My mother’s physician-assisted suicide

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Bernice Silk

Silk family

Bernice Silk

Bernice Silk

Bernice Silk

In late January of 2011, my mother asked her internist if it would be OK for her to stop eating. The doctor said yes, whereupon she stopped eating and, for the most part, drinking. After two weeks, she died. With her doctor’s permission, she starved herself to death. Why?

My mother was not someone who gave up easily. She had chronic leukemia. She had a pacemaker. She had one kidney. At the age of 79 she had major abdominal surgery for peritoneal cancer, then underwent a second surgery to remove the adhesions that had formed. Radiation and chemotherapy followed. Her cancer went into remission.

A brilliant pianist, she set her mind on celebrating her 80th birthday by giving a duo recital with her friend, the renowned cellist Charles Curtis. She did. The following year, she gave a remarkable performance of Beethoven’s Archduke Trio.

Now she was 83 years old. Her peritoneal cancer had returned. An infection put her in the hospital for a week, leaving her seriously weakened. In rehabilitation, she had a mild stroke, which didn’t affect her mind or her speech but left her unable to read.

She returned to her apartment, spoke with the doctor, and got into bed. We called in hospice care.

In her last days, my mother had her sons, her daughters-in-law, and her grandchildren around her. Friends and other relatives came to visit. She talked with them all, told them what she thought they needed to hear, said goodbye. She planned her funeral, picking those she wanted to officiate and giving instructions for her recording of the second movement of Schubert’s A Major piano sonata to be played. She made sure we knew where the coffee urn was for the shiva. There were stories, reminiscences, laughter.

She slipped into a coma on a Friday, we welcomed in the Sabbath at her bedside, and early the next morning she was at rest.

Hers was suicide by voluntarily stopping eating and drinking, or VSED — a way of death that is becoming increasingly common. It’s legal but for some it’s morally problematic. We learned that the staff of our Catholic hospice agency was going to meet to discuss what their policy should be.

Certainly there’s a difference between VSED and taking a lethal dose of a drug, as 29-year-old brain cancer sufferer Brittany Maynard proposes to do has now done. But I judge it to be a difference in degree, not in kind.

So far as I’m concerned, if there was ever a good death, my mother had it. You’re free to judge otherwise.

  • samuel Johnston

    Some have the courage to do more than just let life and death happen to them.
    Your mother understood Arche.

  • Alan J

    The last line should be augmented: “You’re free to judge otherwise, but you are not free to make that decision for her or anyone else.”

  • Josh M

    This headline inaccurately describes this commentary. This isn’t a story about physician-assisted suicide. VSED is not a form of physician-assisted suicide. What this person did is an exact parallel do a patient who refuses medical treatment. There is a big difference between a doctor who accepts a patients’ right to refuse medical treatment and a doctor who knowingly and willfully actively aids in the death of another person. No one who is opposed to euthanasia would classify what happened here as physician-assisted suicide.

    It makes me wonder what the motive was for writing this. Or at least, the motive of the person that wrote the headline, if it was, in-fact, a different person.

  • My mother wanted and received a physician’s permission to take the course she did; she chose to end her life by refusing sustenance. You’re entitled not to consider that physician-assisted suicide. There are those who disagree with you.

  • P.S. I wrote the headline.

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  • Josh M

    My mother wanted and received a physician’s permission to take the course she did; she chose to end her life by refusing sustenance. You’re entitled not to consider that physician-assisted suicide. There are those who disagree with you.

    Thanks for the reply back. It’s great to hear directly from the author (it rarely happens). First off, I do want to tell you that I’m sorry for your loss. It’s never easy to lose a mother, even an elderly one in her condition.

    I would say that, from my perspective, the physician didn’t have to authority, or legality, to either allow or deny permission. Let’s just say for the sake of argument that your mother asked and the physician said ‘no, you don’t have my permission.’ I would say that your mother still had the right to do what she chose to do, and that it would, or should, be illegal for the physician to then forcefully “shove food down your mother’s throat”, so to speak.

