Dying with dignity

My wife bought me this little book for Christmas, "Tuesdays with Morrie" by Mitch Albom. Apparently it was (is?) quite a bestseller, and there was even a movie  based (loosely) on it, under the same title. The book is mostly an account of 14 conversations the author had with Morrie Schwartz, his favorite professor from his university days, who had been diagnosed with ALS ("Lou Gehrig Disease"), and who eventually succumbed to the disease after a 6-month struggle.

 Although "struggle" is not a good choice of a word here, considering that Morrie didn't seem to be "fighting" the illness so much as accepting it, even learning from it. From the vantage point of a man with an irrevocable death sentence, Morrie is dispensing wisdom on everything: from culture, to marriage, to emotions, to money, to death. This book moved me and annoyed me.  It moved me because I could not help but admire his nearly stoic attitude toward his terrible physical deterioration and the suffering that came with it - not that it would necessarily have been my choice in similar circumstances.  

The sense of annoyance came from many angles. Only a small part was caused by the fact that a lot of the wisom being passed onto the reader was pretty trivial and terribly cliché: money doesn't buy happiness; we will all die eventually; having a sense of purpose in life makes it worthwhile; family and friends are very important; we are living too fast; ours is a materialistic society; etc. After all, having had these pearls of wisdom repeated ad nauseam doesn't make them less valid.

What frustrated me the most didn't even have to do anything with Morrie himself, or what he said. It was this: here's a sweet, smart, old guy, who made the choice of waiting for his death, of enduring whatever pain and indignity were thrown his way. He also made a decision to be increasingly dependent on others, including having his ass wiped. (He feared that moment, considering this a kind of a threshold of humiliation, and yet he quickly adjusted to it, even... enjoyed it to some extent, comparing his dependence to that of a child...) He was celebrated for it - NBC's Ted Koppel interviewed him three times, at different stages of the disease. Scores of people came to visit him, many more wrote him letters. Obviously, he inspired a lot of people. That's great. But what about the people who want to make a different choice?

 There are those of us, who don't want to follow Mr. Schwartz's path, passively waiting for nature to take its course, in whatever cruel manner it chooses. Those, who would prefer to choose the moment and maner od their death themselves. Isn't it a legitimate and noble choice, worth celebrating? The book talks about the kind of dying that allows to say final good-byes, and be surrounded by one's loved ones while doing so. If that's so desireable - and it is - what is then wrong with saying good-byes and then quietly and peacefully taking one's own life?

People who help a dying person by adjusting his pillows, tending to his sores, dulling his pain with potent painkillers, and  yes, wiping his ass, are admired as persons of compassion. Rightly so. At the same time those who would help that person die with dignity by committing suicide are treated as villains, threatened with jail. Why is one kind of compassion better than the other? Why isn't it considered an inalienable human right to refuse to endure the pain and indignity of a terrible illness? We have laws against torturing people, and would applaud if someone helped a victim of torture run away from his tormentors. We would condemn a doctor working alongside the torturers, who is making sure that the victim doesn't die prematurely and will be able to endure more pain. Why is then OK for nature to torture people and for doctors to be enablers, who prolong the agony?

I know, there are guns, and rope, and poison, and sharp blades, and plastic bags, and tall buildings, and myriad other ways by which people can kill themselves if they want to. But what if they can't? What if they are paralyzed and unable to pull the trigger, unable to get to the top floor of a parking structure to jump off from? And what about the dignity? There is nothing dignified in a wife coming home to find her terminally ill husband with his head blown off. Or hanging from the rafters in the garage.

Of course, there is the "slippery slope" argument: if we make dying nice and easy, will we start nudging at first, and then pressuring ill people toward that easy way out? And what about those suffering from depression, who would now find it so much easier to act on their impulses? Those are legitimate concerns, but shouldn't our advanced society be able to address them? Shouldn't we at least start talking about ways of addressing them?

Tellingly, even Morrie had his limits of acceptance. In his final interview with Ted Koppel he mentioned

 "other people who suffered from ALS [...], some of them famous, such as the brilliant physicist Stephen Hawking [...] He lived with a hole in his throat, spoke through a computer synthesizer, typed words by batting his eyes as a sensor picked up the movement. This was admirable, but this was not the way Morrie wanted to live. "

 What if he was dealt this kind of card? Would there still be a bestseller about Morrie Schwartz, the mild-mannered professor who stoically endured to the end?

A masterpiece of a con

I wanted to write a post about how I hate hypocrisy and hypocrites, and point to this story about Al Gore, the Oscar-winning crusader for the environment, whose Knoxville, Tennessee, mansion consumes 20 times more electricity than an average American household. However, the more information about this gets uncovered by inquisitive bloggers, the harder it becomes not to admire Gore for his devilish cleverness. Get this:

1. Gore's mansion used so much natural gas and electricity in 2006, that his energy bill for that year was $30,000


2. Gore buys "carbon offsets" (a modern form of indulgencies) to compensate for his use of carbon-based energy sources


3. He buys those offsets from a company called Generation Investment Management


4. Gore is a chairman of that company and owns its stock


5. In other words, it is like me issuing a speeding ticket every time I go 100 mph on a highway, and writing a check to myself.

