Complex and Difficult Endings
Suicide, homicide, physician-assisted suicide, violence (including domestic violence), sudden death (from accidents and otherwise), dementia and other forms of lingering illness -- complex and difficult endings may bring complicated losses and complicated grief. You'll find some resources to deal with such losses here.
• End-of-life decision-making
• Assisted suicide
(assisted death, right to die)
• Euthanasia (physician-assisted dying)
• Suicide and suicide prevention
• Books about suicide and surviving suicide
• How to tell children their parent is dying
• A reading list
Aircraft Casualty Emotional Support Services (ACCESS, connecting those who have survived or lost loved ones in private, military and commercial plane crashes and other aviation tragedies with individuals who have lived through similar losses)
A Life-or-Death Situation (Robin Marantz Henig, NY Times Magazine, 7-17-13). A Right to Die, a Will to Live: As a bioethicist, Peggy Battin fought for the right of people to end their own lives. Suffering, suicide, euthanasia, a dignified death — these were subjects she had thought and written about for years, and suddenly, after her husband’s cycling accident, they turned unbearably personal. Follow-up story: Choosing to Die After a Struggle With Life (Henig, The 6th Floor, NY Times, 8-21-13) On Saturday, July 27, six days after the article was published in print, , Brooke Hopkins finally decided he’d had enough. "Later, Peggy told the Tribune reporter, Peggy Fletcher Stack, that 'it was peaceful and painless, just as he wanted it' — close to the kind of ending he described to me earlier as a 'generous death.'" Here's a video slideshow of about the peaceful end of Brooke Hopkins' life (Peggy Fletcher Stack, Salt Lake Tribune, 8-29-13
A Life Worth Ending (Michael Wolff, NY Times Magazine, 5-20-12). The era of medical miracles has created a new phase of aging, as far from living as it is from dying. A son’s plea to let his mother go. I agree with Robin Henig: ""One of the most beautifully done, searing articles I've ever read about death in the age of medical intrusion." Quoting from the article: "The traditional exits, of a sudden heart attack, of dying in one’s sleep, of unreasonably dropping dead in the street, of even a terminal illness, are now exotic ways of going. The longer you live the longer it will take to die. The better you have lived the worse you may die. The healthier you are – through careful diet, diligent exercise and attentive medical scrutiny – the harder it is to die. Part of the advance in life expectancy is that we have technologically inhibited the ultimate event. We have fought natural causes to almost a draw. If you eliminate smokers, drinkers, other substance abusers, the obese and the fatally ill, you are left with a rapidly growing demographic segment peculiarly resistant to death’s appointment – though far, far, far from healthy."
At the end of a loved one's life, why is it so hard to let go? (Craig Bowron, Washington Post, 2-22-12). Craig Bowron is a hospital-based internist in Minneapolis. "When families talk about letting their loved ones die 'naturally,' they often mean 'in their sleep' — not from a treatable illness such as a stroke, cancer or an infection. Choosing to let a loved one pass away by not treating an illness feels too complicit; conversely, choosing treatment that will push a patient into further suffering somehow feels like taking care of him. While it's easy to empathize with these family members' wishes, what they don't appreciate is that very few elderly patients are lucky enough to die in their sleep. Almost everyone dies of something."
Compassionate Friends (national self-help organization for help grieving the loss of a child of any age). Resources include a Chapter Locator and online brochures on topics ranging from Understanding Grief, Sudden Death, Surviving Your Child's Suicide or Homicide, The Death of an Adult Child, Death of a Special-Needs Child, Adults Grieving the Death of a Sibling, Suggestions for Various Professionals Dealing with Someone's Loss of a Child. Compassionate Friends' credo: The Compassionate Friends credo: "We reach out to each other in love to share the pain as well as the joy, share the anger as well as the peace, share the faith as well as the doubts, and help each other to grieve as well as to grow. We need not walk alone. We are The Compassionate Friends." Here Linton Weeks describes the healing that goes on at a Compassionate Friends conference. He writes: "No matter how your child dies, there is an undeniable sense of failure among bereaved parents. Jan and I are haunted by Stone's and Holt's violent, senseless deaths, and all of the wrongs that can never be righted. Including the biggest of them all — we could not save our sons from death. We should have been the ones who died first, not our precious boys. We carry that guilt in our already shattered hearts, and we relearn every morning when we wake up that the loss of our children is something we will never get over. Or past. Or through." The Compassionate Friends conference brings together parents isolated from their friends, family, work by pain and inexperience with such loss.
Complicated Losses, Difficult Deaths: A Practical Guide for Ministering to Grievers (Roslyn A. Karaban, an eBook)
Dad's Last Visit (Pat Jordan, AARP, 2006, posted on Alex Belth's Bronx Banter). He spent his life pretending to be someone he wasn't. Now he wanted me to know the real deal.
