Way back in 2015, November I think it was, I wrote a blog I called L’Chaim, http://my.telegraph.co.uk/applegidley/expatapple/694/lchaim/ borrowing from the Yiddish toast of celebrating life. In the piece I revelled in being 57 and owner of most of my faculties and all the slightlies – overweight, dimpled, wrinkled and grey! To age is, I believe, a privilege. How wonderful to get to that time in our lives when we can wear purple and yellow together or whatever damn colour combination we like, whatever the style consultants say. How wonderful to see our children become adults, real adults with paying jobs. How wonderful to watch their children.
My acceptance of aging doesn’t mean I don’t occasionally rail against it. I’ve already got a titanium back, if I’m told I need a titanium anything else I’ll get it, if I can see the benefit. What I won’t do is apologise for getting older or agree that aging is a disease to be cured. Aging is to be relished, despite the achy joints, and is made ever more precious and poignant as friends and relatives die.
Dignity is not always associated with dying and so yes, I do believe those facing a dreadful and terminal illness should have the right to decide when enough is enough. We sometimes make the excruciating decision of when to euthanize our pets to stop the suffering, the pain. If we are of sound mind we should be able to make that decision for ourselves, and just sometimes, with caveats in place, for those we love if they have passed the stage of decision making. Whatever the circumstances it is I feel crucial to talk about them.
If we are lucky, the moment comes quickly. As it did with my father. Given a few months to live with inoperable lung cancer, he faced an increasingly painful death. He was a strong man, and philosophical. And yet he died within four days of his diagnosis, for which I am grateful. I firmly believe he decided to let go.
Accepting our own mortality, as the German philosopher Martin Heidegger espoused and which was rather more recently advocated by Harvard surgeon Atul Gawande, is key to living a good life, and dying a good death. It’s difficult subject for most of us to discuss, but as Gawande reported in an article on letting go, “there was compelling evidence that suggested patients and the elderly faired better when sensitive topics had been addressed. Patients reported a better quality of life in their final days, physicians showed a better appreciation of their patient’s wishes and families showed less guilt and depression after the inevitable death.” A separate study out of the Massachusetts General Hospital found those patients who’d had palliative care discussions showed less depression and also ‘happier’ final days.
And that is why I find the case of Patient C, as reported in the British press recently, so compelling even if her reasoning was disturbing. A fifty-year-old woman wished to terminate her life because she had lost her ‘sparkle’. A diagnosis of breast cancer, debt, and a failed relationship, one of many it would seem, prompted the mother of three daughters, one still a teenager, to attempt suicide using painkillers and champagne – the real stuff not just any old bubbly. It didn’t work but did leave the woman with kidney and liver damage from which though she was expected, with treatment, to make a recovery.
Doctors attempted to block her refusal of that treatment. Pyschiatrists said Patient C lacked the mental capacity to make such a decision, labelling her with narcissistic personality disorder. Mr Justice MacDonald disagreed, describing the woman as a sometimes “indifferent” mother, “impulsive and self-centred”. “C is,” he continued, “as all who know her and C herself appears to agree, a person who seeks to live life entirely, and unapologetically on her own terms; that life revolving largely around her looks, men, material possessions and ‘living the high life’.” The woman’s older daughters looked after their mother and did not agree with her wishes, though did respect them.
Patient C subsequently died.
Whatever we might think about the woman’s reason to end her life, her determination to refuse treatment has helped bring the discussion of aging and the right to die into the open, which has to be a good thing. It makes us ask awkward questions about the sometimes messy business of aging.
Are we so intimidated by ‘reality’ television shows often depicting anything but reality for most of us; by creams assuring us of rejuvenation; by pills promising perky bosoms and buttocks or perennial gratification should a man, or woman now so desire; by photo-shopped shots of the rich and famous, so great the very fact of aging is becoming something of which to be ashamed?
We shouldn’t be. We have earned our lines, our silver hair, our occasional lapses of concentration. We have stories to tell. And sometimes death must be discussed. That too is the privilege of growing older. That is not morbid. That is reality.