I knew Riva for more than 40 years. At her healthiest she was less than five feet tall, weighed less than 100 pounds and, when energized or angry, she had the mouth of a longshoreman. Feisty is the word that comes to mind.
When she was diagnosed with emphysema, Riva put up more than a vigorous fight, she seemed to take on the whole world. She fought it for 20 years and lived vigorously during those years.
In the last few months of her life, she was hospitalized for a number of lung related ailments and her weight dropped down to about 70 pounds. She was offered and received all sorts of treatments, procedures and medications at huge expense. During her last hospitalization, finally fed up, she complained bitterly they were “killing her.” She took control and removed the IVs that were providing her hydration and medications. She demanded to be released AMA (against medical advice.) She just wanted to go home and die.
Riva knew of my interest in death with dignity. I was called to visit her and talked with her about her most recent hospitalization. She complained she was miserable and uncomfortable in the hospital, they were causing her great pain and discomfort and they were “killing her.” When I asked what she wanted, she said, “I just want to die. Can’t they give me something to do that?”
We were in California. Not Oregon or Washington—the two states with Death with Dignity laws at the time.
What was clear from my conversation with Riva was her fear of suffering. The medical support to keep her alive was invasive, uncomfortable and medications were making her feel awful. All she wanted was to die peacefully.
I explained to her what I believed to be her options. One option she didn’t have was to lawfully obtain medications to help her to die as she wanted like she would’ve had in a state with a Death with Dignity law. However, she could stop taking in food and hydration and she would soon die.
Riva looked at me dumbfounded. She had never thought of just stopping eating in order to die. She wasn’t a person with limited intellect. In her 70s and early 80s she was in school and earned a bachelor’s degree. She was a poet. She was sitting in her bed as I talked with her, using her iPad to pay bills, searching the Internet, and communicating by email with grandchildren. It had just never occurred to her to stop eating in order to die. The concept for most of us sounds awful—for some, even disgusting. I also assured her if she were uncomfortable in the process, medication could be provided to relieve that discomfort.
As I was leaving Riva, she unconsciously picked up a bread roll on the stand beside her bed, bit into it, stopped mid-bite, looked at me and spit it out into her hand, laughing. Our habit of eating is in great measure an unconscious one and certainly ingrained in our being. Riva had made her decision; she just hadn’t fully informed herself what that meant.
Riva had a couple of really wonderful days after that. She was loving and grateful; totally in control and happy. All of the unhappiness and anger she brought with her on return from her last hospitalization was gone. She said over and over she knew she was going to a good place and she was content with her life as it had unfolded.
In her weakened state, it didn’t take long for her to die. Her daughter spent her last hours in bed with her, just holding her, at home, in control and moving on.
For me, I’m saddened there are so many who believe giving people control over the end of their life is a moral issue. To me, it is a personal issue. For those who oppose physician assisted dying, I understand and support their right to die “naturally” with all the help the medical community can provide to delay their demise if they wish. Were there only reciprocal respect from those who resist turning control over dying to those who are dying and enabling that with compassion.
Whether Riva would have ingested medications to end her life or not I’ll never know. But I do know once she obtained control of the process, she took it, relieved of anxiety, and died with courage and in comfort.
The recent report by a Seattle cancer center of its implementation of the Washington Death with Dignity Act has given me a great sense of personal satisfaction as I’ve witnessed acts of compassion and wisdom in helping people to die on their own terms. I’ll never forget debating a person who opposed the Death with Dignity Act, where the opponent claimed there’s “redemptive value in suffering.” To which I retorted, and with compassion there are the values of respect and empathy.
Riva demonstrated for me the value in providing control over one’s dying process. Suffering—which we truly fear at the end of life—is simply relieved.
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