If that isn't a clever, clever scheme, I don't know what is. Gore may still be a hypocrite, but he's also much more than that: he's a brilliant con man. There is nothing particularly impressive about profiting from any public fad or hysteria of the moment. What is impressive is double-dipping: profiting from whipping up that hysteria (e.g. by making a blokbuster "documentary", getting an Oscar, being paid for speeches), and then positioning yourself to make tons of money from the gullible public. In some sense it's akin to a dishonest stockbroker talking up some worthless stock in some chat rooms, and then making a killing by selling it to the suckers. It is however, much more elaborate and intelligent a con - it is a masterpiece of the genre. I've always had a soft pot for mastery. If I could be assured that Gore would use his considerable skill for the benefit of the United States and not merely for personal enrichment and aggrandizement, I'd vote for him in a heartbeat.

Land of the living dead?

OK, so a guy with a really bad brain injury miraculously recovered after spending 20 years in a semi-vegetative state on a hospital bed, with all kinds of high-tech gear hooked up to him. Well, good for him. (I guess. I'm not in his shoes and, obviously, wouldn't wanna be.) For Tammy Bruce and some of her commenters this proves that taking the famously comatose Terri Schiavo out of her vegetative state and allowing her to die was murder, plain and simple - after all, if this guy recovered, why couldn't she? If not after twenty, then maybe 50, maybe 120 years? Let's set aside the difference in the extent of brain damage in both cases, and ask these questions instead:

How much did it cost to keep this guy alive for twenty years, and who paid for it? If the money came from his savings, or his family, I'm perfectly fine with that. They can keep him in the hospital for another 20 years, for what I care. In a private room, with a view of the ocean. However, if the money came from insurance or from the government (read: taxes), then I have a problem with it. Healthcare is neither free nor an infinite resource. If insurance or taxes paid for it, then we all paid for it, without being asked to. Let's imagine, for a second, that a lot of people get inspired by this story and demand, in their living wills, to be kept alive for however long it takes. Let's further assume, that a law is passed (which people like Tammy would undoubtedly support) banning anybody from disconnecting life support from a patient, no matter how hopeless his case. (Remember Terry Wallis? His case seemed hopeless, too!)

Even with today's technology we are able to keep people alive for a very long time. Her heart failed? No problem, hook her up to this machine! His lungs no longer work? No problem, plug him in here! Brain dead? Oh, that's a piece o' cake - this apparatus over there will keep him alive forever. Most of these people will never recover. Our hospitals will turn into some bizarre version of "Matrix", with rows and rows of unconscious, "almost dead" bodies being kept alive decade after decade with sophisticated machinery. Nobody will ever die - but is this life?? This nightmare is technically possible already, and will be even easier to realize in just a couple of decades.

And what about the cost of this ghoulish folly? How many Americans already can't afford health insurance? 40 million? If we force insurance companies to cover life-sustaining machinery for thousands or milions of never-to-die bodies, a few hundred of the richest Americans will perhaps be able to afford health insurance premiums - and they don't need it anyway. When considering something, it helps to think about it as becoming commonplace. (Wasn't it Immanuel Kant, who gave us this sage advice?) Oh, and please spare me the "you can't put a price tag on human life" nonsense. Oh yes, you can. If not on life, then on everything that life needs to stay alive.

P.S. Keeping Terri Schiavo in a vegetative state all these years was nothing if not a "cruel and unusual punishment". I can't fathom how anybody with half a heart would wish this on anybody else. And it fills me with dread to think that my wife or son might be prevented from an act of mercy, were I to become brain dead. That's why I put "do not resuscitate" in my living will. I hope it will be honored.

Ethical Americans

Cavid Carnoy, editor of CNET, wrote a piece describing a very generous return policy at Costco and Sam's Club, that allows customers to return a product during a course of its lifetime (which, potentially, could be years) for a full refund, provided that the product isn't damaged. Carnoy wonders if this isn't an invitation to abuse: given the rapidly falling prices of high-ticket electronics, people will be tempted to exchange that expensive last year's HDTV or LCD TV for this year's bigger and cheaper models.

What's really interesting is the reaction of the article's readers in the Comments: most commenters piled on Carnoy for... lack of moral judgement in suggesting such an unethical way of abusing a return policy of a great company! Aside from the fact that the readers obviously misread the author's message, their outrage is very encouraging. Apparently, there are plenty of people with high moral standards in America, at least among CNET's readers.