A Death with Dignity, By Judith Gordon, Phd, End of Life Washington Board Member
Perry called to say goodbye about ten days before his death. We hadn’t seen each other for over twenty-five years, but I recognized his voice immediately, even though it was weak and strained. He’d been diagnosed with aggressive, inoperable, metastatic lung cancer about six weeks previously. He was in great pain, he didn’t like the effects of morphine, he felt tethered to oxygen, and so he had decided to use Washington State’s Death with Dignity law. He was fortunate to have an oncologist, a consulting physician, and even a hospice nurse who supported his choice, and the day he called me he had picked up his prescription from a cooperative pharmacist.
Perry was referred to me for psychotherapy for chronic anxiety and depression in the 1990s. A highly intelligent, articulate man in his thirties, he was on psychiatric disability because of his inability to perform at work due to his symptoms. Perry was an isolated individual with few friends, though I found him to be warm, responsive, thoughtful, and likeable. In the year we worked together, he tried medications for depression and anxiety, as well as a brief voluntary stay in an inpatient facility, but his symptoms and emotional suffering continued.
Finally, Perry decided to commit suicide. He arranged a diving trip in the Caribbean and planned to never come back up. In anticipation, he gave away most of his few possessions. We shared a tearful goodbye. Two weeks later Perry was back from his trip. While there he’d become friendly with the dive resort staff, enjoyed being with them, and decided he wasn’t ready to die. After several additional months of therapy, trying to extend the good experiences he’d had on vacation into life back home, he decided once again that he didn’t want to live. So he made plans to return to the same dive area, this time determined not to return. I went into grieving and soul searching all over again. But two weeks later Perry came back to Seattle. He’d been put on a dive boat with only two other people, a honeymoon couple, and couldn’t bear to leave them with an anniversary that would always be associated with a suicide. What a thoughtful compassionate human being he was!
Shortly after his return Perry visited an old friend who lived in the country. He got in touch after that to say that he was enjoying being out of the city, hanging out with his friend’s two dogs. He finally moved out of Seattle himself and became a dog walker and sitter. He lived for another twenty-five years caring for dogs until his cancer diagnosis sent him my way again.
We reminisced about our long relationship over several phone calls. I commented on how much joy he had brought to the dogs and the owners he had worked with over the years, as well as to himself, musing about how none of that would have happened had his suicide attempts succeeded. Perry felt ready to die now, at age 69. He was happy that he could use the Death with Dignity law, which allowed him to retain his dignity and his autonomy, core values throughout his life. Perry died in the loving presence of his brother and the close friend he had stayed connected with through the years, both of whom actively supported his choice.
I used to tell Perry’s story as an example of how clients who are suicidal are sometimes helped, not by a psychotherapy intervention, but by the intervention of life itself. Making new friends and experiencing joy, or spending time with someone special, or connecting with animals and nature can add missing meaning to life. Although I know Perry found our relationship warm and supportive, it couldn’t provide him with the life experiences he needed to have a sense of enduring meaning and connection.
As it turns out, Perry was suicidal once again in his life – when his suffering from cancer seemed unbearable and before he realized he might qualify for Death with Dignity. In desperation he researched how to make sure that if he jumped off the Deception Pass Bridge he would die by landing on the rocks, not in the water. He was weak, tired, and distrustful of the medical profession and only pursued Death with Dignity at the entreaties of his family and friends, who were horrified by the suffering his suicide would cause all concerned. With their help, encouragement, and advocacy, as well as with courage, caring, and integrity on his part, Perry was able to use the law. Thoughtful and responsible to the end, Perry chose to die one day after his social security check arrived, so that he could cover the cost of his cremation.
After Perry died, his friend told me, “Death with Dignity is so wonderful because it gives someone control of their destiny and gives them so much comfort, once they are approved, to know that they will not have to bear unbelievable pain and suffering. The knowledge that individuals can act when they are ready, when they know it is the right time, finally provides them something so positive in the midst of so much negative news about their health. It does provide the ultimate dignity and control over their destiny… Perry died thankful, not angry and bitter. He died knowing he was loved and believing in the good of humanity.”
Perry asked me to tell his story to illustrate the critical distinction between physically well people who are suicidal because they are emotionally distraught and individuals whose terminal illness will certainly cause death and who thus choose to use the Death with Dignity law to die on their own terms. Death by suicide is lonely and violent, and it causes grief to the survivors. The personal timing of a death that is inevitable due to terminal illness can help the survivors feel great relief knowing they supported the dignified death of a loved one. In turn, the dying person can experience the love and support of family and friends, as well as the compassionate care of the medical team. Perry died surrounded by love two days after our final goodbye. He told me he was happy and at peace.
His was truly a death with dignity, not a suicide. It was a privilege and an honor to know this courageous and compassionate man. I will never forget him, and I will be forever grateful that Perry and I live in a state where Death with Dignity is a viable option for those who need to pursue it.
Judith Gordon is a licensed psychologist with a psychotherapy practice in Seattle and Clinical Professor of Psychology at the University of Washington. For many years she conducted research, wrote, and trained mental health professionals regarding changing health risk behaviors. She has focused on policy and research in end-of-life decision-making since 1996. She chaired the Washington State Psychological Association (WSPA) End-of-Life Task Force from 1997-2010 and received the WSPA Social Issues Award in 1999 and 2007 for her work related to end-of-life issues.