Darcy at Her Days’ End :A beloved dog afflicted with the disease of old age brings her owner face to face with responsibility in its purest form (Verlyn Klinkenborg, NYTimes, 12-18-09)
The Death Penalty: Righteous Anger or Murderous Revenge?. A Conversation with Thomas Cahill, David R. Dow and Robert K. Elder. Moderated by Jill Patterson (posted on Creative Nonfiction)
Death With Dignity Should Not Be Equated With Physician Assisted Suicide (Peter Ubel, Forbes, 8-26-13)
Death with Dignity and Palliative Care (Melissa Barber, Living with Dying blog, Death with Dignity National Center, 8-28-13).
The Depressed Child
‘Everyone Welcome’—Even Now (Chris Buice, The Daily Beast, 1-9-09). After a senseless act of violence in our church, we did not give in to anger. We sought a better way.
A Facebook story: A mother's joy and a family's sorrow. Ian Shapira, Washington Post, has edited and annotated Shana Greatman Swers Facebook page to tell her story from pre-baby date nights to a medical odyssey that turned the ecstasy of childbirth into a struggle for life.
Families of Military Suicides Seek White House Condolences (James DAO, NY Times, 11-25-09, on pressure to change a hurtful policy)
Growth House provides access to over 4,000 pages of education materials about end-of-life care, palliative medicine, and hospice care, including the full text of several books.
Farrah Fawcett's Long Goodbye (Jim Rutenberg, NY Times, 5-27-11). Dying of cancer, she authorized a documentary of her final days. "Ms. Fawcett had intended the film to address shortcomings she saw in American cancer treatment and to present it in art-house style....After [Ryan] O’Neal and NBC gained full control of the documentary, the film took on the feel of network celebrity fodder — at once more glossy and more morbid....Many scenes addressing the American medical system were scrapped or truncated." Her final story became the object of a lengthy battle.
The Good Short Life by Dudley Clendinen (NYTimes, 7-9-11). Living with Lou Gehrig's disease (ALS) is about life, when you know there's not much left. And Writer Dudley Clendinen has chosen not to go to the great expense and limited potential of extending his life--but to enjoy what he can of it, while he can. He learned he had the disease when he was 66, and Maryland Morning, an NPR news station, has been airing conversations with him about how he and his daughter Whitney have been dealing with the disease and its implications. Listen to the podcasts
The Guardians: An Elegy by Sarah Manguso. “A bittersweet elegy to a friend who ‘eloped’ from a locked psychiatric ward . . . [Manguso] explores the extent to which we are our friends’ guardians and, in outliving them, the guardians of their memory . . . Manguso’s writing manages, in carefully honed bursts of pointed, poetic observation, to transcend the darkness and turn it into something beautiful. The results are also deeply instructive, not in the manner we’ve come to fatuously call “self-help” but in the way that good literature expands and illuminates our realm of experience.” —Heller McAlpin, Barnes and Noble Review
HALOS, a support group for families and friends who have lost a loved one to homicide (not a therapy group and not associated with any religious group)
Homicide Outreach Project Empowering Survivors (HOPES program), William Wendt Center for Loss and Healing, Washington DC
How the mother of a slain 9-year-old sank into despair, then sought justice (Neely Tucker, Washington Post 1-20-10, part 1. Slow-loading. Part 2: Carol Smith fought for justice after daughter Erika's murder in Silver Spring
How to Die by Joe Klein, reads the cover of Time Magazine (June 11, 2012). Inside the story is called "The Long Goodbye." Klein writes about the dramatic improvement in his parents' care when they were moved to a facility with no incentives for unnecessary interventions. "For five months, I was my parents' death panel. And where the costly chaos of Medicare failed, a team of salaried doctors and nurses offered a better way."
How to Die: Safeguards for Life-Ending Decisions (by James Leonard Park). Read this book free online. He defines terms for the right to die (e.g., distinguishes between "irrational suicide" and "voluntary death") and writes about protecting patients from greedy relatives, from family pressure to die, and from health-care administrators who must save money, and other safeguards. Very informative and in useful linked format.
In death, a promise for the future. As her world diminished, Elizabeth Uyehara signed her body over to researchers to help unravel the mystery of Lou Gehrig's disease. (Thomas Curwen, Los Angeles Times, 8-28-10, on the course of Uyehara's ALS and on what happens when organs are donated for science)
In Romania, bribery is a health problem (Dan Bilefsky, NY Times, 3-8-09, from a story in International Herald Tribune) Medical Care in Romania Comes at an Extra Cost
KOTA blog (poems of grief, Knowing Ourselves Through Art)
Let's talk about dying (Lillian B. Rubin, Salon.com, 12-27-12). "At 88 and ailing, I refuse to live at any cost. I only hope that when the time comes, I'll have the courage to act. ... At 88-going-on-89 and not in great health, what’s cowardly about my deciding to turn out the lights before putting my family through the same pain they’ve already lived through with their father and grandfather? What’s courageous about spending our children’s inheritance just so we can live one more month, one more year? Is it courage or cowardice to insist on staying alive at enormous social cost – 27.4 percent of the Medicare budget spent in the last year of life – while so many children in our nation go hungry and without medical care?"
