While perhaps based on good intentions, such proposals are nevertheless very much to be feared. For though these fantasies may sound far-fetched, with increasing economic pressure the “bureaucratization” of suicide, as Margaret Pabst Battin calls it, might conceivably be proposed. “The risk is not Nazism,” says Battin, “but individual manipulation, which is coercive in effect.” Suicide, according to Battin, can be manipulated in two ways. In “circumstantial manipulation,” a person may be given shoddy care, inadequate pain medication, and so forth, so that suicide becomes an obvious choice. In “ideological manipulation,” a social group’s way of thinking may slowly be altered so that suicide seems preferable. “At bottom,” she says, “I think the fear we should all think about is that we may become a society in which the normal, ordinary, expected thing is to do your dying relatively early and easily rather than prolong it and impose a burden on family and on medical personnel.” She compares this to the kind of expectation we have that people will marry, usually in their early twenties. “How easy is it to not marry?” she asks. “How easy would it be to resist this expectation about dying? . . . I can envision an elderly person’s family and friends gathering round her and saying, ‘It’s time to think about how to bring this to a close, Granny. But don’t be frightened, we’ll be supportive.’” Despite such troubling scenarios, Battin believes that the individual’s right to die must be protected. “Even if the kind of choice it favors might calcify into an expectation,” she says, “it still is not a reason to abridge the rights of those who choose to exercise that choice in the first place.”
Basically, it is a question of how simple it should be to complete suicide. In de Maupassant’s story, the secretary of the Institute of Voluntary Death explains what he calls the “annihilations.” “Why should death be gloomy?” he asks his bewildered visitor. “It should be indifferent. We have lightened death, we have made it blossom, we have perfumed it, we have made it easy.” William Archer suggested that one day there would be machines by which a man could kill himself for a penny. “In a rational state of civilization,” he said, “self-effacement should cost us no more physical screwing up of courage than a visit to the barber’s, and much less than a visit to the dentist’s.”
But even those who advocate the right to die under certain circumstances warn that suicide should not be made too easy. “Robert Lowell once remarked that if there were some little switch in the arm which one could press in order to die immediately and without pain, then everyone would sooner or later commit suicide,” wrote A. Alvarez. “People are going to help each other die,” observed A. J. Levinson, the former director of Concern for Dying, a right-to-die group. “But there are risks—legal, moral, psychological. And I think those risks should stay there.” John Arras, former philosopher-in-residence at Montefiore Medical Center in New York City, has frequently advised doctors on ethical dilemmas in medicine. “I believe that the classical philosophical argument for suicide or assisted suicide is very strong,” he says. “But I’m wary of the popularization of suicide. It’s one thing to stake out the abstract right to die, another thing to parade this before depressed people who may take advantage of it. . . . These are decisions that should be made in fear and trembling.” Battin concludes her essay “Manipulated Suicide” by stating, “I myself believe that on moral grounds we must accept, not reject, the notion of rational suicide. But I think we must do so with a clear-sighted view of the moral quicksand into which this notion threatens to lead us; perhaps then we may discover a path around.”
IV
A MODEL HEMLOCK COUPLE
I FIRST MET FRED AND HOLLY ISHAM at Hemlock’s Second National Voluntary Euthanasia conference in Los Angeles. They were introduced to me by a friend who had described them as a model Hemlock couple: articulate and attractive people in their eighties, they were planning a double suicide. When the time came, my friend said, they planned to take a fatal overdose on a mountaintop at sunset.
I liked the Ishams immediately; they were the kind of people one might choose for grandparents. Holly was charming, talkative, and as alert as a squirrel. A beautiful woman with neat gray hair and a luminous smile, she had turned eighty-three the day before I met her, but she looked much younger. Fred, a youthful eighty-four, was a small, balding, handsome man with a neat mustache, a shy, almost deferential manner, and a sheepish, endearing grin. Married fifty-nine years, they still looked into each other’s eyes, they still touched each other with affection, they still seemed very much in love.
