In its recent vote to overrule Oregon's first-in-the-nation law permitting physician-assisted suicide, the Republican House of Representatives showed its usual heavy hand in dealing with delicate social issues. There was major hypocrisy, to say the least, in conservatives' sudden discovery that some issues are too important to be decided at the state level. But it's hard for me to shake an increasing sympathy for the ethical imperative on which the House was acting.
My mother was a great advocate of the dignified exit. As she neared 70, she gathered a collection of books from the Hemlock Society, polished her living will and joked about having a friend dispatch her with a pillow if she ever languished in a nursing home. Once, when I sought to probe a little past her jokes and brisk comments, she gave me a look that I saw only half a dozen times in my life with her: unguarded, unvarnished by good manners. "Don't you know?" she asked. "Whenever there's no one your age around, that's all people my age talk about."
But it was her death, from liver failure, that overturned my settled assumptions about assisted suicide. As far as I am able to say, my mother's was an "easy" death. She wasn't in terrible pain. She was at home, in the house she had loved for more than 35 years into a place of comfort and grace; she was surrounded by her three daughters and a group of women friends who tiptoed in each day with small offerings of the spring flowers that bloomed just in time. She had all the comforts and care it is possible to buy, and, in her hospice nurse, the good fortune that has no price. From the time she entered hospice care to the morning of her death was a little under three weeks.
Yet even this short, kind end was excruciating to be a part of. She looked, at the very least, miserably uncomfortable. On the days when she unexpectedly drifted back to us, out of her semi-coma, she seemed to want something nameless, out of our power to deliver or even guess. Her dying seemed, during those weeks, an endless state, a slow, inconsistent progress that made each day open before us with dreary mystery. The nurses would tell us what we might expect, from the clinical (the cooling of the extremities that would signal the slowing of circulation) to the superstitious (pets, one nurse told us, sometimes come to lie down with an owner when death is imminent). The childlike intensity with which we, three women in our forties, watched for these signs--Look! The cat is on the bed! No, Annie brought him up and put him there earlier--told us how painful it was to drift through a crucial passage that was so entirely beyond our control.
Later I found things in that time to value: the privilege of caring well for her, the tenderness of the bond I shared with my sisters. But as we lived it, we felt most clearly our powerlessness. It was so big, that feeling, that I began to wonder if human beings can really be trusted with the suggestion that there are ways to make the process manageable, to combat the losses of autonomy and control that are the essence of death. You bear the unbearable, in the orbit of a loved one's death, because you have to. If we come to believe that we and our families can sometimes be spared that, how many of us will be willing to endure it at all, under any circumstances?
This concern is somewhat borne out by the Oregon Health Division's report on the first year after passage of the state's suicide act. Of the 21 persons who secured lethal prescriptions from their doctors in 1998, 15 of whom went through with their suicides, only one cited the fear of intractable pain. More than anything, these patients cited concerns about "autonomy and personal control." Advocates of Oregon's system point out that it includes an elaborate series of safety mechanisms, of waiting periods and second opinions and witnesses not related to the dying person, to ensure against family pressure and medical cost-cutting and all the other obviously sinister temptations that are said to lurk at the bottom of the slippery slope.
But I wonder now if it is that very structure--the sensible, humane, normalizing particulars by which suicide is enshrined in social policy--that constitutes the threat, because it offers such reassuring authority to anyone who might be tempted to manage death away.
In other words, to us all. I can easily imagine circumstances far worse than my mother's. I wouldn't dream of judging anyone--physician, patient or family--who privately chose to end or help end the unendurable. But officially, publicly, in the open realm where our norms develop, I hope we continue to honor the assumption that death is the one matter that is out of our hands.
Marjorie Williams, a former Washington Post staff writer, is a contributing editor at Vanity Fair.