The Last Dance

 By Kenneth Ring, Ph.D.

Half a lifetime ago – I was in the summer of my life then – I was running the newly formed International Association for Near-Death Studies (IANDS) at the University of Connecticut. It was at that time that I became acquainted with a then noted anthropologist named Virginia Hine who was one of the first persons to become a member of this organization. We hit it off immediately and soon became good, even loving, friends.

I had actually heard of Ginny before she joined IANDS. I had read one of her articles on altered states of consciousness, which had impressed me, and a bit later, her book, Last Letter to the Pebble People, which dealt with the death of her beloved husband, Aldie, of cancer a few years earlier.

Over the years, our letters grew warm and loving despite the fact that we were never able to meet. She mostly divided her time between her home in Florida and her organization, Rites of Passage, in California. Whenever I traveled to Florida, she seemed to be in California, and vice versa. Once, when she came to Connecticut, I was away myself. We came to joke about our mismatched schedules. The closest we ever came to meeting face to face was a single telephone call. I remember that she had a beautiful voice.

When one day I received a letter from Ginny informing me that she had decided to choose the manner and time of her death, and that the time was coming quite soon, I was stunned. I had not known or suspected her plans. I remember thinking, "Now we will never meet!"

I thought a good deal about that letter of hers before replying to it. I could see that she had considered the matter extremely carefully and that she had discussed her plans thoroughly with her friends and family. She had secured some Seconal, which she knew would allow her to die peacefully, which according to her family, as I was to learn later, had indeed proved to be the case.

She did not need nor did she ask for any advice from me. I certainly did not attempt to dissuade her – it was her choice, and I respected that. I knew she had been ill with cancer and in pain. In the end, I could only send her my love and prayers for a gentle passage into death. I also didn’t think that it made sense to regard Ginny’s death as a suicide. Instead, I viewed it as an example of a well planned and rational chosen death.

I had occasion to think of Ginny recently as a result of reading a new book by a journalist named Katie Englehart entitled The Inevitable: Dispatches on the Right to Die. It is full of cases like that of Ginny’s. These days, many people are choosing to die the way Ginny did, and an increasing number of them are doing so by finding ways to circumvent the law.

Frankly, if you will indulge a brief confessional aside, now that I’m in the deep winter of my life, I have to admit that in recent years, I’ve thought quite a bit about the fact that I definitely do not want to wind up, decrepit and demented, in one of those warehouses for the those slated for death that we euphemistically call "nursing homes." No sirree, that’s not for me! After all, would anyone, given the choice, opt to spend their last years in such a depressing environment surrounded by scores of wheelchair-bound human wrecks just "waiting to die," to use the title of one of my recent immortal books?

I have a couple of friends who share my concern about these end of life matters, and we have had a number of conversations over the years about how best to dispatch ourselves. A few years ago, for example, we all read and discussed Derek Humphry’s 1991 best seller, Final Exit, which describes various ways to kill yourself (the book has sold over two million copies in twelve languages). I did not find any of the methods Humphry offers particularly appealing nor did my friends, but one of them has since made plans to lay in a supply of drugs that she feels would do the job for her. The three of us don’t exactly have a "pact" with each other about how to prepare for a self-administered exit, should one become necessary, but we have certainly explored a number of options.

Englehart, however, has encountered people who have made such a pact. In fact her book begins with such an example. She had interviewed a New Yorker whom she calls Betty who had made such a pact with her two best friends. "We have a pact," Betty told Englehart. "The first one who gets Alzheimer’s gets the Nembutal."

Although Betty herself was in good health in her seventies, she had been around a number of even older people, including one man in his nineties, and was distressed to see them in deep pain and just "hanging around," to use her phrase. But worst was having to witness her husband die.

Her own husband had died quickly enough. Seventy-five years old. Cancer. Still, he suffered. Sometimes he cried. In his final days, Betty imagined taking firm hold of a pillow and smothering him, partly because she thought that’s what he would have wanted, but also because she couldn’t bear to see him that way. In the end, he grew so agitated that the doctors gave him enough painkillers to knock him out. He spent three days in a morphine-induced languor and then died. Betty and her friends agreed that they would never let themselves get to that place and also they would never rely on a physician to help them, because who knew where the bounds of a doctor’s mercy lay?

(Incidentally, Betty’s account here reminded me of Michael Haneke’s marvelous and moving 2012 film, "Amour," in which an elderly husband eventually has to suffocate his demented wife with a pillow because he was unable to bear her suffering any longer.)

Betty wound up going to Mexico where she had learned she could buy in pet stores a lethal poison that is used to euthanize dogs. She was able to score enough for her and her friends. The story of her escapade is actually quite amusing and was not without risk, but you’ll have to read the book for that. However, the point is that in New York, physician-assisted death is still illegal. If you wanted to orchestrate your own death, it had to be a DIY endeavor.

