If Jane had a social worker . . .

Thanks to everyone who made suggestions to deal with Jane’s presumptive problems.  If Jane had an independent social worker–one not in her healthcare system–that person might respond to Jane’s difficulties with something like the following: 

What Jane wants to do is extricate herself from a situation that has turned her into a virtual captive of others because her values and desires about her life are blocked by caregivers and family members.

She is burdened by several debilitating medical conditions, all of which are treated through a Catholic health system that she has been a part of for many decades.  All of her physicians are part of this system–her primary care doctor, an orthopedic surgeon, a rheumatologist, a cardiologist, an ophthalmologist, an endocrinologist, a neurologist, a psychiatrist, and a psychologist. 

Though Jane can afford to find a new healthcare provider, she would have to leave the only system that is approved by her late husband’s insurance plan.  It would mean she would have to arrange for a new secondary insurance provider for her Medicare coverage.  Even if she can find a provider that can offer the full range of medical services she needs, the transition to nine new doctors, meeting each of them, assessing their suitability, and having her medical records transferred to them is a daunting task, even with help.  It will sap Jane’s time and energy to make such a transition–energy that Jane does not have at the age of 87, especially considering her medical problems.

Even if Jane focuses just on finding an understanding psychiatrist or psychologist (or other appropriate professional), there may be no pathway to the deliverance she seeks that is legal, painless, effective, and within her ability to carry out.

Jane is so frightened by what she has gone through with Redemption™ that she has a new psychological hurdle to overcome.  She is traumatized by her experience, both with the psychologist at Redemption™ and with the attitudes of her adult children.  Another factor not mentioned in the case study is that Jane also feels that other residents at the retirement center where she lives now see her as a crazy lady.  They have drawn away from interacting with her, and she feels more isolated than ever before.  She has no social contacts from which she can derive support and understanding.  Her primary focus now is preventing another involuntary detention because of her desire to not go on living with the health problems she has.

As Jane expressed it to me, she has lived a full and fulfilling life.  She has accomplished all that she wants to accomplish.  Her medical problems have slowly accumulated to a point that continuing to live is not an option she wants to consider.  She knows that her suffering will only get worse.  She wants to do something about this circumstance before her loss of cognitive capacity (and perhaps her physical ability) renders her incapable of hastening her own death.

She has thought about going to Dignitas for relief.  But she will need a traveling companion to make the trip to Zurich and she knows no one who can make the trip with her and help her with all of the arrangements, including getting a passport, collecting necessary medical records, applying to Dignitas, and all of the other details the trip would entail.  Jane can afford to hire a traveling companion, but such a person, if found, could face legal jeopardy, which makes locating a traveling companion unlikely.  

To make matters worse, she has to do all of this without her three children learning of her plans.  If they do learn of them, she may well be back in psychiatric detention, perhaps for longer than three days.  All of these things are on her mind and burden her every day.

Jane is a gracious, delightful older lady who is committed to her decision that now is the time for her life to conclude, but frightened about what may happen if she continues to pursue her plans.  She has become discouraged to the point of despair because of what has happened to her.

Hiring an attorney may help her avoid further involuntary detention, but that will not happen without court hearings, testimony, recrimination from her children, and maybe confrontations with caregivers from Redemption™.  Contemplating such a battle is too much for her to consider under the circumstances.  It would be a challenge at any age and with any health condition.

She has thought about moving to another retirement community, but this will almost surely cause more attention from her children, attention that Jane definitely doesn’t want.  She does not want to fight with her children.  She wants them to respect her decisions and honor her autonomy as a human being.  But this respect seems impossible to achieve.

The Final Exit Network (FEN) seems like a good choice to support Jane’s plans, but given the opposition of Jane’s adult children, it is unlikely that FEN would be able to provide her the education and training that she will need.  In every case of which I am aware where FEN and its volunteers have been pursued by prosecutors, the legal actions have been precipitated by family members who opposed the hastening of death.  It is too great a risk to the organization and to the volunteers who would be involved to take Jane on as a client. 

When prosecutors pursue charges against individuals, they search their homes and offices for material relating to the client, confiscate computers, take mobile phones, and could seize automobiles if they believed they were used to further the crime of “assisted suicide,” a likely crime that would be charged.  These actions disrupt the lives of the volunteers and subject them to the stress of defending against criminal charges, no matter how improper such charges may be, and even if FEN takes care of the legal costs.

Jane has the physical ability to exit using the inert gas method.  She has the manual dexterity to make a hood and maneuver a tank of nitrogen.  She still has the mental capacity to make her own decisions.  She has read Derek Humphry’s book Final Exit.  Her problem now is having the emotional strength to continue to pursue a hastened death and avoid an even more undesirable future filled with even more suffering than she has endured to this point.  In fact, the emotional turmoil may have surpassed the physical debilitation she experiences daily.

One other possible choice for Jane is to hasten her death by voluntarily stopping eating and drinking (VSED).  But for VSED to be successful as a peaceful, effective means of dying, the assistance of a caregiver is essential.  It has proven difficult to find people who care for the elderly and infirm who are comfortable with VSED, so even this method may be beyond Jane’s reach.

Jane now realizes that remaining so long in a Catholic-run healthcare system was a mistake, as was trying to talk to her children about her wishes and plans.  She misjudged her children badly.  Jane may be trapped with an unacceptable quality of life and no good remedies.  As her social worker, I will continue to work with her to help her sort through her options, decide what is realistic for her, and provide whatever support I can within the legal and ethical limits placed on my profession. Sometimes, however, there are no ideal or even decent choices.