Tuesday, April 3, 2012

Euthanasia and suicide

On March 29 Charles Snelling killed Adrienne, his wife of 61 years (the mode of her death has not been publicly revealed) and then shot himself. Both were 81.

Charles and Adrienne had an exceptionally loving marriage. He was a successful entrepreneur and inventor who ultimately went into public service. She cared for their five children and then became a fine arts photographer.

Six years ago Adrienne developed Alzheimer's disease. Charles cared for her at home, with 14 hours of help per day. When he travelled for his work he often took Adrienne with him. Charles spoke of their lives together as a love story.

On November 22, 2009, Adrienne wrote to her children:
As you know I have Alzheimer’s. It is not a nice disease. So far I have held up pretty well. Dad and I are still having a pretty good life. There is no doubt where my sickness will end up for me.

All of our lives, Dad and I have talked over our end of life beliefs. We are both in agreement that neither one of us wants to live after all reasonable hope for a good life is over. . . . We have had such a great life together and with all of you.
Several hundred readers commented on the New York Times obituary, creating a kind of Rorschach test of our attitudes about euthanasia, suicide, and the right to control the manner of our own death.

Some condemned Charles:

When people choose to take another person's life, regardless of circumstances, it is a deliberate execution. I say that as a hospice volunteer, a daughter of a fully demented mother with Alzheimer's, and a medically fragile 90-year old father. Life counts until the end.
Some focused on quality of life with Alzheimer's:
For those of you who'd rather be institutionalized than peacefully put out of your misery (given a complete loss of your personhood)--all I can say is that you've either not spent much time in institutions or you have a masochistic streak a mile wide.
For me, the quality of my life is far more meaningful than the quantity of it….
Some saw the murder/suicide as the right way for a loving life to end:
In my mind, this husband was brave, loving and strong. He gave his wife a beautiful gift by allowing her death with some dignity left; a death alongside the love of her life and a death that spared her the worst parts of the Alzheimer's "spiral".

And some withheld judgment:
This is one of those things that I don't think you can understand unless you're in it.
I agree with this last comment. The actual facts about the Snellings' health and ethical beliefs don't matter to those who believe (a) it's a sin against God to hasten death or (b) that individuals have complete liberty to choose their own path. For them there's an irrefutable "right" answer. They "know" whether the way Mr. and Mrs. Snelling's lives ended was right or wrong.

For others, facts matter. Adrienne Snelling's letter to her children certainly sounds as if she contemplated the possibility of suicide and euthanasia. If this was her consistent view, those who call her death an "execution" are doing an injustice to her husband, who was carrying out her wishes.

 But even if you're prepared to see what Charles did as an act of love, not an execution, did he do the right thing? In a New York Times op ed this morning, David Brooks says "no":
Either Snelling was so overcome that he lost control of his faculties, or he made a lamentable mistake. ..who is to say how Snelling would have felt four months from now? The fact is, we are all terrible at imagining how we will feel in the future. We exaggerate how much the future will be like the present. We underestimate the power of temperament to gradually pull us up from the lowest lows. And if our capacities for imagining the future are bad in normal times, they are horrible in moments of stress and suffering.

Given these weaknesses, it seems wrong to make a decision that will foreclose future thinking. It seems wrong to imagine that you have mastery over everything you will feel and believe. It’s better to respect the future, to remain humbly open to your own unfolding.
Brooks is making an important point. In my clinical practice I often spoke with people about the "logic" of their suicidal thinking, and I often argued that the ostensible "logic" was faulty. That's what Brooks is doing in his imagined posthumous conversation with Snelling. This would have been the right conversation for a family member, close friend, or primary care physician to have over time. But even if Mr. Snelling initially said, in effect, "you might be right," at a later time he may well have said "I've waited long enough, and the future you're imagining seems further and further away."

Two years before their deaths the Snellings sent a holiday card with a photograph of them walking together holding hands, with their backs to the camera. A friend interpreted the card as saying they were "going home." That's how I like to think about the end of their lives.

(In December, 2011, Charles Snelling wrote a remarkable essay about his life and Adrienne's condition. You can see it here.)



eric said...

"What if I die before she does?" asked the elderly guardian of my elderly, demented, nursing home patient. She's been waiting two years for the legal process to wend its way to establishing a contingent guardian, if she does die before her ward. She hopes that the new guardian will care as much about her dear relative as she does.
Would that be a life worth living, institutionalized, cared for by strangers, with TVs blaring, alarms beeping, and disinfectant smells? When your partner is gone?
The martyrs of Masada committed murder/suicide to avoid rape and slavery.

Jim Sabin said...

Hi Eric -

Thank you for this comment. It's always good to hear from you.

What a poignant story! The elderly guardian sounds like a very responsible, loving person. She is right to be concerned about guardianship by a stranger. Those arrangements can vary from very responsible and caring to commercial and exploitative.

As longevity, accompanied by increasing incidence of dementia, increases, I anticipate that we'll see societies allowing for people like the nursing home patient you describe to make anticipatory "contracts" for physician assistance in dying if they fall into a state like your patient's. The US will be a follower, not a leader, in this movement. If a person with dementia has a surrogate decision maker who understands her or his values and wishes, the surrogate can work with the care team to "allow nature to take its course."

My understanding of what was said about the Snellings is that they were acting as those at Masada did.