Lives Cut Short by Depression (Daniel Ofri, Well, NY Times 6-9-11)
'Making Toast': Simple Gestures for Moving On, National Public Radio story and review of Making Toast by Roger Rosenblatt, which E.L. Doctorow describes thus: "A painfully beautiful memoir telling how grandparents are made over into parents, how people die out of order, how time goes backwards. Written with such restraint as to be both heartbreaking and instructive."
The Mercy Papers: A Memoir of Three Weeks by Robin Romm (a young woman's raw unflinching account of losing her mother to cancer--with no sugar coating, as one reviewer puts it)
Months to Live, Palliative Care Doctor Fought for Life (Anemona Hartocollis, NYTimes, 4-3-10). Desiree Pardi the palliative care doctor who believed in a peaceful death, chose at the end of her own life to endure a lot, even though she knew deep inside "this was not fixable," because she wasn't ready to let go.
Moving Away From Death Panels: Health Reform for the Way We Die (Ira Byock, The Atlantic, 3-6-12). There is surprisingly little disagreement about what constitutes good care at the end of life, but we still can't seem to fix any of our problems. It's time for conservatives and progressives to declare a truce before we lose opportunities for health reform to improve the way Americans are cared for and die.
Music for Funerals and Memorial Services. This could be a healing part of the process of burying the dead. Here are links to samples of selections that may help you remember the good times, and mourn the end of the life.
National Child Traumatic Stress Network (NCTST)
National Organization for Victim Assistance (NOVA)
Now I Lay Me Down to Sleep (NILMDTS), a nonprofit organization of professional photographers who, as volunteers, take photos for grieving parents, when a baby dies
Mothers in Charge Stop the Violence! Prevention, Education, and Intervention
Out of This World (Pulse: Voices from the heart of medicine). Fourth-year medical student Katelyn Mohrbacher on the family's and medical staff's experience with an eighty-year-old man in a persistent coma.
Parents of Murdered Children (POMC, for family and friends of those who have died by violence)
Sick and Tired (Paul Rousseau, in Pulse: Voices from the heart of medicine). A mother being kept alive by transfusions is sick of them and must decide whether to continue for the sake of her daughter.
The Still Point of the Turning World by Emily Rapp. This luminous memoir about mothering a dying child, Ronan, from his diagnosis with Tay-Sachs disease, a degenerative condition with no cure is also about "the loving process of letting go while holding on for dear life." Read Sarah Manguso's review, Requiem (NY Times, 3-15-13) and listen to Terry Gross's interview with the author (Fresh Air, NPR, 3-18-13).
• How do you tell children their father is dead? (Barbara Want, The Guardian, 4-29-11) And what happens next? Barbara Want (author of Why Not Me?: A Story of Love and Loss , explains how she and her twins adjusted to being 'just the three of us' after her husband died four years ago.
• Troubled Ears And Tender Hearts: Breaking The News Of A Parent's Death (Carole Fleet, Huff Post, 5-20-13)
• Helping Children When a Family Member Has Cancer: Dealing With a Parent`s Terminal Illness (American Cencer Society), including Why should I tell my children I’m dying?
• When a parent is dying (Don Seccareccia, palliative care physician, and Andrea Warnick, RN, Palliative Care Files in Canadian Family Physician)
• How to tell your child you might be dying (Elizabeth Cohen, CNN Health, 7-1-10)
• When a Parent Dies (Hospice.net) A guide for patients and their families
Resources for when terminal or life-threatening illness requires decisions about what individuals, families, and professional caregivers should do
• Five Wishes lets your family and doctors know:
* Who you want to make health care decisions for you when you can't make them.
* The kind of medical treatment you want or don't want.
* How comfortable you want to be.
* How you want people to treat you.
* What you want your loved ones to know.
• What an End-of-Life Adviser Could Have Told Me (Jane Gross, The New Old Age, NY Times, 12-15-08). "If only I’d had the 800 number for Compassion & Choices in the last difficult months of my mother’s life."'
• In Plain Language: A Glossary Of Terms For End-Of-Life Planning (New Hampshire Public Radio, 8-28-13)
• Compassion and Choices (supports, educates and advocates for choice and care at the end of life -- improving pain and palliative care, enforcing living wills and advance directives, and legalizing aid in dying)
• Answers to common end-of-life questions (Compassion & Choices, scroll down)
• The Right to Know, Then to Say ‘No’ (Jane Gross, New Old Age, NY Times 10-21-08)
• Letting Go (Atul Gawande, New Yorker, 8-2-10). What should medicine do when it can't save your life? Modern medicine is good at staving off death with aggressive interventions—and bad at knowing when to focus, instead, on improving the days that terminal patients have left.
