On Their Own Terms

(Laurie Loisel is a journalist who lives in Northampton, Massachusetts. For 30 years she worked as a reporter and editor for a daily newspaper in western Massachusetts and her work has appeared in the Boston Globe and other publications. She is author of two books, “On Their Own Terms: How One Woman’s Choice to Die Helped Me Understand My Father’s Suicide” published in 2019 by Levellers Press, and “Those Left Behind: The Secret Club Inside the Nation’s Opioid Epidemic” published in 2021 by Gallery of Readers Press.)

In  April, I was one of three panelists in a  Dying Well workshop that drew nearly 70 people eager to fully engage with complicated and highly personal  issues around end-of-life decisions. I read from my book, “On Their Own Terms: How One Woman’s Choice to Die helped Me Understand My Father’s Suicide.” A physician spoke about hospice and palliative care. A legislator talked about recent progress on a death with dignity bill.

It was clear the majority of the people attending were most interested in the state senator’s talk — our state of Massachusetts was nearing the end of the line for a controversial bill that would allow terminally-ill people with six months or less to live the ability to request medication to help them die. After our respective presentations, many peppered the senator with questions about the best strategy to get the bill passed into law.

To date, death with dignity proposals have not met success in liberal Massachusetts. Despite polls showing huge popular support for a similar measure in 2012, a ballot initiative failed narrowly that year.

It so happens that was the year my father decided to end his life, just about a month after the defeat of that ballot measure. I mention that because even though he lived in Maine, my father followed the Massachusetts referendum with avid interest. In his older years he had become deeply interested in end of life options, a fierce proponent of individual  autonomy and control around these essential end-of-life choices. He didn’t want to tell anybody else how to make those decisions, and by the same token, he wanted nobody to have a say over his personal choices.

My father died by suicide when he was 83, a couple hours after a warm and loving family dinner with five of his adult children. He was not sick, he had no terminal diagnosis, but he did not want to age past the point where he could no longer care for himself independently.

He’d thought this through enough to have purchased a firearm for the purpose and left its receipt in a safe deposit box explaining he’d bought it on his own; to have chosen a spot where none of his children would find him, where, he believed, trained professionals able to weather the trauma would discover him. He’d thought it through enough to write a goodbye note apologizing for the deception his choice involved, a note that expressed his love for us and encouraged us to support one another to heal.

As violent suicides go, in certain ways, my father’s was pretty thoughtful.

And yet, while I fully support his right to make his own choices, I also deeply wish he’d made a different one. In fact, professionals did not find him. Civilian passersby came upon him in the police station parking lot — and they were traumatized. His grandchildren were deeply impacted in ways I only later came to understand. My siblings and I were deprived of the chance to say a conscious goodbye to him, and to care for him as he aged, if even just a little.

As life would have it, my father’s suicide led me to an unexpected friendship with a woman who attended the same Unitarian congregation where I was a member.  She was vibrant, full of life, in robust health relative to her age.

And she had something in common with my father. She did not want to live beyond the point where she could take care of herself. She would accept some help, but she wouldn’t go into a care facility, nor did she want to move in with her children.  And so, at the age of 90 she took steps to bring about what she referred to as a planned death, something she’d long talked about with her children.

Her choice involved a perfectly legal step that is not commonly discussed as a legitimate option, yet is common enough to have an acronym, VSED, voluntarily stopping eating and drinking.

By the time she embarked upon VSED, my friend considered me to be almost like part of the family — and she and her children also consented to have me observe the process for the purpose of writing a series of newspaper articles about VSED.

While death is never easy, I was moved by the gentleness of her death and the way it allowed her to spend time with people she loved up until the very end. I was amazed at the way her children cared for her and the tenderness expressed in the many acts of caring during this process — as they read books to her, swabbed her parched lips and held her hand as she napped.

In comparison, my father’s death felt harsh, abrupt and punishing.

This brings me back to the death with dignity movement efforts in Massachusetts, where advocates have not had an easy time. Since the failed referendum vote in 2012, four bills never made it out of legislative committees. This year, the closest the effort has gotten, the bill is hanging by a thread since the legislature extended consideration of the End Of Life Options Act through July 31.

I wholeheartedly support passage of this bill because I believe people have a right to make choices about their own deaths.

But the truth is that death with dignity laws are not enough. They help a select group of people, those with a terminal illness facing impending death. But in my mind, these provisions are simply one more tool in the toolbox for people navigating complex and personal end-of-life decisions.

It’s an important tool, for sure, but it won’t meet the needs of a lot of people who feel without decent choices, people who are looking at the end of their lives, but for whom death with dignity laws provide no respite. These are people like my father and my friend, who face mortality, but suffer from nothing more terminal than being human.

For people in that situation, I believe there simply has to be a better way than the action my father — and, sadly, an increasing number of men in his demographic — took.

Though not for everyone, VSED is certainly a valid choice and I wish more families would discuss it as an option. There are palliative care decisions and choices people make as they age about whether or how much to intervene when health issues arise.

Sadly, too many families are unprepared for nuanced discussions when a beloved elder reaches forks in the road that lead in one direction to greater medical intervention and in the other fewer interventions. Each person — and each family — will make different decisions in such cases, but those decisions will be more informed, loving, supportive and honest when discussions are held before a crisis, (or even simply a hard decision) presents itself.

I wrote my book about what I learned from watching the differences in the process (and, importantly, the aftermath) of the deaths of my father and my friend in part to better understand those experiences for myself. But I also hoped others might be inspired to hold frank and open conversations about fundamental questions most of us will face.

I hope more families or close friend groups can find the courage to engage with one another to reach a better understanding of each other’s hopes and fears around dying. It would be so much less lonely for us all.

“On Their Own Terms How One Woman’s Choice to Die Helped Me Understand My Father’s Suicide” can be found by visiting this link at Levellers Press in Amherst, Massachusetts.