Headings
The Application of Drugs to Terminate life
Preparation for a Mindful Death
Ways to Commit Suicide
Suicide of a Member of the Family
Comfort for the Dying
A Matter of Life and Death
The Application of the Drug to Terminate Life
The doctor may prescribe the necessary medication, plus painkillers, to keep a person alive but simply cannot ameliorate the emotional and psychological suffering that can overshadow the actual physical pain. Mindfulness, meditation and spiritual practises matter at these times for mind and body, otherwise painful thoughts obscure the depth of enquiry to resolve the mental suffering.
Various diseases can make a significant impact on various parts of the body whether a stroke, heart disease, diabetes or cancer. Palliative care serves to benefit those with a long, advanced, progressive illness but palliative care cannot address loss of functions of body and mind. Doctors can provide a range of strong painkillers but this will not resolve the spiritual and existential issues of life and death.
For example, motor neuron disease leads to a gradual wasting away of the use of muscles through systematic weakness with the disease attacking the nerves in the brain and spinal-cord so that there is a fading away of the capacity to control use of muscles. In time, this affects the person’s capacity to speak, to swallow and eventually to breathe. Those who support assisted death or euthanasia will sometimes describe the support to end life as the final expression of palliative care.
The primary drug used for euthanasia is Nembutal – often used to euthanize animals. Some refer to Nembutal as ‘death in a bottle’ since those who choose self-exit will acquire a bottle of Nembutal from places like Mexico. The person will mix it with a drink and die a relatively painless death. This form of terminal sedation has much appeal to those desiring self exit since it leaves the person appearing relatively peaceful in death.
The pharmaceutical industry regularly put out information at the latest breakthrough in medicine or the capacity to develop a medication to solve a particular disease within the space of a few years. These reports give hope of a dramatic breakthrough relatively close at hand. Some people might yearn for the medical establishment to provide them with the latest medicine. If unavailable or too many years away, the attraction towards termination begins to grow. Long-lasting pain and unhappiness function as the two factors, physical and psychological, to motivate a determination to bring life to a close. A tiny number takes steps to end of their life without any current major physical or mental health issues. They simply have no wish to live any longer.
Preparation for a Mindful Death
A friend in Totnes, Ursula Faucett, 87, a psychotherapist, a founder of the London Gestalt in the early 1970s, has attended numerous retreats at Gaia House in South Devon and is a member of the Diamond Heart Approach to psychology/spirituality. She regularly shares her views on death. She kindly wrote an article on death for my Dharma eNews. She told she could not wait any longer for the government to give legal support to doctors to assist in death. She plans a mindful end to her life. Here is an extract from what Ursula wrote:
“Words are so important: we need a new word for a do-it-yourself exit strategy. My hope is to act when I hear my familiar still small voice guiding me. We are not just bodies. We don’t need religion to recognize the power of love.
“Even if thousands of people feel like I do, it would still be illegal for them to give me a prescription to end it all when I hear that calling. In some conditions informed fasting can be a gentle way to go.
“Yes, I believe I will know when my time has come. I have discussed it all with my family and they are totally with me in my decision to die when I feel it is right. I am very aware that this also involves them and many others. It is important that I feel at peace with my dear ones, that all is forgiven and there will be no regrets when I am gone.
“Hearing the call, knowing that the time has come, and having the trust that it’s true and the courage to say goodbye, requires fundamental faith. Ideally I’d have a party the week before!
“Realistically, I probably won’t be in a fit state.
“I have my pretty box of ‘goodbye pills’. I am fortunate in having friends who would risk the law and sit with my dying body.
Ursula has given much time to reflect and meditate on death. She has discussed with her family her attitude to death and attended meetings of Death Café in Totnes to listen and talk with others on issues around dying and death. She has also made the necessary arrangements for her funeral. Ursula has invited family and friends to see her corpse for their reflections and meditations.
Ursula has made her funeral arrangements. She will be buried three miles from her home at Sharpham Meadow Natural Burial Ground. The Green Funeral Company take care of the burial area for the Sharpham Trust, a non-profit charity. The trust offers an ecological alternative to traditional burial or cremation. Ursula’s caring approach to death shows a mature response to death and deserves widespread attention to inspire others.
Ways to Commit Suicide
Unlike the final sedation for self-exit, the person who commits suicide may suffer from intense expressions of emotional and psychological stress that can drive him or her to pursue a violent end to their life. Some experience a catastrophe or a series of catastrophes with all pathways and all doors to resolution seemingly closed blocking any kind of resolution. Death then has a greater attraction than life.
There is a desire for non-existence over existence. The pressing and unresolved desire for non-existence can bring about suicide for all ages and all manner of backgrounds and cultures. People engaged in fields of violence continue to be more vulnerable to inflicting a violence upon themselves through lack of support, counselling and care for their circumstances. Soldiers and civilians in war remain particularly vulnerable to despair and taking steps towards self-harm.
