Advocating Suicide.

Suicide is a personal choice, of course. To some, it indicates weakness of the will. An easy way out when the going gets tough. Like some of us view no-fault divorce.

To some, it's a sin. A cultural no-no, that happens surely, but nothing to advocate. The late Pope John Paul II set an example in illness about the dignity of life, even a life lesser lived due to health. If the mind is there...

Hemingway is the other side of the coin, of course. Hunter Thompson too. They were in pain, perhaps unable to work -- or write at the level they'd come to expect of themselves. They took themselves out of the game -- a clean death for them, quick, painless, over. They left behind cleanup for others, and perhaps collateral damage, but that too is their choice, and I'm glad every one of us has the chance to make it. Some like the control that comes with knowing they direct their own destiny, to the timing of the grave even.

Still, I'm leery of advocating suicide as some noble pursuit. I too read the ailing gentleman's clarion call for death in the NYTimes. I had pity for him, and the toll his illness will take.

And one, from Texas, put a hand on my thinning shoulder, and appeared to study the ground where we were standing. He had flown in to see me.

“We need to go buy you a pistol, don’t we?” he asked quietly. He meant to shoot myself with.

“Yes, Sweet Thing,” I said, with a smile. “We do.”

I loved him for that.

I love them all. I am acutely lucky in my family and friends, and in my daughter, my work and my life. But I have amyotrophic lateral sclerosis, or A.L.S., more kindly known as Lou Gehrig’s disease, for the great Yankee hitter and first baseman who was told he had it in 1939, accepted the verdict with such famous grace, and died less than two years later. He was almost 38.

Then, I looked him up online. It's interesting the background details: The dying man, in his 50s only, checked himself into an old-age home when his own mother was suffering from a stroke. Interesting. Having been around Mal's mother herself post-stroke, I know some of the physical limitations -- she never walked again, for example, needed help "transferring" and ate messily. Cradled her arm as it withered into her, and often held her head in her hands, from the body pain or the physical fatigue with the medications, I don't know.

Still, she was a great lady, a good patient, always paying compliments ("Your hair is so shiny", she used to tell me, admiring the wave and thickness) and always thanking everyone, even for the smaller things. She said, "I love you" a lot, and the simple things -- a pillow to separate her feet, helping fix her elastic stockings, a sweet treat or listening to old stories... It was a life worth living, and to this day, I think there's a reason she lived after the stroke: to help her family prepare for her death, to show them in her dying how rich everyday life is, to keep fighting until she was ready to go...

This man writing the essay chooses differently. What he saw, and experienced, checking himself in prematurely to that assisted care living/nursing home earned him a published book, full of tales of aging, companionship, working, and sex even, though one wonders if his age permitted him to see things, perhaps participate in them?, that others did not.

Another thing: the man is gay, not that there's anything wrong with that. But you wonder if his culture -- ever youthful, ever valuing physical images of health, happiness, and fun, fun, fun! -- influenced his thinking too, on being less desirable in a limited physical capacity and having less reason to live if "you can't have that..."

Maybe, maybe not.

The next morning, I realized I did have a way of life. For 22 years, I have been going to therapists and 12-step meetings. They helped me deal with being alcoholic and gay. They taught me how to be sober and sane. They taught me that I could be myself, but that life wasn’t just about me. They taught me how to be a father. And perhaps most important, they taught me that I can do anything, one day at a time.

Including this.

I am, in fact, prepared. This is not as hard for me as it is for others. Not nearly as hard as it is for Whitney, my 30-year-old daughter, and for my family and friends. I know. I have experience.
...
I’d rather die. I respect the wishes of people who want to live as long as they can. But I would like the same respect for those of us who decide — rationally — not to. I’ve done my homework. I have a plan. If I get pneumonia, I’ll let it snuff me out. If not, there are those other ways. I just have to act while my hands still work: the gun, narcotics, sharp blades, a plastic bag, a fast car, over-the-counter drugs, oleander tea (the polite Southern way), carbon monoxide, even helium. That would give me a really funny voice at the end.

I have found the way. Not a gun. A way that’s quiet and calm.

My point is: how we live, and how we die, are personal choices. Influenced by our cultures, our families, our friends surely, and mostly, our character. Do we struggle and fight and fail, or do we throw in the towel before our own body is prepared to surrender on our behalf?

I admired Hemingway's strength for controlling his destiny to the end, but I'd never advocate it. Maybe it was depression, or a weakness really. I mean, for most folk, life does go on when your writing and professional talents wane in later days. If you value yourself, surely there are other people, other communities counting on you. Every life has value, and all that.

It's great that this man touched so many with his call to suicide before he ends up living in a manner he sees as lesser and could not tolerate. He's suffering from Lou Gehrig's disease, and like so many chronic illnesses, the end is not pretty. Living is not for the feint of heart. Dying takes toughness, an inner strength that some simply don't have.

Bringing the profitability factor into it: that's really what bothers me. Absolutely we have a medical costs crisis in this country. It's why so many object to revamping the system by forcing everyone to play brothers' keeper, instead of allowing the costs and choices to be borne by individual families as we've done in matters of life and death throughout history. No, now we're all going to be shepherded into some big government, corporate insurance plan, with ... outsiders influencing who lives, and primarily, who dies.

Let's not conflate the two topics. Brooks today in "Death and Budgets":

Clendinen’s article is worth reading for the way he defines what life is. Life is not just breathing and existing as a self-enclosed skin bag. It’s doing the activities with others you were put on earth to do.