*** How to Talk End-of-Life Care with a Dying Patient (video, Atul Gawande speaking at New Yorker festival, 10-12-10) An expert tells him what to ask patients about. Do they know their prognosis? What are their fears of what is to come? What are their goals--what would they like to do as time runs short? What tradeoffs are they willing to make? How much suffering are they willing to go through for the sake of added time? There is no checklist to mark off--instead, you need a series of conversations.
• The Conversation Project (important discussions families need to have later in life)
• The Conversation: A Family's Private Decision (ABC News)
• Re-Examining End-Of-Life Care (Laura Knoy with guestsPatrick Clary – doctor at the New Hampshire Palliative Care Service in Portsmouth; John Loughnane – medical director at Commonwealth Community Care in Boston, on New Hampshire Public Radio 8-28-13)
• Planning For The End: When Courts Have To Make Medical Decisions (Todd Bookman, New Hampshire Public Radio 8-28-13)
• Planning For The End: Miraculous Recovery, Little Regret (Todd Bookman, NHPR 8-28-13)
• A Graceful Exit: Taking Charge at the End of Life (Claudia Rowe, Yes! magazine, 9-19-12) How can we break the silence about what happens when we’re dying? The best thing to come out of Compassion & Choices’ campaign (informed choices about how we die) may be a peace of mind that allows us to soldier on, knowing we can control the manner of our death, even if we never choose to exercise that power.
• Let's talk about dying (Peter Saul's TED talk, Nov 2011) We can't control if we'll die, but we can “occupy death,” says Dr. Peter Saul, an Australian intensive care doctor (intensivist) who is passionate about improving the ways we die. He calls on us to make clear our preferences for end of life care -- and suggests two questions for starting the conversation.
• Death with Dignity: The Oregon Experience by Susan Hedlund (Association for Death Education and Counseling, or ADEC)
• The Art of Dying: A Mind-Body Transformation by Danielle Schroeder (ADEC)
• When to Refer to Hospice by Lisa Wayman (ADEC)
• Compassion & Choices: Choice and Care at the End of Life, including the blog entry A dying patient is not a battlefield (by Theresa Brown)
• Knocking on Heaven's Door: The Path to a Better Way of Death by Katy Butler. An expertly reported memoir and exposé of modern medicine that leads the way to more humane, less invasive end-of-life care—based on Butler’s acclaimed NY Times Magazine piece What Broke My Father’s Heart. Against a backdrop of familial love, wrenching moral choices, and redemption, Butler celebrates the inventors of the 1950s who cobbled together lifesaving machines like the pacemaker—and she exposes the tangled marriage of technology, medicine, and commerce that gave us a modern way of death: more painful, expensive, and prolonged than ever before. See also:
• A Family Says 'Enough' (Paula Span, Health, NY Times, 9-12-13). Before you agree to that pacemaker, know how hard it might be to undo. Deactivating an implanted cardiac device is neither euthanasia nor assisted suicide, and a doctor who feels morally unable to do it should find a colleague willing to help. The end of Katy Butler's story.
• Why Americans Can't Die With Dignity (Mother Jones, 9-7-13) Katy Butler on overtreatment, end-of-life suffering, and the need for a Slow Medicine movement.
• A dying patient is not a battlefield (Theresa Brown, CNN Opinion, 8-31-10) Brown is author of Critical Care: A New Nurse Faces Death, Life, and Everything in Between
• Quiet deaths don't come easy (Melissa Healy, Los Angeles Times, 2-5-12) A study finds that Medicare patients near death are increasingly choosing hospice or palliative care over heroic measures in their last days — but that many go through futile hospitalizations and treatments first. "Doctors often fail to be clear about a patient's poor prognosis and to plainly state the likely consequences of continuing painful, aggressive care." If a patient's wish to avoid aggressive treatment is clear, "you need to prevent him from getting into that cycle of acute care," gerontologist Julie Bynum said, "because once they get into the hospital, it's really hard to get them out."
• When Prolonging Death Seems Worse Than Death (Fresh Air from WHYY, 10-11-12). Terry Gross interview Judith Schwarz, who helps dying patients and their families decide whether and how to hasten the end. Compassion & Choices is an organization that helps terminally ill patients and their families make informed and thoughtful end-of-life decisions. Schwartz discusses the practicalities of various choices.
• More on end-of-life care and decision-making.
• Another Word for It (I highly recommend this essay by Alison Lester, about her father's death in 2010). Lester writes of this essay (in a comment about a RadioLab podcast, The Bitter End) "My father owned the way he wanted to die in a way that had us all in awe." Lester's essay "covers what it was about him that made it possible for him to decide how to end his life and see that decision through, and what it required from us as a family. It is my fervent hope that this account of his death can help people facing similar situations."
