Sunday, 10 July 2011

Sunday Mornings: Coffee, Reflections and Music

In Terry Pratchett's recent documentary 'Choosing to Die' the author says at the very beginning: "Sometimes, particularly when I'm depressed, I dread what the future may hold. And it's occurred to me that in these modern times one shouldn't have to fear that sort of thing." Terry suffers from Alzheimer's, a condition characterised by memory lapses, confusion and emotional instability. The process is irreversible and the result is loss of one's mental abilities. In our 21st century, as Sir Pratchett avers, we should be able to deal with this kind of malaise. I'm not talking about the total elimination of it, though, that, I think, is still light-years ahead. After all, nature is the smooth operator steering the wheel and as we well know nothing can stop it, but at least let's ensure that sufferers have access to the best care possible. Including the most humane. Terry is of the mind that one of the available options should be assisted suicide. He wants to be able to decide when and where he should die, possibly aided by a loved one without any legal repercussions for him or her.

Terry's dread, however, is not just shared by those afffected by Alzheimer's. About the same time his documentary premiered on the BBC, the news delivered a couple of shockers. One concerned the alleged attack on a female resident at a care home by a male worker. The other one was about Southern Cross, Britain's biggest care homes operator and its struggle to stay afloat because of its inability to pay its rent.

All these items are related in the end: Terry's support for assisted suicide, the way some elderly people are treated in care homes, and the financial constraints under which many of these residences find themselves in our economically straitened times.

Would a person think of ending his or her life all of a sudden, if there was any hope of dying when "their time came" in a dignified way, surrounded by the people he or she cared about and who loved them in return? I don't think so. Would a person feel so despondent to the point where death would be a welcomed, soothing balm if we, as a society, showed him or her that we cared? I have my doubts about that. And yet, here we are at a crossroads: one arrow seems to point at a third age where, in order to be cared for properly, one will have to sell their own home; a second sign leads us to Dignitas, the famous Swiss assisted-dying group that helps those with severe physical and mental impediments die. And even that option is chiefly available to the well-heeled. The third prong of this fork forces us to confront an image before venturing down its path. It is the future to which some of us will be subjected: bad-tempered nurses and care workers leaving us in sodden beds for days on end, denying us food and water when we want them and abusing us physically and mentally when we dare to protest. Ironically the only company for whom 'Dignity' is paramount is the one trading in death when, really, the (still) living should be the ones accorded the respect and decorum they deserve.

I agree with Terry's stand on assisted suiced and, after having watched the programme, I came away thinking that should I fall prey to a terrible and terminal disease, I would like to have the right to end it all when and where I wished. If I was incapable of doing so myself, however, I would like my long-term partner to do it for me. What better leave-taking present than to die in the arms of the wife whom you so much loved and who returned the same affection in equal if not larger quantities?

But at the same time I can't stop thinking about what would (or will) happen if I ended up in a care home. In the same way that society - and that includes me, too - benefits from my contributions to it, be it through my taxes which help fund our cherished NHS and our schools, or through my cultural input as an immigrant, I would like that contribution to benefit me in my twilight years. Quid pro quo.

To be clear, not all care homes are like the Ash Court Centre, the scene of the alleged assault on the elderly female resident. Nor are our care workers 'Nurse Ratched' wannabes salivating at the prospect of inflicting pain on unsuspecting and vulnerable OAPs. The majority of them do a commendable job, sometimes under dire situations. Frequently for very little financial retribution. But when money comes before our human principles, then it shouldn't surprise anyone that scandals such as the one engulfing the Kentish Town-based institution break out. In order to maximise profit safeguards and checks are sometimes overlooked and staff hired with a cost-effective business plan in mind instead of a palliative one. Faced with this between-a-rock-and-a-hard-place situation even I would be on the Easyjet website trying to book a one-way ticket to Zurich.

As Terry says in the documentary there are plenty of people in the UK who are against assisted suicide. Some of them on moral grounds, and others on religious ones (ha, surprise, surprise!). I understand the motivation of the former. Helping someone die can become an excuse for unscrupulous relatives willing to take advantage of a frail person who is no longer capable of making decisions by themselves. But I, naive and gullible human being that I am, think that the immoral brigade will always be outnumbered by the principled one. Plus, not everyone has the dosh to top themselves off against the backdrop of the magnificent Swiss landscape.

