I have read two books lately about old people, dementia sufferers, who make the decision to go to Switzerland for assisted suicide. One was the memoir In Love by Amy Bloom about her last weeks with her husband, and the other was the novel Switzy by Emily Cline.
Bloom’s husband Brian Ameche was diagnosed with Alzheimer’s in his 60s and swiftly decided that this was not a situation he wanted to ride out to the end. “I’d rather die on my feet than live on my knees” states this former football player. He convinces his wife; they look for a way. But in this country, voluntary exit is not one of our freedoms. The only viable alternative they found was self-starvation, and neither thought they had the patience or heart for that. (For a memoir about a sane person (at 100) using the starvation method, please look at Helen Nearing’s Loving and Leaving the Good Life.)
Going to Switzerland is not a poor man’s solution. Even this upper middle-class couple has to borrow money to pull it off, but they are resolute. Bloom is so determined to do this for her husband that it is uncomfortable at times, she seems somewhat too forceful. Then you remember that this is what he wants; she is giving him one last great gift. Ameche is depicted mostly by his own words. We feel his losses, his confusions, his determination, and his grief. It all rings true.
Emily Cline has the disadvantage of being a young woman writing about an old man. This old man, David Hastings, is alone, but privileged – someone has paid an escort to take him to Switzerland, on a trip where he will see a daughter and old friend along the way, while not divulging to them his real mission. He gets confused, but then muses intellectually over his forgetfulness. We are in his head, but it does not seem real. He is too self-conscious. When my mother was in the throes of dementia, she never questioned herself. I know every experience varies, but his does not ring true. For example, David muses about communications satellites:
Interesting, to be here on Earth at a time when we had put the sky to work. Pretty much what we’d want from God, wasn’t it – finally we’d roped the stars into our human affairs. Pressed them into our service. Thanks for everything, heaven – now tell me where the next turn is.
David can’t remember where his phone is, but addresses the heavens in this wise way? There are surely moments of clarity within dementia, but Cline supplies them as constant intermissions in David’s struggle to remember where and who he is. David’s mind drifts, points of view shift recklessly, and some of the sentiments are wise. But, in the end, this does not sound like the consciousness of a demented mind.
Suicide in old age is a hard topic. My mother belonged to the Hemlock Society when she was young and cheered Dr. Kevorkian on, but when her brain started to close down in her eighties there was never any indication that she wanted to do anything but muster on. Of course, there is a small window (think of Still Alice) between the point where we are rational enough to choose death and when we are beyond such choice, both legally (not of sane mind) and physically (can’t handle the logistics). Stoics saw suicide as the ever-present and comforting “open door.” Camus said that “there was only one really serious philosophical problem, and that is suicide.” But, even Camus concluded that – as absurd as life can be – we were probably better off making terms with it.
When I began writing this blog entry, “Writing Our Own Ending” was a provisional title, but as I progressed, I realized that “writing our own ending” is a good description for all the choices that we make in old age. We didn’t get to write the chapter of our childhood – we were not in control. Adolescence and young adulthood seemed to be in the control of our hormones. And then life caught up with us – babies, jobs, marriage, divorce, illness – and only in retirement (and sometimes not even then – think of grandparents impelled to take custody of grandchildren) do we have a real shot at choosing how we live – assuming, of course, that we have at least a bare minimum to keep us fed and housed. It is a wonderful opportunity. Elders in India used to “go forth” to the forest for contemplation, some medieval aristocrats went to the monastery or convent. In any case it should be a conscious choice. And then, at the end of it, we should be able to decide how to die. This does not necessarily mean suicide; it means a conscious choice if we are capable, and a pain-free death if we are not.
The best fictional depiction I have ever read of dementia was Out of Mind by the Dutch author J. Bernlef. Hard to find, but worth it.
I have written about dementia many times. As I get older and have more and more “senior moments,” I am getting a better sense of how it might feel. How to live a diminished life. But, mostly, I want to write my own ending as much as is possible. We’ll see.