• Quebec's 'dying with dignity' law would set new standards (Janet Davison, CBS News, 2-17-14) Quebec's proposed Bill 52 follows Europe's lead, legalizing both physician-assisted suicide and voluntary euthanasia for those experiencing "unbearable suffering," but who may not be within months of dying, which is the U.S. criterion. Related story: The fight for the right to die (CBS News, 6-15-12)
• A Life-or-Death Situation (Robin Marantz Henig, NY Times magazine, 7-17-13). Behind the Cover Story: Robin Marantz Henig on Making End-of-Life Decisions (and Changing Your Mind) (Rachel Nolan's interview appeared 7-22-13)
• Assisted Suicide (American Psychological Association). Arguments for and against and what experience in Oregon and Amsterdam teaches.
• Happy Endings: In Real Life, Mystery Writer Promotes Assisted Death (Elihu Blotnick, Stanford Magazine, 11-8-12). At 82, Merla Zellerbach has been reborn as a mystery writer. Her culprits always get their just deserts, but her “main concern is with the needless suffering of those who don’t know they have choices, don’t want to know for religious or other reasons, or who don’t have access to aid in dying.” She explains: “I saw my beloved father die a terrible death from pancreatic cancer, and I also saw my late husband Fred die pain-free and peacefully, with physician help. After those two experiences, I began delving into the mysteries of life and death.”
• Assisted Suicide — Murder or Mercy? by Ellen Hawley Roddick (Open Salon, 2010). "Do I believe in assisted suicide? You bet I do. And here ... is why."
• Assisted-suicide laws advance, but issue still divides Americans (gperreault, ReligionLink, 7-7-13, with extensive links to other stories and sites)
• Who’ll be in charge when we die? (Ashton Applewhite's excellent essay on the need for an advocate who will know what we want and realize that we might change our minds, on the blog, Yo, Is This Ageist? on her website on ageism, This Chair Rocks)
• New Trial Ordered for Man Who Helped a Long Island Motivational Speaker Kill Himself (Russ Buettner, NY Times, 10-3-13). The state penal code allows an assisted suicide defense in a murder case if the defendant only caused or aided another person to commit suicide “without the use of duress or deception.” Things can go terribly wrong.
• Hemlock Society (now Compassion & Choices)providing information about options for dignified death and legalized physician aid in dying
• 'The Last Good Nights'. (John West tells Diane Rehm and radio listeners why and how he assisted his parents with their suicides. He offers a first-hand account of the decision no child wants to face and explains why he followed through on his parent's desire to choose death with dignity. He also tells the story in his book The Last Goodnights: Assisting My Parents with Their Suicides Here is an excerpt (Good Morning, America)
• Tread Carefully When You Help to Die: Assisted Suicide Laws Around the World (Derek Humphrey, author of Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying (Euthanasia Research and Guidance Organization, ERGO, which publishes other books on the subject)
• Hans Kueng Considering Assisted Suicide As Parkinson's Disease Suffering Continues (Tom Heneghan, Reuters, Huff Post 10-4-13) Roman Catholicism's best known rebel theologian is considering capping a life of challenges to the Vatican with a final act of dissent--assisted suicide.
• Doctor-Assisted Suicide Is Moral Issue Dividing Americans Most (Gallup poll, 5-31-11)
• Cancer center goes public with assisted-suicide protocol (Kevin O'Reilly, American Medical News, 4-22-13)
• Getting the Freedom to Die (Roy Speckhardt, director, American Humanist Association, on HuffPost, 04/16/2013, with stories about recent cases)
• In Montana, New Controversy Over Physician-Assisted Suicide (Paula Span, NY Times, New Old Age blog, 4-15-13)
• Assisted Suicide . Wikipedia's entry distinguishes between "assisted suicide" (where one person helps another end his life) and "euthanasia" or "mercy killing" (where another person ends the life). Indicates what the laws are in various countries and U.S. states.
• Why Do Americans Balk at Euthanasia Laws? (Room for Debate, NY Times, 4-10-12) What would need to change before the U.S. would legalize physician-assisted suicide?
---Comfort and Familiarity
---Too Many Flaws in the Law (Marilyn Golden, a senior policy analyst at the Disability Rights Education and Defense Fund)
---How the Dutch Are Different (Petra M. de Jong, a pulmonologist and head of Right to Die Netherlands)
---Address Inequalities First (Patricia King, the Carmack Waterhouse professor of law, medicine, ethics and public policy at Georgetown Law)
---Skeptical of the System (Rita L. Marker, a lawyer and executive director of the Patients Rights Council)
---The Role of Religion in the U.S. (Philip Nitschke, author of The Peaceful Pill Handbook)
---A Recipe for Elder Abuse (Margaret Dore, a lawyer in Washington State and president of Choice is an Illusion, a nonprofit organization opposed to assisted suicide)
---The Power of the the Culture War (Jacob Appel, a doctor and lawyer in New York City)
• Frequently asked questions, Death with Dignity National Center
• Euthanasia and physician-assisted suicide (BBC). Types of euthanasia, arguments for and against, good deaths and the practicalities of dying, legislation, religious views
• Euthanasia and physician-assisted suicide, all sides to the issue, ReligiousTolerance.org, Ontario consultants on religious tolerance)
• A method for dying with dignity (Marcia Angell, Boston Globe, 9-29-12) This is not a matter of life versus death, but about the timing and manner of an inevitable death. We respect people’s right to self-determination when they’re healthy. That shouldn’t be denied to them when they’re dying.
