Euthanasia: “The bull looks different once you enter the ring.”

Bad-boy British novelist Martin Amis  is in the news for proposing euthanasia “booths” on street corners where the old old could off themselves with “a martini and a medal.” Amis maintained that his comments were meant to be “satirical” rather than “glib”, but there’s something to offend just about everyone in his prediction that “a population of demented very old people, like an invasion of terrible immigrants, [will be] stinking out the restaurants and cafes and shops.”

One commenter called out the journalist for not challenging Amis to provide any actual facts (e.g. Amis’s absurd claim that “Geriatric science has been allowed to take over”), and pointed out the felicitous timing of the media storm to coincide with the release of his next novel. Although readers didn’t seem to be jumping on the War-Between-the-Generations Bandwagon, I was reminded of last summer’s brouhaha about the “death panels” that Sarah Palin claimed would go hand-in-hand with health-care reform.

Euthanasia is a hot-button issue, and for a lot of very good reasons. The potential for abuse is significant, as is the potential for social pressure upon the disabled to “do the right thing.” One thing most people agree on is the terminally ill and mentally competent should be able to have some control over the circumstances of their deaths. Because of our numbers and our sense of entitlement, my generation is sure to advance this right-to-die agenda, and I’m all in favor. I’ve got a Living Will with every do-not-resuscitate-unless-she’s-tap-dancing box checked off, and medical power of attorney assigned to my sister because my partner’s going to be too squeamish. He, on the other hand, can’t seem to get around to signing any papers and when pressed will only say that he doesn’t want mine to be the hand on the proverbial plug.

No matter how well prepared we imagine ourselves to be, most of us will never reach a fixed point at which life no longer becomes worth living. This is the case no matter how degraded our quality of life may appear to others. I learned this when I helped stockpile pills for my brother-in-law who was dying of AIDS. Each day with his young family was too precious to take them, until suddenly he was no longer competent to act.

I learned it as a journalist from a talk on end-of-life issues by Dr. Thomas Funicane, a tall, bald, extremely compelling gerontologist at Johns Hopkins University Hospital. Funicane quoted a Mexican saying: “The appearance of the bull changes once you enter the ring.” Behind him was a chart that described women in labor, with the X axis being the number of centimeters dilated and the Y axis the desire for anesthesia. The line ascended in a steady diagonal.

Another data point from Funicane: right after the accident that turns people into quadriplegics, most say they don’t want to live like this. A year later, 60% rate their quality of life as good or excellent. Funicane told two stories that also stuck with me.  One was of an extremely straight-laced woman, who was struck by a form of dementia that robbed her of all propriety. She told dirty jokes, she lifted her skirts, she flirted with her grandsons. There was no doubt that the woman, if compos mentis, would have chosen death over this mortifying incarnation. There was also no doubt that she was having a fine time, a fact that eased the burden on well-meaning witnesses to the transition.

One more. A man drank. He drove. He told his wife that if he were ever incapacitated he definitely wanted her to pull the plug. He crashed his car and suffered terrible brain damage.  After a year of rehabilitation, he remained completely paralyzed, barely sentient, able only to blink. His wife dutifully reiterated his wishes, and the medical ethics team sat down at his bedside. Did he know who he was? Yes. Where he was? Yes. What had happened to him? Yes.  Did he want to die?  No answer.

The bull looks different once you enter the ring. A 60-year-old grandfather, Martin Amis is still in the bleachers, but he acknowledged that “I’m not a million miles away from [old age] myself.” Despite my professed certainties, all I know for certain is that I won’t know till I get there.