“If you think she seems uncomfortable I can increase her morphine.” Those were the words of the caring and thoughtful nurse who was standing in the room as I sat on my mother’s bed. My mother’s breath came in ragged sounding heaves. The nurse and I knew she was going to die soon. Whether it would be minutes or hours wasn’t clear, but it would almost certainly be that evening.
The morphine drip had been started about an hour earlier, after my sister and I had agreed that it was time to shift mom to acute hospice care. Like many people, we made this decision only after our mother was already so close to death that she was unlikely to receive much benefit from the shift. Still, her last few hours would be peaceful.
“If you think she seems uncomfortable, I can increase her morphine.” The nurse had spoken those words to me because I’d asked about the ragged, heaving breaths. Not long before, she’d told me that it was unlikely that mom was aware any longer. Now, though, she repeated her statement, as if to make sure that I understood that I was the one who could decide whether or not my mother seemed to need the morphine. Whether she intended to or not, she’d offered me an out. Without saying it, she’d told me that if I was uncomfortable with my mother’s death rattle, we could increase the morphine. My mother and I had a lifetime of codependence between us and I can’t swear that in those moments I could easily tell the difference between my discomfort and hers.
“Please,” I said. And she did.
This is a story I tell in My Mother’s Cross: Cancer, Kink, Sex, and Death, my memoir of the time spent caring for my mother to be published by She Writes Press next fall, but I thought of this conversation today as I read Sarah Lyall’s New York Times Dispatch piece published with the heart wrenching title, “Could I Kill My Mother?” The question turns out to have a complicated answer, as many of us who have cared for a person who is actively dying will already understand. In Lyall’s case, her mother was dying of lung cancer and she was caring for her mother at home. She had direct control over the morphine and her mother pleaded with her to help her die, but Lyall, uncertain about how much to give, didn’t get the help or the permission that I implicitly received.
In my case, the morphine was controlled by a nurse who put the assessment of my mother’s pain in my hands. It isn’t that she administered an immediately lethal dose of morphine. She offered enough to make mom seem comfortable. After she increased the morphine, mom’s breathing became shallower, quieter. Within a few hours, her heart rate increased dramatically and then started to fall. Her breaths came farther and farther apart. By 6:30 that evening she’d died.
The health care and legal systems in the United States make it very hard for people to claim autonomy over their bodies in relation to dying. They make it even harder for people to receive assistance in taking control over the most profound transition of their lives.
As I write this, a person’s legal ability to receive assistance ending their own life in protected by legislation or the courts in only six states and the District of Columbia. Hawaii will be added to the list in January. I generally wouldn’t say that I’m glad my mother died in a hospital instead of at home, but I’m extraordinarily grateful that she died in a place where she received compassionate care in the final hours of her life. This shouldn’t be a privilege. The right to choose the manner of one’s death, when it is logistically and technically possible to do so, should be protected as fiercely as any other right we have to our bodies. Sarah Lyall and her mother should have had access to the information they needed. We need to do better by the terminally ill and the people who care for them.
If you are in the United States, Death With Dignity National Center is a great place to start for information about how to advocate for laws in your state, how the laws work, and what documents you might want to prepare even if your state does not have a death with dignity statute.
For those outside the U. S., Final Exit’s World Right To Die Page offers contact information and links to organizations in a number of nations that can help you.