Six years earlier, Fred had learned he had cancer of the prostate. Although a bilateral orchiectomy—the removal of both testicles—slowed the growth of the cancer, two years ago a subsequent bone scan found bone cancer. “Fred had the option of radiation and chemotherapy, but he was told that his quality of life would be greatly impaired, so he refused it,” Holly, who did most of the talking, told me. “So for the last two years we’ve been living it up. But we know there will come a time when the pain will be too great, and we want to be ready.” Fred nodded assent. “We’ve seen so many of our friends and family go the hard way, and we don’t want to go through that ourselves,” he said. “I don’t fear death, but I do fear dying.” Holly shook her head. “As long as we have some control over that, I have a comfortable feeling,” she said. “We’ve lived a long and happy life, and we do not want to be dependent on our children. After eighty-three years we feel it doesn’t matter when it happens—we’ve already surpassed the average life span, so que sera, sera.” She gave a gay laugh. “I don’t see why death has to be a fearful thing. I don’t see why it can’t be as happy and euphoric as our wedding day.”
Fred and Holly were married in 1926, two years after they’d graduated from college. In the sixty years since, they’d experienced a full share of highs and lows: the Depression; the house they designed and built in 1931 and still occupied; their three children; their trips around the world. While Fred worked as a commercial artist until his retirement, much of Holly’s adult life was devoted to caring for the youngest of their three daughters, whose life was spent in and out of hospitals. At the age of seventeen, surgery to remove a malignant tumor of the spinal cord left her a paraplegic. But in her late twenties the cancer spread, and her life became a nightmare of radiation, medication, and surgery until her death at age thirty.
Seeing their daughter’s harrowing final years encouraged the Ishams to be more in control of their own deaths. When I met them, however, Holly and Fred seemed far from the end. They talked with excitement of tours they had taken to Nova Scotia, Tahiti, and Europe; of traveling around the United States to visit their two children, five grandchildren, and two great-grandchildren; of hiking near the cabin they had built in the mountains. They went to movies, concerts, and dinner parties. (“For twenty-two years we’ve spent New Year’s Eve with the same group of friends,” Holly told me. “But we’re dying off. Our group started with fourteen. Now we’re down to seven.”) Holly’s datebook was crammed with lectures, bridge parties, community service meetings, and garden club get-togethers, most of them sponsored by the local women’s club. Fred often drove her to meetings and helped her make place cards and posters for club functions. “I don’t have a social life of my own, really,” said Fred. “My activities are mostly related to Hol’s.” Fred seemed content to be in his wife’s shadow; he was proud of her, and his quiet strength complemented her high-strung energy. Her devotion to him was evident even when she teased him about his passivity. “I’ve lived with him fifty-nine years, and I still don’t know what he thinks about some things,” she said. “He’s so agreeable. He’ll agree with you, he’ll agree with me, he’ll agree with everybody.” She laughed and gazed at Fred with affection. “And it would take a man like that to put up with me.”
As in most of their activities, Holly was the impetus behind their interest in Hemlock. They had joined two years earlier, after she’d seen Derek Humphry interviewed on television. “I’m the aggressor in these things,” she adm
itted. “Fred goes to these meetings to satisfy me.” Holly had read Let Me Die Before I Wake and Common-Sense Suicide, and she studied the Hemlock Quarterly. “I talk to friends at the club about it if I feel they’re ripe,” she said. “I’ve circulated Hemlock books and membership applications, and I think I’ve gotten at least six members.” At the Hemlock conference Holly was quite active, introducing herself to other members, exchanging stories and phone numbers, asking questions about insurance and death certificates, jotting down ideas in her brown Hemlock notebook. Fred, who hadn’t read the Hemlock books, agreed in principle with much of the Hemlock philosophy but was uncomfortable contemplating its practice. “I think that self-deliverance, in connection with the two of us . . .” His voice trailed off. “I haven’t sorted it out enough to definitely put me in the position or her in the position, but as an idea, I accept it.” Said Holly, “He shares my interest but not my enthusiasm, I would say.” Fred nodded: “That’s probably it.”
