From a constitutional perspective, the court does not believe that a distinction can be drawn between refusing life-sustaining medical treatment and physician-assisted suicide by an uncoerced, mentally incompetent, terminally ill adult."

1. Michael Shernoff (1996, Jan/Feb). "The Last Journey," The Family Networker. 35-41.

2. This study lacked some essential information in that it didn't discriminate between people who were newly tested and still healthy when they killed themselves, and those who are the subject of this legislation: people near death who want to choose the manner in which they die.



Last messed with November 15, 2001

Copyright(c) 2001 Michael E. Holtby, LCSW. All rights reserved.