Last Friday’s symposium at New Mexico State University, “A Beautiful Death… What will you choose?” featured Margaret “Peggy” Battin, Distinguished Professor of Philosophy and Adjunct Professor of Internal Medicine, Division of Medical Ethics, at the University of Utah, presenting the keynote speech. Your faithful correspondent took copious notes to share with you.
As a philosopher and bioethicist, Peggy Battin has worked for decades to defend the right of terminally ill individuals to have greater control over the timing and manner of their deaths. Her academic work tackles issues around end-of-life care, suicide, euthanasia, and religion.
In 2008, her personal and professional worlds collided when her husband Brooke broke his neck in a bicycle accident, becoming quadriplegic. When he eventually decided to die after years of struggling with his condition, Peggy found she was the one dragging her feet the most as he sought to have his ventilator and other life-prolonging technologies disconnected. Her personal experience made her re-examine her beliefs around an individual’s right to autonomy, as he sought to achieve the death he believed “least worst” for him.
Before sharing her TEDMED talk about death in the modern age and her experience with her husband’s situation, Peggy Battin shared three vignettes from her own life. After the video, she posed five questions for the audience to consider before transitioning to a panel discussion.
“It was 1961. My mother is dying of cancer and I remember at that time, this is before it was socially permitted to talk about death and dying at all. Kubler-Ross hadn’t yet done her work on death and dying,” Battin shared.
Her mother got out of bed, stumbled, fell, and said, “Why should it be so hard to die?” People kept telling her she’d get better by spring. People couldn’t talk about it then.
Fast forward to the 1980s. There was news coming out of the Netherlands about euthanasia taking place there. Battin got on a plane and went to the Netherlands to see what was going on. She knew that you saw what you wanted to see, so she took a Catholic nun with her as a research partner – someone who would see the other side of the issue. She was a “plainclothes nun.”
Over three weeks, together they visited a number of people and groups. Even though they’d been in the same room, interviewing the same people at the same time, taking their own notes, they heard different things. “Our views are different, and they affect what we hear,” she said.
However, after spending those three weeks together, the professor and the nun were able to view with similar eyes and hear with similar ears.
Fast forward to 1990s. Doctors are issuing statements on physician aid-in-dying. There were concerns that this movement would affect the most vulnerable groups – the elderly, minorities, mentally challenged, depressed, people with AIDS/HIV and so forth. Despite disparaging statements from major medical associations, no evidence emerged to support this idea.
So she did a study about who was actually getting aid-in-dying in Oregon and the Netherlands. It turns out it wasn’t the vulnerable and disenfranchised, it was just the opposite. The patients who used physician aid-in-dying were white, affluent, better educated, and did not have stigmatized diseases like AIDS, depression, and mental illness.
Battin said to the audience, “Ask questions. What choices don’t we have? We can’t always hear each other. What groupthink, social conditioning are we subject to that we don’t recognize?”
Her TEDMED talk was 20 minutes long. It started out illustrating the poor fit between contemporary dying and the ways we died in the past up until 1850 – rapid, unpredictable, and could occur at any point in the life span. Then the story got personal, as she talked about her husband’s tragic bike accident, near death, life as a quadriplegic for five years, and his choice to turn off the respirator that was keeping him alive.
She then posed these five questions for the panel discussion after her presentation:
- How does contemporary dying differ from the olden days?
- What is the distinction between letting die and causing to die?
- What about negative messages? There are concerns about the different ways we negotiate dying. “Old age – no good. Disability – no good. Dementia – no good. Better to be dead than those things… It’s usually not expressed so baldly, but it’s there.” She mentioned DNRs, wishes for no artificial nutrition/hydration, etc.
- What about language? Suicide vs. aid-in-dying, self-deliverance – these terms come with attached connotations – negative and positive. “We need to think about being attentive to the terms we use in regard to end-of-life issues.”
- The physician-patient relationship: Do we regard the physician as a healer or someone who can relieve symptoms? How do we hope to interact with our physicians as we come to die?
“The best we can hope for is the least worst death – nobody wants to die. A Beautiful Death – that’s a bit optimistic,” she said. “One way we can live our lives better is to ensure our deaths go better when the time comes.”