But it’s also valuable as a backdrop to the current budget mess. This fiscal crisis is about many things, but one of them is our inability to face death — our willingness to spend our nation into bankruptcy to extend life for a few more sickly months.

The fiscal crisis is driven largely by health care costs. We have the illusion that in spending so much on health care we are radically improving the quality of our lives. We have the illusion that through advances in medical research we are in the process of eradicating deadly diseases. We have the barely suppressed hope that someday all this spending and innovation will produce something close to immortality.

But that’s not actually what we are buying.

If you want to advocate suicide for the suffering, that's very libertarian of you. But to hold someone up as a hero, for being a "money saver", when I suspect the writer's personal background -- the "been there (early), done that" stint in the senior care facility before he really needed to be there, the possible impact of his lifestyle choice discussed above -- influenced his thinking much more than the noble impulse of not wanting to further burden taxpayers with the costs of his care.

Sorry, Brooks has it wrong. What he sees as a "quick fix" -- urging others to choose death -- to our medical costs problem ought to be eyed very warily. Keep your private decisions private. Don't go sticking your nose, a very well-intentioned nose I'm sure, into other people's private situations because that's how these things start...

Others disagree with this pessimistic view of medical progress. But that phrase, “marginally extend the lives of the very sick,” should ring in the ears. Many of our budget problems spring from our quest to do that.
...
The fiscal implications are all around. A large share of our health care spending is devoted to ill patients in the last phases of life. This sort of spending is growing fast. Americans spent $91 billion caring for Alzheimer’s patients in 2005. By 2015, according to Callahan and Nuland, the cost of Alzheimer’s will rise to $189 billion and by 2050 it is projected to rise to $1 trillion annually — double what Medicare costs right now.

Obviously, we are never going to cut off Alzheimer’s patients and leave them out on a hillside. We are never coercive going to give up on the old and ailing. But it is hard to see us reducing health care inflation seriously unless people and their families are willing to do what Clendinen is doing — confront death and their obligations to the living.

Who says if a life is worth living? Who determines which illnesses -- Alzheimer's, dementia, physical immobility? -- mean you'd be better off dead, as the writer here is choosing for himself.

Sorry but "obligations to the living" sound dangerously close to the current entitlement "obligations" that some of our more productive citizens and achievers are already paying to carry the personal decisions of others...

My only point today is that we think the budget mess is a squabble between partisans in Washington. But in large measure it’s about our inability to face death and our willingness as a nation to spend whatever it takes to push it just slightly over the horizon.

You want slippery slopes, whoop there it is.

I don't trust David Brooks to be sticking his nose anywhere near the private choices made via cultural, familial, and personal values transmitted over a lifetime. Look for other ways to save your bucks -- including scaling back the system as a whole if medical costs have skyrocketed. Let those who choose to, and can afford to, live life to the end. Don't lock everyone into a government program, like we've done with these entitlement structures, and then secretly slip your own cultural choices and values into the mix. Something tells me, what you'd choose for others might not be what you'd choose for your own. Those like the writer who personally want to go, because their lifestyle/family connections to life just aren't that strong, sure they have a right to check out early. But let's not pretend that size fits everyone.

Let's put an end to interfering with other people's values and choices, before we even go there. Let's not culturally stigmatize the suffering and elderly, just because they now cost us all money when we're all collected into the same healthcare cost pot because nobody is allowed to remain independent and stand by their own fiscal choices.

You know it's coming. Demographically, it's a financial problem, not an old-person abundance. Premature babies cost us an awful lot for their little lives too. Should we urge a cost-saving there too, if we think their lives are not worth of the money expended? Who will make the call?

Keep private decisions private. Respect, and pity, men like the writer suffering from LGS. But don't hold him out as a hero, when in reality, he's an increasingly weak man making his own personal choices based on what he's learned and valued in his own life. That's it. Nothing more.

RELATED: More on personal choices being compared and ... equalized? Sure people have different options and make different choices. That's what happens when you permit them to be independent, and take care of their own. Pretending that we all will end up with the same results, and have to somehow equalize or justify the end-of-life results, when all the factors up to that point have never been equalized ... again, this is where it begins, and why we don't want to toss everybody into the same pool.

The end of life really is where the hard work and gambles pay off, or not.

"On average, whites have more income and education and can better afford these options,” Dr. Feng said. “They don’t have to go to nursing homes, or they’re better able to delay going.”

With greater scrutiny, then, this demographic trend represents a less happy scenario. Just as minority seniors are pouring into nursing homes, whites are turning to more attractive choices and staying out.

Because there’s much less data on who, exactly, relies on home and community services, compared to who enters nursing homes, Dr. Feng is couching this explanation as a hypothesis.

He notes that the statistics may also reflect cultural changes. Immigrant communities that care for parents in multigenerational households may be less able to maintain that practice as they acculturate. “A lot of things are happening to undermine those traditional family options,” he said. He’s seen a similar shift in his native China, a topic I’ll return to in a subsequent post.

Overall, he sees a good news-bad news story, in which minority seniors get stuck in the institutions that whites have the means to avoid. “I’m struck by this persistent disparity,” Dr. Feng said. “It looks like we’re making some progress, but not really. The disparities are still there and are deeply rooted in history, geography, segregation and socioeconomic differences.”