Limited Taxation
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Barbara's Column
June 2001 #2-4

Dying with Dignity
(A 3-Part Series)

by Barbara Anderson

The Salem Evening News
June, 2001

Part 1

If you grew up in an orphanage, or, like Romulus, Remus and Mowgli, were raised in the wilderness by wolves: this column is not for you.

We who have parents are going to talk about that "final taboo" subject: dying.

Not about death, mind you. Death has always been a subject of discussion, drama, even poetry: from Saint Paul's "Death, where is thy sting?" to the latest screen version of Romeo and Juliet. You're young, beautiful, you lie down on a slab next to your young beautiful true love, take poison and fall asleep, then are made immortal by Shakespeare.

No, we're not going to talk about young lovers. We are talking about our parents. And in the back of our minds, we know we are talking about ourselves, someday, sooner than we'd like.

The relevant quote for us is Woody Allen's "I don't mind dying; I just don't want to be there when it happens." Or even better, our own John Silber's "when you're ripe, it's time to go."

Remember his saying that during his campaign for Governor in 1990? The media immediately called it "another Silber shocker." A lot of the rest of us, however, including many senior citizens, said nothing. Taboo.

His was a brave, politically incorrect statement, and it's been on my mind lately, as I spend several hours a day with my mother at a nursing facility here in western Pennsylvania.

As nursing homes go, this one if quite nice. Clean, cheerfully decorated, and you hardly notice "that smell" in the hallways — you know the one. Decay. Anxiety. Fear. The last two are produced not only by the patients, but by their visitors as they wonder: how can I help them? Who will help me when it's my turn?

When I'm not thinking about John Silber, I'm thinking about Edward G. Robinson. He starred, with Charlton Heston, in a 1973 movie called "Soylent Green," which I've noticed coming up in conversation lately. People who saw it seem to vividly remember not the out-of-date premise, that the overpopulated world would run out of food, or just the shocking conclusion when the secret of soylent green was discovered, but the part where Edward G. had to die because it was time to make room for new people. Everyone was required by the state to die at — I think it was age 55. So while Charlton fought big government, as usual, Edward G. sat in a comfortable reclining chair and watched his favorite scenery on a movie screen while playing his favorite music and sipping his hemlock or something from a handsome goblet until he fell asleep for the last time.

Well, Malthus' population bomb hasn't gone off, 55 is considered young, and my alert 85 year old mother is still eating easily-available meals and watching real movies on TV. But she fights for every breath, and around us, people stare vacantly into space or talk nonsensically to themselves, and you wonder — what is the point anyhow? And I think: when it's me, pass the hemlock, put Hawaii in the VCR, and play Queen's "Who wants to live forever?" in my headphones.

The Senate Ways & Means budget contains several health care initiatives: some of them are intended to help prolong life, others to deal with the cost of long living. The budget summary states that nine out of ten Medicaid dollars are spent on long term care in institutional settings. The document creates a commission to study the future of long term care in the commonwealth, "the health care needs of elders 65 and older." I hope they realize the problem is much bigger than money can solve. I hope they put John Silber on the commission if he's still in a mood to continue the discussion.

He never had a chance to follow through with a suggestion on what to do even if it's acknowledged that it's time to go. Despite what you might be thinking, I'm not talking about assisted suicide here: legal euthanasia is a subject for which the phrase "slippery slope" is a barely adequate warning.

Meanwhile, in western Pennsylvania, there is an attractive elderly man who pops into his wife's room every day with a cheerful "good morning sweetheart!" and then spends the day sitting with her or wheeling her around the nursing home, taking her to the community room where local people come to entertain or lead prayers. I don't think she knows him.

I know him, though. He's Romeo, and his Juliet didn't die; she just started dying, several years of daily visits ago. This is the real world, and it's time to talk about dying, but I ... have no idea what to say.

Part 2

"I would not stay here if I could
Except for the little green leaves in the wood,
And the wind on the water."

—Archibald MacLeash

As life's juxtapositions go, it was an interesting few hours.

On Sunday evening "60 minutes" re-ran its segment on Dr. Kevorkian, during which a patient was euthanized on camera. At the nursing home, my mother's sweet, occasionally addled roommate was perched on the bottom of her bed, watching intently.

It was her television so it wasn't my place to turn it off; I distracted mother with conversation on other subjects. Assisted dying was not a discussion that I wished to share at that time in that setting. Our living wills were prepared and filed when the need was perceived to be far in the future; enough said.

The next morning, murderer Timothy McVeigh was also peacefully put to death; his executioner was the federal government.

I've often wondered what Dr. John Silber was going to say, before he was so rudely interrupted, after his 1990 campaign statement "when you're ripe, it's time to go."

Did he have a plan? Did it involve Dr. Kevorkian or the federal government?

I once asked a libertarian friend if he thought the government should allow assisted suicide. He said that people commit suicide all the time without assistance or the government's involvement. True enough. Unless we are suddenly disabled, we are all the "masters of our fate."