• Government lawyer draws line between euthanasia and war (Marc Hume, Vancouver, Globe and Mail, 12-8-11). Read the comments, too.
• Listen on Interfaith Radio to"Bioethics and the Legacy of 'Dr. Death,' which includes interesting segments on dying with dignity (individuals having some control over when they die, particularly if they're heading toward the painful end of a terminal condition: After a segment in which Michael Schermer tells how our brains are hard-wired for "beliefs," listen to Should Doctors Hasten Death? (starts at 21 min 36 seconds), in which bioethicist Art Caplan explains the pros and cons of one of the most controversial practices in both religion and medicine. (You can listen to full segment here . A third segment is Making the Choice: Merrily's Story (begins at 33 min. 46 sec.). One important point: Knowing that they have some choice allows patients who are terminally ill to relax and accept the natural course of death; only 10% of those who knew they had the option to end their life with medication did so.
• Hastening Death, information and arguments for and against physician-assisted suicide (from online edition of HANDBOOK FOR MORTALS by Joanne Lynn and Joan Harrold
• The Hemlock Society, founded as a right-to-die organization founded in Santa Monica, California, by Derek Humphrey, merged with and changed its name to Compassion & Choices in 2003, helping with end-of-life consultation.
• Should an incurably-ill patient be able to commit physician-assisted suicide? (BalancedPolitics.org)
• State-by-State Guide to Physician-Assisted Suicide (ProCon.org)
• U.S. Supreme Court rulings on physician-assisted suicide cases (University at Buffalo Center for Clinical Ethics and Humanities in Health Care)
• For Belgium's Tormented Souls, Euthanasia-Made-Easy Beckons (Naftali Bendavid, Wall Street Journal, 6-14-13).
• Tony Nicklinson Dead: U.K. Man With Locked-In Syndrome Who Failed To Overturn Euthanasia Law Dies (Maria Cheng, Huff Post 8-22-12)
• Unflinching End-of-Life Moments, review in NYTimes of HBO documentary about physician-assisted suicide (to air summer 2011), How to Die in Oregon, which was shown at the Sundance Festival.
Order the beautiful gift edition of Dying: A Book of Comfort
• American Foundation for Suicide Prevention/a> (AFSP). Walk to save lives: Out of the Darkness Walks
• Bible passages dealing with suicide (Religious.tolerance.org)
• Biology of Suicide (NPR, audio and transcript, part of its End of Life series: Exploring Death in America)
• By My Own Hand by Anita Darcel Taylor (Bellevue Literary Review). Taylor writes that for those who go through the hell of manic depression, suicide is simply a tool to end great pain -- an "earned choice."
• Daniel, 1988-2000: A child's suicide, unending grief and lessons learned (Sara Fritz, St. Petersburg Times, 11-16-03)
• Oregon Father’s Memorial Trek Across Country Ends in a Family’s Second Tragedy (Jack Healy, NY Times, 10-15-13) Joe Bell was walking across the country to tell the story of his gay son, Jadin, 15, who killed himself after being bullied.
• Prayers for Bobby: A Mother's Coming to Terms with the Suicide of Her Gay Son by Leroy Aarons. Mary Griffith persuaded her son Bobby to pray that God would cure him, but the church's hatred of homosexuality and the obvious pain his gayness was causing his family led him increasingly to loathe himself. After his suicide, her anguish led her on a journey from faithful churchgoer to national crusader for gay and lesbian youth. Read this story about her and Stephanie Reed, for a few of how parents feel after such a suicide, and what they often do about it.
• Decades after 2 suicide attempts, I'm thankful to have the life I nearly cut short (Jacquielynn Floyd Dallas News.com, 2-2-13). "For me, depression took on a camouflaged veneer of normal that made it difficult to “read the signals.” "What I suffered from was real. It was also temporary and entirely treatable."
• Murder-suicide disturbing trend among the elderly (Diana Reese, Washington Post, 1-26-13). "The typical case? A depressed, controlling husband who shoots his ailing wife — without her permission, according to Cohen. . . . Experts say depression, exhaustion and isolation all play a role; often, it’s men who are thrust into the unfamiliar role of caregiver. They may suffer from undiagnosed clinical depression. And if they learn their own health problems put them at risk of dying before their spouses, they may believe that no one else can take care of their wives as well as they can."
• Complicated Grief in Survivors of Suicide Loss (American Foundation for Suicide Prevention). Watch free video of webinar on subject.
