While basking in Alaska’s spectacular beauty and charm on my recent cruise, my new friend Brian and I had some interesting discussions. His idea-bursting mind reflected itself in a fascinatingly varied career in the CIA, as a professor and corporate executive.

In retirement, he’s focusing passion on rational suicide, what he calls “self deliverance.”

After returning home he arranged for me to attend the Final Exit Network (FEN) Board and annual membership meeting in Chicago two weeks ago.

FEN provides free, compassionate support and practical advice to individuals and their families facing intolerable suffering from incurable conditions. Its goal is that one day no one will have to experience a prolonged and agonizing death.

Though FEN doesn’t provide assistance with death, Washington, Oregon, California, Montana, Vermont and the District of Columbia allow physicians to assist with suicide. And Switzerland, Luxembourg, the Netherlands and Canada allow assistance as well.

Canada and the U.S. are very similar countries. Canada’s route to allowing assistance with death is worth noting. After three years of court cases and deliberation, Canada’s Supreme Court unanimously ruled in 2015 that laws barring physician assistance with dying in gravely iill, competent adults violate their basic rights of self determination and are unconstitutional.

In other words, the answer in Canada to the simple question of whose life am I living is: Yours. Criteria for assistance with death include being an adult, mentally competency and intolerable suffering from an irremediable medical condition.

As a group, Canadian physicians are equally divided in supporting and opposing assisting patients’ deaths. A significant number of supporters will participate in assisting qualified people with dying.

Physician assistance with death, rational suicide and self deliverance are not new interests of mine. I’d been perplexed for years by the difficulty society and my medical profession has with the basic principle of self-determination in abortion and death.

Not long after I moved to Ludington, the abortion debate was tearing medicine and society apart. One of my colleagues was vociferously anti-abortion. When his university-student daughter announced she was pregnant, he did an 180 degree turnaround and helped with her dilemma. Many of us are internally torn.

As Mason County medical examiner I was called to the edge of the woods to pronounce an 85-year-old man dead. He hanged himself by placing a noose around his neck, tying the other end of the rope to a limb, climbing atop and then kicking away a box. The grass and leaves were scuffled by his struggle to breathe in the throes of death.

He died painfully. Alone. His family, whom I knew, was shocked. I was speechless.

I was also troubled by experiences as a nursing-home attending physician and medical director. Aged and often essentially bed bound or demented patients were sent to hospital emergency rooms by ambulance when they developed rectal bleeding or similar problems. The best that could have been hoped for through treatment was returning to their condition prior to the incident. That wouldn’t help their underlying condition. They were invariably returned to the home the next day.

In 1987, my father was no longer able to provide sole care for my demented, terminally ill mother. She was admitted to a nursing home for what proved to be the last three months of life. When she stopped eating, they put a tube in her stomach to tube-feed her. She pulled it out. They reinserted it and tied her down. We and her physician objected and were told she wouldn’t be allowed to starve.

Coincidentally, that’s the year I left Ludington and a comfortable anesthesiology practice, with auxiliary interests in hospice and nursing home patients. I moved to East Lansing to attend graduate school to study philosophy to prepare for a radical, drastic life and career change to medical ethics, with special interest in end-of-life decision making.

Recently, I was visiting with a 90-year-old, longtime good friend who is exhausted from living. Multiple tests and physical examinations over years haven’t found a treatable condition.

After exchanging salutary comments, she leaned over and in a soft voice said, “I wish I could go to sleep and not wake up.”

I commiserated with her and told her about my interest in FEN and how its assistance would fit her. I told her she deserves the kind of death we currently reserve for our treasured pets who have lived full lives.

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