    The same would go even if the physician did grant permission. If for any reason your mother changed her mind after the fact, the physician couldn’t say ‘You can’t change your mind now. Too bad.’ So the physician’s role in this whole affair is unneeded.

    I personally I’m against PAS, so I believe that the physician’s role in these sort of situations (where the patient refuses treatment, and VSED) should take more of an informative role and explain to the patient what her final few days will be like, from a medical perspective and if wanted, or by choice, stay with them until the end. And it does seem, that in your mother’s case, this is the role that the physician took.

    And again, sorry for your loss.

  • Chaplain Martin

    Thank you for sharing your experience with your mothers decision to allow herself to die.
    While I may question your interpretation of physician assisted suicide, his giving his permission for your mother to follow her wishes, empowered her to do what she wanted to do. I’m an elderly man and I have observed how we get so dependent on physicians words/orders, seeking permission for even the slightest of decisions much less such a big one.
    My mother died at 84, when she went into a coma, unfortunately she was sent, (not our choice) to a higher care nursing home than the one she was in, they inserted a feeding tube. Somehow my sister was able to get her in a hospital (where my sister worked). Turned out the feeding tube they inserted at the new nursing home was inserted wrong and actually went nowhere, but the hospital was under the rule that they had to insert it properly, which they did. By the mercy of God she soon died. Thankfully your mother did not have to suffer such indignity.

  • GTO

    My husband and I have lost all our parents, and have observed a variety of incidents surrounding their demise. My mother-in-law could have slipped away so peacefully and easily, if she had been allowed to succumb to the electrolyte imbalance that threatened her several times. Instead, after a devastating stroke, she had a feeding tube, which she pulled out several times during bouts of anxiety. She finally died when the hospital administered too much sedative. My father-in-law drifted away over weeks of declining consciousness, under the watchcare of his family. My father had a horrible open-chest surgery to remove (and move) cancer, which became a brain tumor that dislodged and killed him. My mother was not ill, just bereft. Already anorexic, she stopped eating. It only took two weeks for her to go into heart failure. Unfortunately, her frail, 100 lb body was “revived” with paddles and then kept on life support for days before we let her go. There must be a way to get this right.

  • I’m so sorry about your mother’s death. How fortunate you were to have her as long as you did. Your description of her makes her sound as though she was a fantastic lady.

    Every human being should be able to control the end of life. It’s a terrible shame that we haven’t developed better methods of supporting individuals in their death choices. Other people should not be able to impose their beliefs onto any other individual choosing death. Nor should the medical profession perform heroic measures to extend life if someone prefers to die. This choice should be in the control of the individual.

    It may be that more people are aware of VSED now, but I’m certain it has been used quietly by many people for a very long time. I believe that my mother chose this path, partly in contrast to her mother who had a severe stroke that put her into a coma. Mom was not permitted to ride in the ambulance and had to drive separately. Had she been at the hospital when Grandma was admitted, Mom would have prevented heroic measures. As it turned out, grandma was in a coma for 58 days on life support. When the doctors finally asked the family’s permission to take her off, Mom wouldn’t permit it as it felt to her as though she would be responsible for killing her mother.

  • rob

    my Mom will be 99 and she is not going to die of thirst or starve to death..

  • Emily

    How easy it is for us all to forget that at any time we have the right to refuse treatment. I also agree that the headline is misleading, as none of us need any laws to change to simply refuse to continue treatment or refuse consent to any procedure.

  • Debra L. Mason

    A lovely tribute to your Mom, Mark, and her honorable choice in death. It was wonderful to learn a bit about your Mom’s great gifts and talents. And I agree with the sentiments, 100%.