More US soldiers have died through suicide than died in Afghanistan owing to wounds, trauma, loss of comrades, frequent deployment, clinical depression, bullying, marital conflicts and separation from family and friends. Aged between 18 and 24, young soldiers commit half the suicides. US Department of Defence estimates that on average 18 US soldiers who have left the army commit suicide every day. Once they have left the army, they become largely forgotten and left to themselves. They are left with their traumas and wounds. Soldiers deserve better.
I remember the head of a psychiatric unit in the EU telling me of the determination of one of his patients to commit suicide. The doctors and staff did everything possible, week after week, so that she would not engage in self-harm. They offered as much love as possible, held many sessions of counselling and took steps to ensure she could not have access to instruments to kill herself.
Eventually, she found a way to kill herself. A year or two later, I wrote a poem on the sad event. It is very, very hard to change a person’s motivation when the mind stays totally set on a certain course of direction to end their life.
GOODBYE TO THIS WORLD
She hung herself. With washing line,
and a chair she had climbed on,
a goodbye to one, all alike,
and stood there from the beam anon,
before she stepped in emptiness,
it was the final use of her chair.
They found her there in laundry room.
Still. With swollen eyes and limp hair,
with fearful glances on the ward.
She had waved goodbye to this world,
her desolation as reward.
They lowered her down to the earth,
she had surrendered to the force
and they bore her away her girth,
wrapped her up in unused white sheets.
Poor souls were left behind in shock,
and a flurry of whisper meets,
where wise counsel and kind words
never match for the act of will.
A hand with pills and meaning blurred,
games and TV to no avail;
staff sat on chairs day after day,
to let buckets of care, prevail,
when no love can find its access,
she is left with neck’s raw red ring,
with the door locked to one more day,
a composed act to end breathing.
Never before has she been touched
so sensitively by such caring hands.
Some people say that it is easy to commit suicide. They say a person intent on suicide does not have to wait for the legalisation of assisted death or euthanasia. People do attempt to kill themselves and adopt various methods to die. They kill themselves with a bullet to the head, a plastic bag over the head, a jump off a high roof. People who commit suicide throw themselves under a train, hang themselves, electrocute themselves, cut their wrists, sit in a car and fill it with carbon monoxide fumes, overdose on drugs, drown themselves or take poison.
One person gave me a personal account on a retreat in the USA of his attempt to commit suicide. He had a history of drug problems. During a time of severe withdrawals, he really wanted to die. He bought a water pistol, booked a room in a hotel and started screaming out that he was going to kill somebody. The hotel called the police. He sat upright on the bed with the gun pointing at the door. He knew the police would break in with guns cocked to fire. With the gun in the hand pointing at the door, he believed the police officer would shoot him in self-defence. The addict told me he survived because the police officer kept the first chamber of his gun empty so he would not fire on impulse. That split second save the life of the addict. The addict told me the police officer wet his pants in the intensity of the moment.
Figures show that only one in 20 who attempt to kill themselves actually succeed. Some attempted suicides result in physical handicaps, brain damage, burns and scarring as well as becoming stricken with feelings of guilt or failure. Some lose the capacity to live and also lose the capacity to die. Others feel grateful that they survived their attempt (s) at suicide and to start to get their life back on track.
Assuming that the outcome of these deliberate attempts to commit suicide are successful, the police, ambulance services friends and family may well have to face a terrifying shock on seeing the body, often in appalling condition after a suicide.
The majority of people die a normal death in the presence of family and friends whether at home hospital hospice. Some go to die in a remote place in the nature. Small numbers die from accidents
Comfort for the Dying
he right to choose one’s time and place today with such a drug as Nembutal gives certain comfort to those who cannot tolerate any more pain or physical deterioration or the gradual collapse of the mental faculties. Some people have travelled to parts of the world when Nembutal is available. They have purchased a sufficient amount and keep it hidden away at home in case they should need to use it at some time in the future.
Some experience comfort owing to their belief in their God. They decline to use any medication to end their life. They believe that after death they will go to Heaven for eternity to be reunited with their loved ones. We should respect these deeply held beliefs and the support they provide for the sick and the dying. It is an arrogance to dismiss such views of such an afterlife, even if we don’t hold to them. Peace of mind matters more than being politically correct.
Doctors report on numerous patients, who remain happy and satisfied with palliative care., Owing to their receptivity to kindness, such patients very rarely ask doctors to hasten their death. Those who find themselves moving towards the end of their life will often decline to take food and water as the body slowly begins to wind down. This is a natural process of moving toward the last breath. Unfortunately, some medical staff will force liquid intake rather than respect the final stages of life.
We need to talk openly about dying and death. Some people cannot bear the thought of death and bring death into the conversation because of fears that get exposed. There is a phobia of death in society; the desire for goods, money position and continued existence carries with it the denial and resistance to non-existence, to death. There is a dread of death because it is so hidden from the presence of life.
