From Greek, “Eu,” meaning “Good,” and “Thanos” meaning “Death.” For those of you who followed me here from my blog, which was my attempt to humorously portray life undergoing cancer treatment, this will be much more in line with what you’re used to. By discussing suicide and dead bees. Stick with me.

Whenever people ask me about my writing, the question usually comes up, “How much of this is fictional?” My usual response is, “Far less than you’d think.” I try to go for 70–85% accuracy, just enough to keep everyone anonymous and allow me to emphasize or deemphasize certain aspects to make it all engaging. Really, this is a form of therapy to keep me invested and interested in my own life, even when it’s all going to shit. Certainly, if you’re ever in a similar situation, you’d recognize what I’m writing about (the best response I ever got was when my step-mother drove me to an experimental infusion — don’t drive on chemo — and, after the infusion, the nurses wheeled out the BP cuff and pulse-ox to make sure nothing interesting was happening on a cardiac level, responded, “I thought you were making that up!”). I try to keep it as real as possible for two reasons:

  1. It would be a disservice to all the survivors who tread in my footsteps to over-fictionalize my experiences, and, more importantly,
  2. I really am not that creative. Honestly, if you just have enough interesting people and events in your life (and God help you if that’s the case), these things write themselves.

Which brings me to Recent Social Media Events. I actually do use FaceBook to keep in touch with people I’ve met in real life (sadly, if I don’t know you, I don’t “Friend” you)(that’s what Instagram is for). Even though Zuckerberg and his Russian investors are morally repugnant, they, unfortunately, hold the monopoly on keeping track of my high school friends. One of which recently got into trouble at work for putting a dead bee in the fridge. On a leaf bed. I am not making this up, although the “I was saving it for later” jokes write themselves (especially those of us who have intentionally eaten insects)(bad news; if you eat shellfish, you’re already chowing down on arthropods, but I digress). Upon questioning, she pointed out that she’d encountered a dying bee, and, rather than squash it, she thought freezing it would be a kinder alternative. Based on my experience as an EMT, I’m not sure if hypothermia or squashing is a better way to go, but I’d agree that a faster, less-painful death than Agent Orange (pesticide has a rather dramatic effect on bees)(and humans, as the Round-Up scandal starts up) is preferable, although I suppose a good argument could be made to look at this as a form of cryogenic freezing.

But, all of this highlights an unfortunate fact that our society likes to put off; death is inevitable. And we don’t like to talk about it. Which shrouds the whole process in an unpleasant air of mystery. If we want to assume Michael Lewis’s thesis that end-stage capitalism isn’t about creating or selling products, it’s about cynically identifying and exploiting market inefficiencies (his own words), and I see no reason to doubt that hypothesis, then organized religion is simply about seizing that market gap and keeping the process of death and dying shrouded in mystery, instead of pointing out that death is an unfortunate, but inevitable, part of life. The Celts — and I could very well be wrong about this, they’ve been dead for over a thousand years — viewed this as a sort of inverted birth into the afterlife. As my LDS neighbors would agree, no one that we can substantially verify has come back from beyond to prove or disprove any sentiment, and, in the meantime, we’re kind of fumbling around and putting off having “The Talk” about death. I wouldn’t necessarily use my friend’s tactic of hiding dead insects in the freezer as a way of raising awareness (especially not with the sky-rocketing price of Epi-Pens), but it’s a start.

All of which brings me to my central discussion point: a good death. This is all based on my own opinion (the only one I really count), and the medico-legal framework I got in grad school, from an MD/JD. I think this is a talk Western civilization has been putting off for millennia, although, unlike my friend, I wouldn’t think the best way to raise awareness is by leaving dead bees in the ice cube tray (okay, so that last part about bees and ice cubes isn’t accurate, but the point remains). You are going to die. This is unavoidable. Let’s say, for the sake of this essay, you get to choose the manner of your death. For my money, the “Best Ever” death recommendation was from my bioethics prof, who said he wanted to be shot at the age of 90, by a jealous husband, whilst climbing out a bedroom window. Hard to beat that one. Surrounded by your loved ones as you pass into the void is another. If you’re in an industrialized nation, however, it’s increasingly likely that you’re going to die in an impersonal hospital room, unexpectedly (all deaths are unexpected).

What if your death isn’t unexpected, though? What if, like me, you’ve been diagnosed with a serious, terminal illness, and you have — thanks to modern medical documentation — a pretty good idea of what the end will look like? What if words like “expressive aphasia,” “loss of bowel control,” and “seizures” could be used to describe your final days? What if your doctors have had the “We’ve done all we can do” speech with you? Would you really be interested in toughing out those last six months? Some people would, sure, power to ’em.

At this juncture, I think it’s important to distinguish between medically-assisted suicide, euthanasia, and suicide as most people think of it. “Suicide” is the classic issue most people think of; “A permanent solution to a temporary problem.” There’s a whole host of social-psychological issues surrounding it, and all I’ll say about it is that it’s not a course of action I agree with or endorse, but people in that situation are usually in a bad place in their life, and don’t need the extra judgement or stigma healthy, successful people attach to it. I think Nick Hornby actually rather nicely and sensitively summarized the situation in “A Long Way Down,” as, “You love your life, and then something happens and you get locked out, and can’t see any way back in.”

Euthanasia is distinct from medically-assisted suicide in that it’s someone else hitting the kill-switch or pushing the plunger, as opposed to the patient (this is the critical difference between medically-assisted suicide and euthanasia), and, in countries where it’s legal (parts of Canada, the Netherlands), things usually get iffy quickly (I’m paraphrasing from my bioethics class), for the very basic, obvious reason that medical error and/or errors in medical records become very fatal very quickly. And I don’t think anyone is going to advocate for that, just on the simple basis that no one trusts large, faceless bureaucratic organizations with that sort of power (we’ll ignore the fact that we task the armed force with that on a regular basis).

What I do ardently advocate for is when a patient is given less than a year to live, and there’s no medically reasonable chance of some sort of breakthrough discovery or miraculous turn-about before the patient’s “expiration date.” And we don’t actually have to reinvent the wheel on this one; there are several states with “Death with Dignity” laws that mostly-seem to work (my statistics are a decade old, but Washington’s laws had been around for a few years before they were presented in class, and something like 500 people had used them; all of them terminal AIDS or cancer cases). In my own case, I know what brain cancer at the end looks like, because it’s pretty well-documented. And it isn’t pretty. The words “nausea,” “organic brain disease,” “dementia,” “seizures,” “loss of bowel control,” “unrelenting nausea,” and “constant pain” summarize it nicely. I personally wouldn’t have any intention of seeing that out if there wasn’t a glimmer of hope.

Speaking of hope, that’s the note I’d like to end on. If you disagree with medically-assisted suicide for the terminally ill, for whatever reason, there’s a very simple solution: end terminal illness. Instead of Iran, pretend we’re at war with cancer, and throw a trillion dollars at the NIH and hospitals. Provide everyone with some sort of affordable, basic health insurance to make access and early detection possible.

The week before John McCain died of glioblastoma, there were 120-odd GBM trials registered with the FDA; the week after, 1200 (no, I’m not exaggerating that). We can absolutely cure vast swathes of illnesses, if there is political will and funding for it. At the moment, we just don’t want to, it would seem. And if we’re not willing to invest in helping the lepers of the 21st century (I believe Christ said something about that), you shouldn’t expect us to stick it out to the bitter, brutal end.

And you should also recognize — and plan for — your own mortality, gruesome as that might seem.

Science journalist, cancer survivor, biomedical consultant, the “Wednesday Addams of travel writers.”

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