In the end, it comes down to death per se and how we deal with it. In a totally unrelated article in the paper the other day the writer Karen Armstrong remarked on this very issue. According to Ms Armstrong 'we prefer to speak of somebody "passing away" and push the dying out of sight into hospices and nursing homes.' What's clear to me, too, is that we still can't make up our minds as to what to do with this - growing - elderly population. If they want to bring their lives to a halt, either themselves or aided by a loved one, that's to be frowned upon. If, on the other hand, they insist on living longer, then that's also wrong because who'll foot the bill for their care? No wonder Roger Daltrey was singing in 1965: "I hope I die before I get old". What I would like to happen in the next few years is that today's twenty-year-old, on coming across with the The Who's famous song, will be able to say confidently three decades henceforth: "That's a lot of old bollocks. I love being old." And when he/she dies that they do so with dignity.

Terry Pratchett's documentary can be seen in its entirey by clicking here. Please, be aware that it contains distressing images.

© 2011

Next Post: “Pieces of Me, Pieces of Havana”, to be published on Wednesday 13th July at 11:59pm (GMT)

The Who- My Generation 12-17-82 from Christopher Petrilli on Vimeo


  1. Being "civilized" should include being able to live and to die with dignity, both.

  2. Every person has the right to dignity in life and in death. But, as you have mentioned, one of the issues with legalizing assisted suicide is that the person in question, too old, too weak, too weathered, might be taken advantage of. The pros and cons of it are a delicate matter. I also think the 'greedy relatives affecting suicide' percentage might differ from country to country, society to society. So perhaps, the lawmakers should take into account the characteristics of their society if and when they legalize this.

  3. Tough issue. By faith, it is not man's right to end his life. Yet it is by man's medicine that life is prolonged and extended. Or perhaps not totally.
    What's stopping us from letting nature take it's course?

    As the population ages, I forsee that man will have to decide for man if the system(state or family) cannot cope with care of the elderly - to set up the criteria and laws for this 'entitlement'. This will most likely be decided by the availability of money and resources. That would be a sad day.

    Can one human expect another to help carry out that termination. It is painful to see one suffer but is it fair to impose it?
    Who will carry it out?
    I 'm just beginning to think of the endless qualifiers and conditions.. ramifications. We could go at this from different aspects.

    But ultimately we should be allowed to die in the way we wish to.

  4. Cuban, I'm not surprised by your view of assisted suicide, so well-stated in this excellent post. But the part that made me stop and really think began with 'Would a person think of ending his or her life all of a sudden, if there was any hope of dying when "their time came" in a dignified way, surrounded by the poeple he or she care about and hwo loved them in return?'

    This, honestly, came as a revelation. I believe assisted suicide should be legal, but I realized after reading your words that I have assumed that there will be no one to look after me, that there will be no 'going gently into that good night', and that the end of life is simply something to be over and done with.
    And isn't that wrong??

    This is quite troubling. Reading what you had written in that paragraph brought an image to mind of another world, one where the elderly are respected and helped and loved, and makes me question now why we have ended up as we have, warehousing our old folks. My parents died in care facilities, very fortunately of good quality and staffed by compassionate, competent people. But we, the family, were - for the most part - absent. Due to distance in two cases, but also a certain attitude that our ongoing lives were ore important than their terminal ones.

    You very often make me stop and assess my own views on a wide variety of topics, but I did not expect to be challenged on this one. I thank you for the re-think you have provoked.

  5. Cuban, thanks to blogger going AWOL, I've just lost a long, long, l-o-n-g post on a variety of aspects discussed in your post. I haven't got the heart to try to recapture what I said. I'll just rewrite the last paragraph

    Have you seen the brilliant Spanish movie The Sea Inside starring Javier Bardem? Based on a true life story of a man who struggled for years to be helped with an assisted suicide. Heart rending and thought-provoking movie.
    Judy, South Africa

  6. I read the Terry Pratchett's post a week or so ago. I'm not sure what to think. We used to die so young just a hundred years ago. Medicine and the richness of our nations have made it we can live well into our years. Crazy how the problem is living too long with illness now. I had a friend who worked at a nursing home, the owner took advantage of the elderly. Over medicated them to make them sleep longer, eat less, therefore changed the bed pans less. The less care a patient needed, the more patients the home could have. Everything done was to reap every single last dime from the families. It was horrible. I suspect many nursing homes are this way. On a good note, most of the nurses were wonderful and enjoyed their jobs.

    Thoughtful post as always.

  7. It's a very difficult issue.

    I believe that everyone has the right to dignity whether they're alive or dying or dead.