• Copycat suicide (Wikipedia entry)
• Families of Military Suicides Seek White House Condolences (James DAO, NYTimes, 11-25-09, on pressure to change a hurtful policy)
• My big sister took her own life (Ali Grant, Globe & Mail, 4-8-10). "Suicide. My beautiful big sister, Isobel. Dead by her own hands at 62. Literally the unthinkable happening. My mind was unable to allow for the possibility that she would kill herself, in spite of the daily conversations we had, in spite of my knowing that she was struggling with pain, both physical and psychological. "
• On Suicide And why we should talk more about it (Clancy Martin, Ars Philosopha, Harpers Magazine, 6-25-13).
• Preventing Suicide: A Resource for Media Professionals (PDF, World Health Organization)
• Religion and Suicide (Betty Rollin hosts discussion for Religion & Ethics Weekly--listen or read transcript)
• Remembering Denny (Calvin Trillin writes about the life and unfulfilled potential of his Yale classmate and former close friend Roger "Denny" Hansen, a Rhodes scholar, academic, and State Department employee whose great promise ended in middle age with his suicide)
• Reporting on Suicide website. Download PDF of Recommendations for Reporting on Suicide (PDF, American Foundation for Suicide Prevention)
• Sad End to a Long, Slow Slide (Corey Kilgannon, New York Times Regional edition 8-12-07), a loving couple dies together
• SAVE (Suicide Awareness, Voices of Education), suicide prevention
• Suicide and the Media (New Zealand Ministry of Health, tips on media coverage to reduce risk of encouraging suicide in at-risk individuals)
• Suicide Contagion and the Reporting of Suicide: Recommendations from a National Workshop (CDC)
• The Suicide Index: Putting My Father's Death in Order by Joan Wickersham. "Sixteen years ago, Joan Wickersham’s father shot himself in the head. The father she loved would never have killed himself, and yet he had. His death made a mystery of his entire life. Using an index—that most formal and orderly of structures—Wickersham explores this chaotic and incomprehensible reality. Every bit of family history—marriage, parents, business failures—and every encounter with friends, doctors, and other survivors exposes another facet of elusive truth. Dark, funny, sad, and gripping, at once a philosophical and deeply personal exploration, The Suicide Index is, finally, a daughter’s anguished, loving elegy to her father."
• Media and the hard truth about suicides (Stephen J.A. Ward, Center for Journalism Ethics, 9-24-11) "The guiding principle should be: publish uncomfortable facts where such information is necessary for a clear public understanding of the event and to indicate what social responses might be necessary."
• Suicide Notes (Liam Casey, Ryerson Review of Journalism 12-22-10). "I contemplated killing myself five years ago. Now, to help others, I call on all journalists to break the silence on our final taboo."
• Think about the words you use when covering suicide (Andrew Lowndes, AHCJ, Covering Health, 4-25-14). Journalists: Say died by suicide, or death by suicide because ‘committed suicide' stigmatizes families where suicide has occurred. You don’t say ‘committed’ cancer.
• The search for sensitive coverage of the tragedy of suicide: An Australian story (Leo Bowman, Center for Journalism Ethics, 4-17-13)
• Suicide Prevention (many useful resources from Centers for Disease Control and Prevention, CDC)
• Suicide Prevention (National Institute of Mental Health)
• Mice and Mothers by Nathalia Holt (partly about her mother's suicide). Too many deaths have no meaning. I needed these animals' lives to be part of the fight against H.I.V..
• Teen Suicide Prevention Campaign (American Foundation for Suicide Prevention). Watch these brief public service announcements (PSAs)
• Violent Death Bereavement Society
• Why Michael Grosvenor Myer left his wife to die alone (Andrew Alderson, New York Times, 11-29-08), the story of a novelist whose final gift to her husband was to die alone, sparing him a jail sentence for assisting in her suicide.
"When speaking of those who take their own lives, it is always most dignified to use silence or at least restrained language, for the ones left most vulnerable and most deeply hurt by such an occurrence can feel oppressed by the louder assertions of understanding, wisdom, and depth of remorse foisted on them by others. One must ask: Who is best served by speculation? Who is really able to comprehend? Perhaps we must, as human beings, continue to try and comprehend, but we will fall short. And the falling short will deepen our sense of emptiness." ~attributed to Yasunari Kawabata by Howard Norman, in the fifth section of his excellent memoir I Hate to Leave This Beautiful Place
• Adorján, Joanna. An Exclusive Love: A Memoir (translated by Anthea Bell). Adorján tries to make sense of the dual suicide of her fascinating grandparents, who survived the Holocaust and the Hungarian uprising of 1956 and died in a suicide pact in Denmark in 1991.
• Bialosky, Jill. History of a Suicide: My Sister's Unfinished Life (about both her sister, Kim's, life and death and about sibling loss and survival guilt)
• Bolton, Iris. My Son...My Son: A Guide to Healing After Death, Loss, or Suicide
• Farr, Moira. After Daniel: A suicide survivor's tale. Here is an excellent review of the book (PDF), in which the reviewer, Paul S. Links, writes: "This chilling account will remind physicians that the suicide survivor’s response is often a complex combination of posttraumatic features and guilt-laden grief. Both aspects must be worked through during the process of recovery....this book is not a tell-all story of the Toronto artistic scene. It is not an academic recounting of current scientific formulations of suicide. It is not a prescription for the self-directed recovery from grief. Rather, it is an offer of hope, a beautifully written journey of reclamation, and simply a very personal account of the author’s own grief."
