Monday, January 21, 2013

Assessing the Vehicle

A long time ago, someone told me my body is just a vehicle that gets me from point A to point B—or maybe I read that in some New Age book. Nevertheless, it’s an image I can live with, and, pushing the analogy a bit, I can recognize that the minute I drove my vehicle off the new car lot, it begins to depreciate. We basically start aging from the moment we’re born, and a goodly part of our existence as functioning humans is spent keeping decay at bay. I fact, it strikes me that it’s a wonder most of us survive to any age. If look back over the past few years without major illnesses—Bell’s  palsy (WTF?), shingles, allergies and infections; a few weeks of flu and a back that once every three years goes out of whack. There’s been stupid stuff like a Weed-Whacker incident leading to a scratched retina, and another gardening event involving a dozen-or-so mud dauber stings. I had a motorcycle accident many years ago when I hit an eight-point stag, and when I was still drinking, I fell off a roof while playing Frisbee.  Surgeries prior to the cancer included a hernia, a deviated septum and a shoulder fixed with arthroscopic procedures.

Talking with friends over the weekend, I began exploring seriously what may happen in a near future I had not given much thought to. Yikes. This cancer thing may take me out…

Now that’s an eye-opener. It requires the sort of serious, objective contemplation I’m not at all sure I’m equipped to do. What I have found out is that I am now on the cusp of the 50 percent survival rate. Could be better, could be worse, and I can still get hit by a bus tomorrow.

I'm a big believer in the right to die. In fact, I plan to have "Do Not Resuscitate" tattooed on my chest before too long and my will has a clause forbidding caretakers from taking extraordinary steps to lengthen my life. This is not meant to be morbid. I'm simply a proponent of dignified exits with no interest in spending on hospital and medical care whatever I may have accumulated during a lifetime.

To me, insisting on life while striding through the gates of death is the ultimate selfishness. We don't like to talk about death and dying and we don't want to face the fact that our health care system is a money-syphoning sham. As one physician put it, "No one wants to talk about what we really need: a good kick in the ass and rationing care for our terminal patients."

S.K. Jindal, a physician and author for the Indian Journal Of Medical Ethics, writes, "Technological advances in the last few decades have made us believe that death is an unnatural event and that life can be prolonged at will. This has resulted in the adoption of life-supporting measures, which are sometimes antagonistic to the very dignity of life. Death is an inevitable conclusion of life. The dignity of death therefore is as important as that of life. The fortunate few die without much suffering, but most people face either the debility of old age or an incurable and progressive illness." He goes on to examine the 'right to refuse' issue. "A most contentious subject relates to the decision of patients to refuse life-prolonging treatment. The law generally gives adults the right to refuse treatment; however, [a medical practitioner] must often decide whether a dying adult is competent to decide or even communicate his or her decision.

"Legally speaking, adults are presumed to be competent to make decisions unless there are reasons to suppose otherwise. The right to refuse treatment is firmly established in British medical practice standards--it was upheld even in a patient diagnosed as psychotic who refused amputation of his gangrenous foot. In the United States, the Supreme Court in the Cruzan case is one of many which asserted the principle that individuals have the constitutional right to refuse treatment even if this may result in the person's death. This right has been reiterated in several other judgments even where patients did not have life-threatening illnesses."

Me, I simply refuse to have an everyday life that involves tubes draining liquids or solids from my body. My oldest sister, who six years ago died from bladder cancer and preferred life at all costs, was in constant pain and a shell of her former beautiful self by the time she passed away. I really don’t want that.

This, hopefully, is mindless conjecture. The surgeries and chemotherapies may indeed make everything all right again, but bladder cancer, as it turns out, has a nasty habit of commng back time after time, and each recurrence lowers the survival rate.  

I am reminded of the of the passing of Sir Edward Downs, the former conductor of Britain's Royal Opera, and his wife, Joan, who at 74 had been diagnosed with pancreatic cancer. The couple, married 54 years, decided they wanted to end it together and secured the services of Dignitas, a Swiss concern that orchestrated their deaths. It was a painless and inexpensive affair when compared to the end-of-life care Joan would have had to go through and the suffering Sir Edward did not want to bear living without his mate. That Sir Edward was not terminally ill became a serious issue, debated endlessly in the British media. In the end, it became a question of accepting or rejecting Sir Edward's "typically brave and courageous" choice, according to his manager. Personally, I think the conductor--and anyone else of sane mind--has every right to choose the moment of one's demise. After all, if we are not given a choice of when to be born, shouldn't we be given the choice of when to leave? And when is the right time to retire the vehicle?


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