  • LOB

    I am surprised to read this situation was problematic to the Hospice staff Catholic or otherwise. Given this ladies list of diagnosis and medical history, I think she was arguably “dying”, before she made this decision. To have Hospice intervention, one needs a ‘terminal disease diagnosis’. Dame Cicely’s ( founder of St.Christophers Hospice – founding hospice in modern hospice movement ) approach was always, we will not shorten your life, but neither will we prolong it. Passive euthanasia is legal, perhaps this lady recognised, that if she did not take the decision to stop eating, she may have experienced one more medical event, like a larger stroke (which is highly likely to follow a small event,) and therefore feared she may end up attached to life support etc.. Or maybe she just had no strength left. The difference is subtle, but a really important one. If we take away the physicians right to support a persons choice to withdraw treatment, when they are facing a terminal diagnosis, it could lead to everyone suffering a long, undignified and protracted death. I can’t speak to current hospice practice, but I know we supported peoples decisions about when was ‘the right time’, and respected their decision offering as much information as possible about expected outcomes of withdrawing treatment or providing sedation, which was another decision we also respected. I am glad this gentleman feels his mother had a good death, it sounds as though it was lovely, in her home surrounded by family and traditions she held dear. The author raises a really important point however. When we promote assisted suicide, we perpetuate the fear that there is “no other way” to retain control over our own deaths and I understand why people would want to retain that control. But, if we promote Hospice and End of Life Care, not Palliative care, we will be helping people achieve this end. Palliative care is NOT end of life care, it is a process of treating a symptom as opposed to the medical problem causing the symptom, the process of palliation. In this circumstance, the patient received End of Life care, and would have been offered palliation, to manage any uncomfortable symptoms she experienced therein. Again, it has been a while since I worked in hospice care, but I get the sense that people find the term Palliative, more palatable than End of Life care. It appears to me that the medical profession has itself, got caught up in providing palliative care as a way to prolong life, and unwittingly it has become another way of avoiding the inevitability of death. It is a really dangerous road it seems to me, if we now get these two terms confused too. This lady did not have a physician assisted suicide, she was allowed to die with dignity. A physician assisted suicide, would have required the administration o a drug that would have caused her to die. Two very different sets of circumstances.

  • rob

    though shall not murder..
    a person who chooses never to eat and drink are murdering them selves .

    hope fully a member of one of our Lutheran churches would not do that even at the end of ones life the church still has a duty to discipline its members ..
    murder is never right whether one of our members with hold food and water from others or them selves.

  • cken

    Voluntary termination of one’s own life is not murder. Murder is an act on a person by another person.
    Do you think it is preferable to be kept alive by artificial means and suffer in pain. Unfortunately God doesn’t take everybody quietly in their sleep.
    Life doesn’t end when the body expires.
    Assisted suicide should be legalized for those suffering in end stage illness.
    Although I suppose there are those who would choose to burden the family and suffer in pain for as long as possible.
    Why are we less humane about human death than we are that of the family pet.
    John Lennon said there is no such thing as death, you simply change vehicles. Having a rare end stage illness myself called MDS I am excited about finding what my next vehicle is. Not in a hurry, as I apparently have a few good years left, but I am most curious. I have informed my family my biggest fear is not death; it is suffering and being a burden on those I love for an extended period at the end.

  • cken

    Your Mother-in-law’s situation is not uncommon. Death by morphine is a deep dark secret, far more common than the medical profession will aver admit. It is in part based when your insurance benefits end. If we don’t choose to get this “right” as you so nicely put it; the ACA (Obamacare) is going to get it right for us. I would rather it be a personal decision not the governments.

  • John Turner

    While the comments (and, admittedly, the piece’s conclusion) focus on your mother’s death, I found her late-life goals and willpower inspiring. Thanks for sharing a poignant story.

  • Christine McCarthy McMorris

    A lovely post, Mark. I was happy to have met her, however briefly.
    My mother became unable to communicate after seizures, was pronounced terminal, and we had to make the decision not to use a feeding tube. Much harder than with my father, who not only discussed his end of life wishes with us and made a living will, but appointed a medical proxy. Although it can be difficult we need to talk about these choices with our families.