As we talked, I realized that the mountaintop-at-sunset suicide scenario was Holly’s, and her enthusiasm had made it seem as if it were shared by her husband. Holly had clearly thought a great deal about contingency plans. “If we don’t have a pact to go together, if Fred died and I were the survivor, I would just weed out the house, get my affairs in shape, get the pills by some means or other, and have a kind of indefinite date as to when I’d use them,” she said. “And if I felt deterioration in the quality of life or became dependent on others to the point that I wanted out, I would take my own life.” Holly didn’t have the pills yet and was anxious to find a source. “The only fear I have is of not being successful,” she said. “And if I woke up and found I was unsuccessful, I hope I’d have a plastic bag handy and be able to finish it off with that.” Despite her extensive planning for death, Holly talked with as much excitement about their upcoming sixtieth anniversary as she did about the possibility of a double suicide. “I’m not going to give up any sooner than I have to,” she said. “We’ve had such a good life for fifty-nine years.”
Fred, when pressed, said he didn’t think about what he’d do without Holly because he was sure he’d die before her. If he didn’t? “For the foreseeable future I would go on living here in this home,” he said slowly. “Even though I’m sure our daughters would invite Hol or me to live with them, we don’t want to be a burden. But I don’t know what my life would be because so much of my life concerns her activities.” Fred admitted that the Hemlock conference intrigued him. “Those meetings were so thought-provoking that I do want to read some of those books now.” Holly beamed. “You can start reading Jean’s Way this evening to me,” she said. They looked at each other fondly.
Over the following year I received several notes from the Ishams written by Holly, who had signed both their names. In December I received a Christmas card, a Chinese watercolor titled Flight in which two people were hiking through mountains. “We have a few more aches and pains as the years rush by,” Holly wrote in her neat, energetic hand, “but we try to ignore them and are keeping very busy with family, friends, and club activities. Who says eighty-four and eighty-five is old? Old is a state of mind.”
When I saw Holly at the next Hemlock conference, in Washington, D.C., she was with her elder daughter, a nurse. Fred had stayed home. “It’s not good,” said Holly anxiously. “Things have deteriorated.” Fred had undergone radiation treatments in February and again in August. “It’s made him quieter and depressed,” she said. “He just agrees with everyone—he always has—and he takes every treatment and every medication the doctors recommend.” Over the summer he was hospitalized for congestive heart failure; his lungs filled with fluid. Holly and Fred asked the doctors to issue a no-code order. Fred recovered. “The doctors say he probably won’t die of the cancer but of heart or kidney failure.” As Holly talked, frustration and bitterness seeped into her voice. Although she cared deeply for Fred, she was clearly exhausted by the demands of caring for him. She said that there had been few conversations about suicide; she didn’t want to push it. “But at one point I reminded him about the idea of going out together,” she said. “I told him that I’d go to Mexico, get the drugs, and we could have a cocktail hour and go out together. He didn’t say anything.” Holly looked down. “I feel terribly guilty, but sometimes I feel as if I’m just waiting for him to die. He’s so down about things. . . . I think he will hang on as long as he can. . . . So I guess my dreams of going out together are . . .” Holly raised her hands in a gesture of despair.
Two months later in Los Angeles, I arranged to see Fred and Holly. On the phone Holly told me the doctors had estimated that Fred had between six months and a year to live. For several months Fred had been confined to the house except for trips to the hospital. He slept up to sixteen hours a day and spent most of the rest of the time staring at the television set. The last time he and Holly had visited their cabin was many months earlier, and their last golf game was almost a year ago. Although her doctor and her daughters had urged her not to worry so much about Fred and to maintain her own activities, Holly, who spent most of her time caring for her husband, clearly felt hampered by the restrictions Fred’s condition imposed on her life. And yet her voice had little of the anxiety that had been so evident in Washington.