Actually, in the book, Englehart doesn’t spend much time talking about people like Betty. Instead, she focuses on those who have serious, debilitating and often very painful illnesses, and who are often desperate to die, but who do not qualify for physician-assisted death even in the states where it is legal. She also spends a great deal of time interviewing doctors, nurses, researchers, authors, advocates for and opponents of the right-to-die movement. In each of her six chapters, she focuses on one personal story: two about doctors who specialize in helping people to die and four case studies of people who wanted to die because of unbearable suffering they were forced to endure. One because she had lived too long and nothing worked anymore; one who was suffering from multiple sclerosis; another who had progressive dementia; and a fourth who was mad.

Engelhart is herself not an advocate for the rights of the dying; she is a reporter who simply narrates these stories and who tries to listen to them without judgment but with compassion. She is open to a variety of perspectives. Self-administered death, like abortion, is a controversial subject. But when you read the heartbreaking stories of those who do not "qualify" to die because they do not satisfy the eligibility requirements, such as having been certified as being "within six weeks of dying" or for other reasons, it’s impossible not to feel sympathy for those who find themselves having to operate outside the law in order to effectuate their own deaths. It’s like reading what pregnant women had to go through or still do where abortion is illegal. The Inevitable is one long horror story. But it is also the story of some very courageous physicians who have risked everything in order to help such people.

One of themes that runs through Englehart’s book – it almost becomes a cliché or a tired trope – is how many people yearning to die because of their needless suffering often mention that we euthanize our dogs and cats in a loving way. One man, at a conference on death with dignity, sported a t-shirt saying, "I want to die like a dog." Does it make sense that we can compassionately end the suffering of our beloved pets but can’t extend the same mercy to ourselves? After all, we didn’t really need Darwin to tell us that we are animals, too.

Recently I was reading an article about all the horses who died a couple of years ago at the track at Santa Anita – 37 of them in 2019, causing a scandal. It made me remember the old film, "They Shoot Horses, Don’t They?" (although that film wasn’t about horses). But we don’t permit horses who have no hope of recovering from a painful injury to survive. We act to end their suffering as soon as possible. What sense does it make not to grant the same privilege to people who are suffering from incurable conditions or simply from enduring, intractable pain?

I mean, why should such people suffer needlessly? If those of us who believe in abortion rights hold that women, not doctors and certainly not politicians, should have dominion over their own bodies, why shouldn’t we have dominion over our own lives? Don’t our bodies belong to us?

This same question was raised in another old film I saw some years ago, which was entitled, "Whose Life Is it, Anyway?" In the film, the main character, played by Richard Dreyfuss, is a sculptor who becomes paralyzed from the neck down as a result of an automobile accident. Since his life depends on the use of his hands (his whole life is sculpting, he avers), he finds there is no point in living, and he chooses to refuse treatment in order to die. The drama of the film centers on the reactions to his choice on the part of his friends and the medical staff and hinges on the question whether the medical and legal institutions in which he was enmeshed will respect or prevent his choice to die.

This film also brings to the fore a central thorny issue of Englehart’s book – whether dying is a matter for medicine to decide or whether it should be regarded as human right. One of the doctors who has been active for a long time in the right-to-die movement, a man named Philip Nitschke, the author of the book, The Peaceful Pill Handbook, is a staunch defender of the latter position. This is how he frames the issue:

The medical model is where we see this as a service that you provide to the sick. If a person gets sick enough, and all the doctors agree, the person who is very sick and keen to die gets lawful help to die. The rights model, which I’m strongly in favor of, says this has got nothing to do with sickness. The idea is: having a peaceful death is a human right. And as a right it’s not something you have to ask permission for. In other words, it’s something you have simply because you’re a person of this planet. The rights model, of course, means that doctors don’t necessarily have to be involved … The right of a rational adult to a peaceful death, at the time of one’s own choosing, is fundamental.

This perspective, still very controversial and the subject of heated, often rancorous, debate, is nevertheless seemingly gaining strength and more adherents in America. After all, it’s well known that the right to die movement is already strong in such countries as the Netherlands, Belgium and Switzerland, and even physician-assisted death, as limited and hedged in by complex legal and medical regulations as it is, is now permitted in a number of states. If you were to read Englehart’s book – and I strongly recommend it to anyone with an interest in these matters – you would quickly learn about all the latest techniques doctors and engineers have devised to ease people into death, the books available on the subject, the organizations devoted to the right-to-die movement, and so forth.

But there is still another reason to think that in the coming years this movement will continue to grow stronger, and that has to do with demographics. The elderly are now the fastest growing segment in America. In 2010, there were about 40 million Americans 65 or older. By 2030, it is projected that one in five Americans will have reached that age. If so, that means we will soon be saddled with a population that is increasingly afflicted with dementia or otherwise seriously physically compromised. And since a quarter of all Medicare spending goes to people in the last year of their lives, there will be an even greater financial strain on our social networks, such as Medicare, Medicaid and Social Security.

