Ron Kokish

By Ron Kokish

Charlie was 10 the day he came home from school to find his father Hugo dead in their Montreal living room, an empty whiskey glass on the table and a cigarette still smoldering between two fingers. Hugo’s decision to overdose was tragic and understandable.
Fleeing the Third Reich with his wife in 1938, Hugo spent 12 years seeking refuge in foreign lands. His son was born in Shanghai’s Jewish sector during the Japanese occupation, where tuberculosis found Hugo and Hugo found morphine. In 1950, now an addict fleeing Chinese Communism, he found his way into Canada as a “displaced person.”
He was painfully and probably incurably sick. Sufficient amounts of morphine were difficult to obtain. He was begrudgingly supported by a wife who wanted to move to the United States, where she had a sister and several close friends from her Vienna days. Hugo wanted that too, but the United States was not accepting unemployed tubercular drug addicts. Death would free him from unbearable suffering, he thought, while his wife and child would be freed to emigrate to America.
On a late fall day, Hugo overdosed, leaving a suicide note, the contents of which I do not know. Shortly after his death, his widow took Charlie to New York City to live near her dear childhood friends: my aunt and mother. Charlie and I grew up as brothers, a relationship that remains intact to the present day.
Although I believe Hugo’s decision to hasten death was understandable under the circumstances, the way he went about it left his wife with mixed feelings of guilt and relief and his son with a deep psychological wound. Still, knowing the situation, one can understand not only Hugo’s decision, but also the surreptitious way he went about it.
Arranging one’s death with full knowledge by, and support from, loved ones was nearly unheard of in 1950, and hastening death was illegal almost everywhere in the developed world. Regardless of circumstances, it was virtually impossible to openly plan and execute one’s own death with support from friends and family. Arranging this in concert with loved ones is still rare and remains exceedingly challenging. It calls for courage, meticulous planning at a time when planning is unusually difficult and, often, an ability and willingness to negotiate complicated and reluctant bureaucracies. But, thankfully, things are changing for the better.
While many are still averse to allowing, much less facilitating, hastened death, the social taboo today is less powerful than it was when Hugo died with only whiskey and tobacco to console him. Canada, the site of Hugo’s martyrdom, now allows physicians to prescribe and administer lethal medication to mentally competent individuals who are suffering unbearably. According to polls, more than three-quarters of Canadian citizens support the right to hasten their deaths.
Whether Hugo’s suffering would have qualified as “unbearable” I do not know, but had hastening death been legal it would have made it easier for Hugo to include his wife (and, ultimately, his son) in his planning. Moreover, the opportunity to speak openly about why he felt as he did might have reduced his isolation and perhaps prolonged his life.
Medical assistance in dying (MAID) is widely available in Western Europe, Australia, New Zealand and some South American countries. In the United States, we are more ambivalent, with only about half of us favoring a terminally ill person’s right to choose the time and means of their death.
Not surprisingly, MAID availability is left for individual states to manage. To date, 10 states (including Colorado) and the District of Columbia allow physicians to prescribe life-ending medication for competent adults under specific circumstances. About 20% of us live in those jurisdictions. In many other states, bills to legalize MAID are repeatedly processed in legislatures, and the number of states institutionalizing MAID is growing steadily.
However, American MAID laws tend to follow the “Oregon Model,” which is more limited than laws in other countries. For example, a patient must have a medical prognosis of under six months to live and also be mentally competent at the time of death. Since advance directives cannot be applied to MAID, people with oncoming dementia cannot use it to avoid the worst parts of their disease. Since third parties are not allowed to administer life-ending medications, patients must swallow the medication, leaving out people who can no longer do that.
Interestingly, every jurisdiction where assisted dying is legal relies on physicians to be gatekeepers. How did it come to be that we look only to physicians to help us end lives? They are, after all, trained to extend life, not end it. Small wonder that many refuse to prescribe these medications even when it’s legal. Those who do know they are the only ones who can relieve intolerable suffering without risking prosecution.
Fortunately, with forethought and preparation, there are ways to achieve peacefully hastened deaths that do not require physicians to actively participate. We’ll explore those in future columns.

Mature Content is a monthly feature from the Carbondale AARP Age-Friendly Community Initiative (CAFCI)