• Fine, Carla. No Time to Say Goodbye: Surviving the Suicide of a Loved One
• Hammer, Signe. By Her Own Hand: Memoirs of a Suicide's Daughter
• Handke, Peter. A Sorrow Beyond Dreams (transl. Ralph Manheim, intro. Jeffrey Eugenides). A slim and sorrowful memoir of the author's depressed mother's life and suicide at 51.
• Page, Patricia. Shadows on a Nameless Beach. A brief and beautifully crafted collection of essays, a memoir of the year after her son's death by suicide, her feelings of parental guilt, finding solace in walks through California's coastal landscape.
• Rappaport, Nancy. In Her Wake: A Child Psychiatrist Explores the Mystery of Her Mother's Suicide. Haunted by the 1963 death of her mother, a Boston socialite, from an overdose when Rappaport was only four (the youngest of six children), the author tries to reconstruct what happened. As her brother asked: Didn't their mother know that she would leave all these shattered children wondering if it was their fault?
• Sharples, Madeline. Leaving the Hall Light On. A mother's memoir of living with her son's bipolar disorder and surviving his suicide. Read review by Dr. Jason M. Dew and interview with the author (on Women's Memoirs).
• Stone, Geo. Suicide and Attempted Suicide: Methods and Consequences
• West, John. The Last Goodnights: Assisting My Parents With Their Suicides
• Wickersham, Joan. The Suicide Index: Putting My Father's Death in Order "Sixteen years ago, Joan Wickersham’s father shot himself in the head. The father she loved would never have killed himself, and yet he had. His death made a mystery of his entire life. Using an index—that most formal and orderly of structures—Wickersham explores this chaotic and incomprehensible reality. Every bit of family history—marriage, parents, business failures—and every encounter with friends, doctors, and other survivors exposes another facet of elusive truth. Dark, funny, sad, and gripping, at once a philosophical and deeply personal exploration, The Suicide Index is, finally, a daughter’s anguished, loving elegy to her father."
• Taking Chance Home (Marine Lieutenant Colonel Strobl's simple and moving account of escorting the remains of Lance Corporal Chance Phelps home from Dover Air Force Base). You can watch HBO's film based on the story, Taking Chance, starring Kevin Bacon.
• TAPS (Tragedy Assistance Program for Survivors)
• Three Little Words . Roy Peter Clark's memorable series in the St. Petersburg Times, "a tale of trust, betrayal and redemption," and AIDS, which "challenges us to reconsider our thoughts about marriage, privacy, public health and sexual identity"
• UNITE (grief support after miscarriage, stillbirth, and infant death)
• What Broke My Father's Heart by Katy Butler (NY Times Magazine, 6-18-10). How putting in a pacemaker wrecked a family's life. Katy Butler's father drifted into what nurses call “the dwindles”: not sick enough to qualify for hospice care, but sick enough to never get better. She writes, of her parents: "I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims." You may also want to read Knocking on Heaven's Door: The Path to a Better Way of Death
• What Comes After by Lisa Mundy (Washington Post Magazine). They lost their daughter in the deadliest campus massacre in U.S. history. One parent wants to file a lawsuit. The other doesn't.
• What It Feels Like To Be Photographed In A Moment Of Grief (Coburn Dukehart, NPR, The Picture Show, 1-28-13)
• When Treating Cancer Is Not an Option (Jane E. Brody, Well, NY Times, 11-12-12). An excellent discussion of how doctors need to communicate with patients who are terminally ill (and check to see if their communications got through). Telling patients to plan for the worst but hope for the best gives them "better outcomes — less depression and less distress, and they’re more likely to die comfortably at home.”
• Why Didn't They Stop Him? (When Domestic Violence Laws Don't Work, by Phoebe Zerwick, O, the Oprah Magazine, August 2009)
• Recommended reading
What Broke My Father's Heart by Katy Butler (NY Times Magazine, 6-18-10). Now scheduled for publication, her book: Knocking on Heaven's Door: The Path to a Better Way of Death
Pills or medicine labeled acetaminophen, "Tylenol," or "aspirin-free pain relief" may all contain acetaminophen. Combining such drugs is like taking poison: it may kill you or irreversibly damage your liver.
If you are in a suicide crisis, call the National Suicide Prevention Lifeline 1-800-273-8255
Order a personally signed copy now: Dying: A Book of Comfort. (ASK for Pat to inscribe it.)
The Beneficial Effects of Life Story and Legacy Activities by Pat McNees (Journal of Geriatric Care Management, Spring 2009). Get PDF file of journal article here (61.9KB)