c. 1997 Religion News Service
SAN MATEO, Calif. _ For more than three decades, Charlotte Ross devoted her life to saving lives, first as executive director of a leading suicide-prevention facility, and later as head of the Youth Suicide National Center in Washington, D.C.
So some colleagues were understandably distraught when she agreed to run the Death With Dignity Education Center and campaign for the right of the terminally ill to doctor-assisted suicide. “I’m aghast,”said Joseph Richman, a psychologist who specializes in treating suicidal people.”She’s contributed so much to the field and now she’s changed her mind.” But in Ross’ mind little has changed. After years of listening to the suicidally depressed, she is in the forefront of a movement advocating listening to the dying.”I’ll do anything to save a life when there’s a life to live,”she says. But if people are terminally ill, they should be able to die with dignity, she adds.
A tall, well-coifed grandmother who uses endearments like”kiddo”and”cookie,”Ross, 65, is a far cry from the more notorious right-to-die advocate Jack Kevorkian, whom she thinks oversimplifies a complex issue and acts without constraint.
Providing the option of assisted suicide, she believes, can actually prolong life. Fearful of impending pain, many terminally ill patients feel compelled to commit suicide while they are still physically able. Offering them the possibility of assisted suicide, she says, alleviates their fears. And few will choose to hasten their deaths.
An Oklahoma City native, Ross was drawn to the field of suicide prevention after she learned her psychology professor and mentor at the University of Oklahoma went to the football stadium late one evening and slit his throat. “How could this happen?”she remembers asking.”Wasn’t there anyone around who cared enough about this guy?”After that, she”became obsessed”with reading everything she could about suicide to prevent it from happening again.
There wasn’t much to read.
As late as the 1960s, the subject of suicide was rarely taught in psychology departments and medical schools. Not until the late 1950s had two psychologists in Los Angeles received a grant to study the subject and open the nation’s first suicide prevention center. In 1966, Ross convinced officials in her hometown of San Mateo to start a facility based on the Los Angeles model and staffed by volunteers who took phone calls 24-hours-a-day.
Too often, she learned, health care professionals treated the suicidal as weak, ungrateful people who were taking up space in emergency rooms. As the center director, she trained her staff to take the suicidal caller’s pain seriously and buy time to get them through the crisis. “The main thing you have to do is listen with an informed heart,”she says.”I never tell people not to kill themselves. I ask them to wait a day, or at least a few hours. Very often people feel that they’ve destroyed their lives because of a romantic breakup. I try to help them remember what their lives were like before they met their partners, and to open up possibilities for the future. You don’t prevent suicide by making them want to live.” The center grew from a small facility that answered 1,800 calls a year to a San Mateo institution handling almost 30,000 calls, referring people to local hospitals and social service agencies for ongoing help.”The center,”says Jerome Motto, professor of psychiatry emeritus at the University of San Francisco School of Medicine,”competed with the Los Angeles center for being tops in the country.” Her goal in suicide prevention was to encourage officials and others to listen to suicidal people and take their pain seriously. Was it humane, she asked herself, to demand that terminally ill people endure pain they found intolerable in the last days of life?
Over time she became convinced that offering the terminally ill the option of assisted suicide would help prevent death. A hospital administrator asked her to intervene in the case of a suicidal staff member and patient whose cancer had spread. Too often, Ross felt, health care workers discouraged such patients from talking about suicidal thoughts, often leaving them desperate to take matters into their own hands while they still had control of their bodies. “I told the woman, `I know what you’re thinking and you don’t have to worry,'”says Ross.”`When you get sick let me know and we’ll get you what you need.’ It was the assurance she needed to go on.” Some specialists in suicide prevention see such promises as antithetical to their mission of saving lives. But Ross, says Motto, was not an exception among her colleagues.”When you move from the theoretical to the bedside and empathize with what patients are going through, obliging some people to stay alive is absolutely brutal,”says Motto, one of the first professors to teach a course in suicidal depression.”I’ve cringed from being in that role, and that’s when it dawned on me: There are exceptions. Somebody who is living in agony and for whom relief is not available should have the prerogative of ending their life.” It would be years before Ross addressed the issue publicly. In 1985, she took a job as executive director of the Youth Suicide National Center in Washington, returning to San Mateo five years later intent on retiring. But soon California was considering a proposition to legalize physician-assisted suicide, and she signed on to support the effort.
The proposition failed, but Ross felt the issue needed a public forum. In 1994, she become the founding executive director of the Death With Dignity Education Center”to promote a comprehensive, humane, responsive system for the care of terminally ill patients,”including the right to physician-assisted suicide as a last resort.
Many health care professionals have told Ross they favor turning a blind eye when doctors help patients end their lives rather than legalizing assisted suicide. Such a laissez-faire attitude, she believes, is more dangerous than compassionate. “It’s a crapshoot when you get a doctor who goes wink-wink, nod-nod. Any time you can’t talk about something, you’ve got a problem,”Ross says.”Doctors can’t get a consult. You don’t have guidelines pushing doctors to double check every kind of comfort care for the patient first. And the doctor may be unavailable when needed. It’s arbitrary, dangerous and uncontrolled.” Ross dismisses the concern that depressed people will take their lives on impulse. Clinical depression is clearly distinguishable from the pain that comes from facing death, she says, and can be diagnosed and treated. And the safeguards her group is proposing would prevent rash decisions. “You don’t go up to someone who has a terminal diagnosis and say, `Rough times ahead. We’ll help you knock yourself off now.’ You say, `We’re going to do everything to make life possible. Should the pain at the very end become more than you can bear, you can hasten the death. It’s your choice.'” More troubling to her is the prospect of assisted suicide in an age of cost-containment and lack of universal access to quality health care. “I have the same fears that many people have. Our health care system (has) devastating shortcomings.” She takes particularly seriously the fears of the disabled community _ the men and women in wheelchairs who worry they will be subjected to subtle and overt pressure to end their lives rather than use expensive life-saving medical equipment. “There are no simple issues in taking a life or giving a life,”she says.”Disabled people have every reason to be as fearful as they are. They have been treated badly by the health care institutions and they are terribly afraid of abuse. I think the trip from the freedom to die and the duty to die is very large. But we need to be very aware and they are making us hear them.”For a debate of such magnitude, there is remarkably little rancor between most of the opposing parties, and Ross knows that many health care workers who share her goals of improving care for the dying fall short of advocating the legalization of assisted suicide. “And that’s alright,”she told a group of hospice workers during a workshop. All she asked was that they listen to their dying patients. Let them talk about death, she said, even if it means saying they want help in dying if the pain becomes too great. “You may not be able to do what they ask, but listen. Too often we tell people they’re weak if they don’t go in and battle. We don’t listen to their soul, their spirit, the meaning of life for them. “Please,”she said,”listen to these dying people.”
MJP END LIEBLICH
