Final Acts: Death, Dying, and the Choices We Make

The Family Tree

111 VVVVVVVVVVV The Family Tree JEAN LEVITAN I have often made the comment “when the time comes, I’m moving to Oregon.” Oregon is that pioneer state far from my home where the citizenry and medical profession seem to support a person’s right to die . . . to take control of the end of life. I suppose, if I were really honest, I should say that I hope “when the time comes, as Oregon goes, so goes the nation.” But from where I sit now, the policies and politics in the United States make Oregon the exception, not the rule.1 I am the child of two World War II veterans. My mother was an army nurse. My father, much to my chagrin during the 1970s, had been a proud graduate of ROTC, leaving his senior year in college to head abroad and later distinguish himself as a captain in the army. Neither parent has ever gone to any great lengths to share war stories. The story we children grew up with was the romantic one: dad broke his leg in Austria skiing, and mom was his nurse. World War II brought them together, and their commitment to each other has extended over sixty years. I know they each saw horrors. I know my mother cared for many injured soldiers in addition to my father. What I don’t know is whether or not their wartime experiences shaped their pragmatic approach to aging and dying. My mother, in particular, and like her brother who was a physician, has always taken a very practical approach to life and death; she will discuss health-related articles in the newspapers, comment on the decisions of others , and sometimes give historical context for her opinions. On more than one occasion she has advised her children: “Put me in a nursing home when the time comes, if necessary.” With the recent experiences our family has had with my father becoming seriously ill and being moved to a nursing home, my mother seems to have revised that advice. More than ever before she’ll tell me how she hopes “to go in her sleep” or be hit by a bus. Many years ago, as oldest child and executor of my parents’ estate, I was given two separate advance directives, each notarized with instructions as to what each parent wanted if no longer able to voice his or her health-care preferences . I was told where their cemetery plot was located, the name of the lawyer to be contacted at the time of their deaths, and the basic parameters of their will. I put the documents away in a drawer and felt proud that my parents had been able to take such a practical approach to the end of their lives. As my parents continued to age and confront more health problems, they met with their attorney and signed durable power of attorney forms. Those forms would enable me or my siblings legally to use our signatures in lieu of theirs, managing their finances and medical needs when and if necessary . Again, as demonstrated through so much of their lives, my parents were “taking care of things.” I pride myself on being able to think about life and death issues and talk openly about them. I’ve watched friends die from cancer and AIDS; I’ve attended many funerals of loved relatives and participated in both funerals and memorial services. As a college professor of public health, my teaching allows me to approach the subject of death and dying. I’ve tried in the classroom to pass along my mother’s wisdom regarding “being prepared.” I teach students about advance directives; they are encouraged to talk with their parents and other relatives about the end of life. I encourage them to sign organ donor cards, gently kidding them that they are prime specimens. We compare funeral rituals based on culture and background and their experiences to date with death and dying. While I often share my own experiences with funerals, I have yet to tell the stories of my aunt and uncle—two people, from different sides of the family , who each ended their lives when they chose to. Perhaps it is more accurate to say: they ended their lives when they couldn’t stand to live any longer with their illness and pain. From my perspective, my aunt and uncle accelerated the end of their lives, lives that were ending. Others may feel they committed suicide. The...