    I also feel that the way the elderly are removed from society and stuck in care homes, away from their homes or anyone who loves them is awful and is a reflection on our own declining values as a people.

    At the same time, I think of the ramifications of assisted suicide and think that it would be a dangerous thing. Apart from the obvious dangers, there are other issues here. For example, even if the patient wanted to die and their relative understood that and helped them, what about the after effects on that person who helped them die? What about the doctor who prescribed the medicine? What about their children, who know that one parent killed another? What about their conscience, knowing that they participated in someone's death?

    Is it not selfish to want to die but not think of the pain that's inflicted upon those left behind?

    At the same time, I see that those who suffer crippling constant pain should be given an option.

    I don't know what the right answer is. I don't know if there is a right answer.


  8. Many thanks for your invaluable feedback.

    Sometimes I feel as if I have a third eye with which I can look into the future. And it's not a comfortable feeling, I can tell you, for what I presage is not good omens on many occasions, but bad ones.

    I began this post a couple of weeks ago after watching Terry's documentary on Catch Up on the BBC iPlayer. I wrote about Southern Cross without realising that today the news delivered yet another shocker concerning the company:

    Jai, your comment made me think a lot. Purely because I've just realised that my post is written in the first person singular and when I write about dying surrounded by loved ones, I think of me dying, not somebody else. How selfish is that? Your words have made reconsider some of the opinions I expressed in my column, however, when it comes to having a legal framework that won't have a negative impact on those who want us to die a painless death and for whom this process is, contradictorily, part of the "caring process", then, yes, I want the law to be on my side.

    Deborah, your response also came as a revelation because of what I explained before.

    Judy, I've heard of the Sea Inside and have it in my lovefilm queue.

    Jodi, ditto in the UK, but as I mentioned in my post, not all care homes are the same and not all staff are heartless. In fact, I have nothing but praise for the hundreds if not thousands women and men who look after the elderly, the infirm and the mentally unstable.

    Judith, I couldn't agree more.

    SG, yes, I agree, too, it's a different situation in other countries. I could never see this discussion taking place in Cuba, for instance.

    Being Me, living is tough. That's what makes it beautiful. But painful, too, sometimes. :-)

    Thanks for your comments.

    Greetings from London.

  9. I believe in assisted suicide. Like having "the plug pulled," it is something that you should be able to put into a legal document suitably ahead of time (perhaps six months or a year previous?) except in cases of sudden physical illness which would warrant sooner decision-making.

    I would support any of my loved ones with that decision. Part of this comes from the events that led to my mother attempting suicide multiple times. I can't help but think it would be far less traumatic for our family if my mom could have had an assisted suicide surrounded by her loved ones with a simple and easy death, instead of my twelve-year-old brother walking in on her vomiting, bloody body over and over as she tried so desperately to die.

  10. I think that every person should have the right to chose. I worked in extended care facilities where the elderly "lived" if you could call it living. Many had no facilities left; they were living corpses, kept alive by tubes and machines. I've also seen other facilities - ones for the poor - which are right up there with the poor houses of Dicken's day in the way that the elderly are treated. Here in the US, it's all about the money, honey and if you don't have the money and need nursing facilities in your old age, the prospects are very grim. I also so people dying of incurable illnesses, denied drugs because they might become "dependent," -- as if they had to suffer for the month or two of life left because of our strictures against morphine. Oh, the health care business is riddled with contradictions. I've told my family that if I can't live my life the way I want, take me to the bridge and throw me over. I can't imagine a worse ending than laying in bed, stuffed with tubes, while medical bills eat up my life's savings.
    Modern medicine has created a Frankenstein monster and while we worship the technology, we can't deal with the difficult ethical decisions.

  11. Thank you ever so much for your kind feedback.

    Greetings from London.

  12. Namastenancy, you make some seriously good points. I agree that so many things about modern healthcare are contradictory and senseless. Especially in America where it's all about the money.

    It doesn't make sense to keep someone alive and living on tubes, especially when they don't want to. It's not even natural, if you were to think of it from a Godly point of view. At the same time, it's the 'Godly' people who argue that people should be kept alive regardless of what their state of living is. The irony is staggering.


  13. Hi Cubano--I saw the image of Pratchett and could not resist checking this out--although I love your immigrants post--really interesting and moving too--but I simply have loved Pratchett for so very long--I have probably read about 40 of his books and many of those at least forty times--I think more--he has been a fixture of my life and my children's too. I was so very sad about his death. I don't think I could bear the documentary. At any rate--keep up your own wonderful writing. K. (Manicddaily)



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