We need to expand our communications to address pain, dying and death. We might start or attend a local Death Café or End of Life group to share our concerns and current feelings about the end of life and listen to the perceptions of others. Communication is critical for the outcome of a good death. The loving engagement of patient with doctors and families and vice-versa serves as a huge step in palliative care.
Doctors have to make regular decisions on whether the quality of life of patients should be maintained. They may decide to allow the patient to reach the end of their life rather than use every method to keep the person alive. Doctors will say that they are not responsible for the killing of the patient.
Many doctors offer immense kindness and empathy to their patients clearly showing their deepest interests at heart. Some doctors may fear to talk openly with their patients about end-of-life issues because they have a Fix it mentality. Doctors need to open up more and more to the patients and listen to their voices rather than being the determinants of their present and future.
I sent a reflection on suicide to a follower of the Dharma after her son’s partner committed suicide following their separation. I have changed her name to Angela.
I wrote: “The world and self can never find any sustainable integration. Struggle and acceptance often functions as the norm. Death, whether through the intentional form or not, makes little real difference to the underlying circumstances that trigger the resignation of the self and its sudden exit.
As you witnessed, and continue to witness, Angela’s termination of presence leaves behind for some a realm of unhappiness, despair and anger, and further expressions of a vulnerable and reactive anguish to Angela’s departure, and the manner of it.
Those with intimate knowledge of unfolding events, noticeably family and close friends, have to deal with her struggle to make sense of it all, and the apparent senselessness of the act of termination. There is task of understanding why Angela saw no further reason to live in her world.
Loved ones will ask why? Why? Why? But the loved one’s were not in her world, and the presence of loved ones in her world had become marginalised as the self-withdrew itself from the familiar, and into the unknown through to the final act.
The wish, the desire for non-existence, functions as the potential for our species when the self no longer sees fit for the constructed world that it knows.
The world and self never have real ease, never knows real harmony, nor long standing co-existence. As human beings, we have to take responsibility for our lives, for the manner of its unfoldment as much as possible, and acknowledge as fully as possible, that Angela’s has acted within her circumstances.
It is hard to know whether it is an act of desperation or a quiet determination to call it a day on the dynamics that formed her existence.
We extend our love and kindness for her, her family, her loved ones to the degree that it transcends the sad circumstances that formed the event. Our condolences are with you all today at the funeral. There is a day-to-day adjustment-taking place at every level of being for the renewal that makes life worthwhile and pays respect to those who take a different view and act on that view.
Another person wrote to me. Her brother made a serious attempt to commit suicide. She reported the difficulties for the whole family to cope with the situation. I wrote:
“Thank you for your e-mail. Yes, I remember our inquiry. This is a terribly difficult situation for you, your family, and for your brother.
It would appear from your e-mail that life has offered him a second chance. For some people, the emotional pain is so hard to bear that there is a desire to transfer that pain onto the body – hence the attempt at suicide.
Your brother needs your support and from the rest of your family, and all those around him, so that he experiences as much love, a deep abiding love and care, as possible.
It is obviously not the time, nor in the foreseeable future to ask questions of him, to try to understand the motives, conscious or unconscious, but to ensure that he understands that you and others do deeply care for him – without feeling sorry for him, nor pity for him, nor angry with him, so that your love and presence reaches him through a variety of means.
Stay steady. Take one day at a time, be outside in the nature or parks as much as possible for inner renewal, so you meet him with confidence, presence and happiness.”
A Matter of Life and Death
A day to day capacity to let go of any kind of holding onto people, issues, forms, things and circumstances prepares the way to letting go of life and death. On first appearance, the difference between life and death seem stark. Differences intensify through holding to one and resistance to the other. A noble life reveals itself as a fulfilled way of being. Death becomes the final rounding off of the movement of life rather than something to resist.
In a fulfilled life, the heart and mind no longer yearn for more experiences, spiritual, religious or secular, nor can one think of anything missing, nor think of something more to add. Death becomes an issue, an area for resistance owing to the desire for more than what has been known so far. Do we need to possess more? We can ask ourselves whether we really need to see, hear, smell, taste and touch more. Do we need more feelings, thoughts and experiences?
It is not so important that we have a long life or a short life or a life interrupted with sickness or injury. Our capacity to go deep into the field of experience through the inter-action of consciousness with heart/mind senses for a single day matters more than a long life with numerous dissatisfactions.
There is the capacity to apprehend the fullness of things. Accommodation of life and death reveals an ultimate wisdom which knows deeply a contentment with life. Fears of mortality and desire in any way for immortality fade away.
There are no walls to liberation and no limits to waking up from the belief in imprisonment to life and death.
May all beings see into life and death
May all beings live in peace
May all beings know the freedom of non-clinging
Next: Part Four of Four
Very beautifully written post. Thank you very much.