When I arrived at their house, Fred was sitting in an armchair in a corner of their bedroom, in pale blue pajamas, watching television. He looked much older and more frail than when I had last seen him almost two years before. His face had sagged, and rather than promising a smile as it once did, the corners of his mouth turned down as if in fear. His voice was even softer and slower than before, and his hand shook as he sipped from a glass of water. His mind was still sharp. I was delighted to see him. He told me about his chemotherapy. “I’ve been lucky,” he said. “It hasn’t given me any discomfort.” But he couldn’t move around as much as he used to, he said, and he suffered from diarrhea. His right leg had been bothering him, and he worried that the cancer had spread there. When I asked him how his spirits were holding up, he gave a rueful smile. “I take it a day at a time,” he said. “Sometimes I feel down, sometimes I feel okay.”
One reason why Holly seemed less anxious emerged when Fred got up and walked slowly to the bathroom. Holly leaned forward and spoke even more urgently than usual. “I have a source where I can get drugs,” she said. “Fred knows I have a source, but he doesn’t know where. One night we were having a cocktail, and he asked if I was stockpiling drugs. I said yes. And he said, ‘Well, get enough for me, too.’” Holly was pleased. “I told him that even though I was in good heath and would probably live a long time, I don’t want to. When he’s gone, I’m sure I could live without him, I’m sure I could learn to adjust, but I would feel that my function in life was gone. I wouldn’t be needed. So I’d just like to put my things in order and go. Or I’d like to go with him—if I’m lucky enough to get all we need, I’d just like to have a nice little cocktail party for the two of us.”
Fred returned. “I’ve been telling George about how I feel about self-deliverance and about the talk we had,” Holly said. Fred was silent for a moment. “I think we understand each other,” he said as he trudged back to the couch. “I think we do,” said Holly. Although they had discussed the relative merits of hospital, hospice, and home care for Fred, they hadn’t talked about suicide since their brief conversation over cocktails. Holly would have liked to, but she didn’t want to appear pushy. The presence of a third person seemed to make it easier. Holly talked about it with intensity; Fred was still a bit frightened and embarrassed by the subject. “I think our feelings on this will change from day to day,” he said. “I know mine do. Some days I feel okay, and sometimes I feel I’d like to just get it over with. I’m uncomfortable with the idea [of suicide], but it’s a matter of deciding whether life is worth living at that time. I wish it were legal and you could have a doctor give a shot.”
Holly brought out the photograph album from their sixtieth anniversary celebra
tion, which had brought Fred and Holly, their two daughters, five grandchildren, and two great-grandchildren together for two days. As Holly turned the pages, proudly pointing out her grandchildren, Fred stood behind the couch, smiling. “She’s just a ball of fire . . . so energetic,” said Holly of a grandchild. “I love her.” Fred chuckled with pleasure. “Oh yes, oh yes,” he said slowly, softly, and his hands moved from the couch to his wife’s shoulders.
When it was time to say good-bye, I kissed Holly, shook Fred’s hand, and squeezed his bony shoulder. Then I realized it might be the last time I would see them, and our bodies came closer in an awkward hug. “I hope to be back in L.A. soon,” I said, then suddenly realized I meant, “I hope I’ll be back in L.A. before one or both of you die.” I was filled with sadness. I wanted to say, “Live, please live,” to both of them. But I didn’t. As I drove across the city, I wondered how I would react to the very real possibility of one or both of them completing suicide—or self-deliverance, as Holly called it. Would I think it had been a “right” or “good” or “rational” choice?
In December I received a letter from Holly.
. . . It became necessary for us to place Fred in a hospice. Our two daughters concurred with the decision, because I could no longer handle 24-hour nursing duty. Naturally it was a painful and tearful decision to make. He updated his Living Will with Durable Power of Attorney. Now his desires are: 1) No resuscitation 2) No intravenous 3) No intubation 4) No injections except for pain or sleep. Simply put, no life supports. Just let nature take its course. . . . I have just talked to Fred’s doctor and to him. He called me. He has improved so much. He wheels himself around the hospital and is alert instead of sleeping 16 out of 24 hours. His doctors said there is some lung involvement now, but he may linger quite a while. C’est la vie! . . . Warmest wishes from
November of the Soul Page 67