Speakout: Letters From Our Readers

Last Wishes Dishonored

My grandmother was 82 when she died, only a year ago. She had a couple of aneurysms in her heart. We were told that they were "serious, but not hard to fix." She went into the hospital for a heart bypass with a 70 percent survival rate.

She was in pretty good health otherwise. She watered her plants every day inside and outside. She tended her flower beds and had "best yard" awards for countless years. She was the absolute love of my life.

She went into surgery on a Saturday. She died 35 days later.

My grandmother had a living will with a DNR in place since 1996. The hospital didn't honor it. My grandma suffered for 35 days with acute respiratory distress, a tracheotomy, fear and everything else that comes with being intubated and knowing you don't want to die in the hospital.

I've known about your organization for a long time. I've seen relatives rot with cancer and beg God to take them. I've even been asked to "do the deed" by an aunt. I am glad there are people and organizations out there who agree with a person's right to die and not be tortured by machines. I only wish my grandma didn't have to go through what she did.

-- Anonymous

A Grateful Family

I need to have you take my mother off your mailing list ... Mother ended her life this spring. She was in a lot of pain and decided she had had enough. She was 83.

I am so thankful for your efforts. She was able to handle life and death in her own way. My only regret is that she had to do it alone. She had expressed a preference to have myself and/or my sister with her. Due to the fact we had monetary gain, we didn't think that was wise. So she did it alone.

Thank you again for all your efforts!

-- Linda Pierce, California

Depression and Hastened Death

In the Fall 2004 issue of End-of-Life Choices, an anonymous writer commented on the article "Depression and Planned Death" from the previous issue. As a psychologist who has worked with chronically and terminally ill individuals for over a decade and who has thought and written a lot about how mental health and relationship issues may affect the desire for death, I wanted to respond to the writer's comment that "'quality of life' is entirely subjective, and for the depressed person who is well aware of the circumstances of the illness and the probable future, a life worth living may quite simply be beyond reach."

I should note that I do believe that, in some situations, death may be a person's best, or least worst, option. However, my experience is that people who are truly clinically depressed -- not just sad, blue, upset or grieving -- may be unable to truly appreciate "the circumstances of the illness and the probable future" and that the person may not realize that "life worth living" is not beyond reach, but just beyond sight.

At the same time, I am not saying that no one who is clinically depressed can make a well-reasoned decision that death is the best choice. Because of the complications associated with clinical depression, I believe that a trained, experienced mental health professional should be involved in helping the person determine whether quality of life can be improved.

My rationale for this is that we often say that a pain-management expert should be involved if someone wants to hasten death because we know that pain and other symptoms can be poorly managed, and this can lead to a person wanting to die. Similarly, we know that clinical depression is poorly detected and treated by many medical professionals. We also know that many medical professionals and ill people and their loved ones assume that depression is normal and should be endured, but I can assure you that clinical depression and hopelessness are neither expected nor untreatable.

A qualified mental health provider should be able to detect depression, even in terminally ill individuals, and collaborate with the ill person to develop a treatment plan that can improve the quality of the person's living and dying. After any clinical depression is eliminated the person may still want to hasten death, but at least it is less likely that the decision and judgment are impaired by a treatable condition such as clinical depression or associated hopelessness.

-- James L. Werth, Jr., Ph.D., Ohio

Editor's Note:

Compassion & Choices supports the balance struck by Oregon's aid-in-dying law. If either physician suspects depression or other psychological cause of impaired judgment, the request cannot proceed without a full evaluation. To evaluate every request implies the request itself is a sign of mental illness and we know that is not true. It also inserts another, unneeded step in a request procedure that is already elaborate and burdensome.