What this portends, to put it crudely, is that in the future, many old and infirm people will be virtually begging to die, their younger relatives will be motivated to help them to do so (since their economic well being is threatened by having so much of our national wealth having to be diverted to care for the elderly) and organizations like the AARP and other organizations that lobby for the old will have to become advocates for the right-to-die movement. You can see the writing on the wall. The demographics make it plain. We can no longer afford (literally) to let death take its course. We must find ways to ease the burdens of life on the old by helping them to die with dignity and lessen the financial burdens on the young so that they can live without themselves suffering unduly. Medical technology has indeed enabled people to live longer than ever, but it has also served to prolong their years of pain and debility, ending with their complete dependence on others. Does this make sense? Is it humane?

Before concluding this blog, there is one more issue I need to deal with that has been with us from the very beginning. It was implicit in the story I told at the outset about Virginia Hine’s death and was explicitly brought out in the film I mentioned, "Whose Life Is It, Anyway?" And that is the question having to do with the S-word. Should such deaths be regarded as suicides? And if so, what can people expect to experience when they die in this way? This is a question that can be addressed, even if not definitively answered, by the research on near-death experiences for people who nearly die, but don’t, as a result of a suicide attempt. In fact, whether one prefers to call deaths like Ginny’s "chosen deaths," or regards them as a form of rational suicide, we still want to know what will such people experience when they cross the threshold into the house of death.

But first, let’s look at some statistics concerning suicide in America, especially for the elderly. Older adults make up 12% of the US population, but account for 18% of all suicide deaths. This is an alarming statistic, as the elderly are the fastest growing segment of the population, making the issue of later-life suicide a major public health priority. Moreover, in 2018, seniors ages 85 and older had the second-highest suicide rate in the nation. From what I have already written, I think you will understand why. Finally, estimates suggest that for every reported death by suicide, an additional 29 attempts are made.

Now turning to what we know about what people experience when they make an unsuccessful suicide attempt, the data both from my research and that of my longtime friend and colleague, the psychiatrist Bruce Greyson, are in agreement. Although many people who come close to death in this way remember nothing (that is true as well for other modes of near-death onset, such as a cardiac arrest), those who do tend to report the same kind of classic, radiant NDE as do people who nearly die from injuries or cardiac conditions. Greyson has found that about 25% of his suicide cases report such NDEs. My findings were similar. I concluded therefore that there is nothing unique about NDEs triggered by a failed suicide attempt.

Furthermore, most of those who do experience an NDE are not tempted to try suicide again, and, indeed, often conclude that suicide would solve nothing – even if they had succeeded, they seem to feel that they would have to deal with the same issues that prompted their attempt in the first place. But most importantly, they typically don’t feel that they would be punished, much less "sent to hell," because of trying to kill themselves. As with NDEs that occur in other ways, they are not judged, but usually experience compassionate understanding and unconditional love during the time they hover between life and death.

However, most of my cases, and I suspect this is also true for Greyson’s, involve people who are relatively young and who normally have attempted suicide because of personal problems, such as alcoholism, drug addiction, financial troubles or a failed love affair. These we may call collectively "despair-based" suicide attempts. But for the elderly, the motivations tend to be different in many cases. For them, there is often a feeling that their lives are complete, that they are suffering needlessly for no good reason, and that they simply "want to go home." For such people, suicide is more of a considered rational decision, not one governed by an impulsive act stemming from an acute condition of despair and despondency. At least, this is the sense one gets from reading the many cases to be found in Englehart’s book.

The trouble is, so far as I know, we don’t have much if any data on what is experienced by elderly people who take this route toward death, in large part, of course, because they succeed in taking their lives. So here I can only speculate.

First, from all the research I’ve done on NDEs, I know that someone who nearly dies in whatever way is not judged. Instead, they tend to be greeted by a warm loving light. They feel that they are home, where they belong and where, in some eternal sense, they have always been. As one man I know well put it, "It was eternity. It’s like I was always there and would always be there, and that my existence on earth was just a brief instant."

Since I’ve mentioned several films in this blog, I can’t help thinking of a famous film actor from another era, Charles Boyer. He often played the part of a sophisticated lover. These days, he is probably best remembered for his role in "Gaslight" in which he starred with Ingrid Bergman.

I mention him here because I remember reading some years ago that he so loved his wife that when she died, he was so distraught that could not bear to live without her. Two days after her death, he committed suicide by taking Seconal.

I was very touched when I learned that. Personally, I just cannot persuade myself that Charles Boyer, when he took that last dance into the Light, would have been made to suffer for his actions. No, that’s just inconceivable to me.

Likewise for my friend, Ginny, who also chose to die so that she could again be with her beloved husband, Aldie.

It is my profound hope and prayer for all those who, having lived a full life and who no longer choose to live in pain, that they, too, will find surcease in the Light. That would only be just, don’t you think?