And most of us choose to live, no matter what.

In Archibald MacLeish's JB and Job, God and Satan were playing the game of "test Job." As in the Bible story, Job lost everything: his herds, his house, his health, his children. When the children all died, Job's angry wife, apparently missing the point of God's wager with Satan, considered suicide by the river. But she returned to the hovel in which they were then living, explaining that "even the forsythia by the stairs" was enough to stop her.

Here at the nursing home, you hear people cry out, but they are not saying "I want to die." They are saying "I want to go home," or "I want to go to the bathroom." My mother says "I want my feet rubbed."

Mostly I think she feels bad for me, away from my other loved ones, home and job, unable to visit my new grandchildren. I can relate to the fear of being a burden; I'm determined not to let my son even know when I get old.

I'll put a message on his answering machine when he is at work: "leaving for Europe, impossible to reach, see you when I get back." The next call he gets about me will be from the funeral home.

Ah, we have such brave plans when we are (relatively) young, don't we! A nurse told me that even the most self-sufficient people get demandingly dependent eventually. But I wonder. I read recently about a woman who told her kids goodbye when she entered a nursing home and ordered them to never visit; they honored her last request.

My guess is that some of us do go out the same way we lived our lives. My mother always wanted her feet rubbed, even when she was young, and I suspect that I will remain master of my fate until I die. I'm quite sure I'd consider hiring someone like Dr. Kevorkian if the alternative was total dependence and I was too disabled to act alone.

I admire him for making us face these issues, and am grateful to the other pioneers who advocated living wills and have put an end to "extraordinary measures" that unnecessarily prolong undesired lives.

But for now, I've ordered her own television for mother's room so we can choose our programs. It has a built-in VCR so we can watch home videos of the grandchildren as they are growing instead of people being put to sleep.

I am lucky to have a job that I can do, at least for awhile, from 524 miles away, using my computer: I am able to get state budgets, legislative debates, and Massachusetts newspapers on line. Ten years ago this would not have been possible. Ten years from now technology will make being old and caring for elderly parents much easier.

The requests of residents of mother's nursing home will be more easily heard. Homes will be more handicapped-friendly so people can stay there longer. Virtual reality will allow the homebound to experience daily visits with distant families.

Robots will make up for a shortage of health care assistants. Some of them will be programmed to help get us to the bathroom, some to rub feet, and some to tend to the forsythia by the stairs.

Part 3

I once joked that when the "Me Generation" joins the AARP, the boomer seniors will be voting to harvest teenagers' second kidneys for replacement parts.

Someone assured me that when it came to that, the computer-raised kids will simply hack into nursing home computers and shut off the support systems.

Just kidding, right?

Cloning technology will probably make kidney harvesting unnecessary. But seriously, folks, if technology also keeps people alive well into their second century, who is going to pay for longlonglong-term care?

Will middle-aged children be caring for parents, grandparents, and great-grandparents until they all drop dead together? Or will there be skyscraper nursing homes and a Medicaid budget that consumes most of the remaining workers' paychecks? Whose bright idea was longevity, anyhow?

One of my many friends who are also dealing with an aging parent sent me an e-mail, excerpted here:

"From a historical and cultural perspective we have two extremes: the Eskimo villagers sending their elders out on an Ice flow; and the Chinese family almost worshiping their  parents for their wisdom. In-between lies us.

"We have the science to keep our parents and grandparents alive through multiple illnesses to a great age but we don't have the ethical answer as to what we do next. It wasn't too long ago that children left home never to return and parents worked till they could no longer function and died after a short illness caused by a lack of medical knowledge."

He added "Some of us live and work at great distances from our parents and cannot just pick up and devote years of our lives to their final care." Then he told me about a friend who left his job to care for his mother in her home. When she finally died he remained in the house, government dependent, for he never made enough to let him retire without public assistance.

Actually, few of us make enough to retire without public assistance. One can fairly argue that Social Security and Medicare are the direct benefits from a lifetime of paying taxes, at least for some years after retirement, but by the time one gets to Medicaid one is on welfare, no matter how little we want to admit it.

My mother has just moved into a Pennsylvania nursing home at her own expense, and I find myself defending myself to the system and to friends here. "Yes," I feel compelled to say, "I do know that assets can be transferred to the children several years before entry, but we didn't do that because I don't want my mother on welfare any sooner than necessary." I get the distinct impression that this is not a common attitude.

I hear lawyers on radio ads assuring us that taking our parents' money and spending it on ourselves while letting the taxpayers support them in a nursing home is legal, and I guess it is. Ethical is something else.

Regardless, the time will come, quickly, when she is out of money. I discussed the issue with my friend Carla Howell, who believes that "small government is beautiful." Does "small government" include taking care of the frail elderly in nursing homes until they die?

Carla responded: "If we FIRST eliminate the federal income tax and all the Big Government Programs and Big Government Regulations that drive up the cost of nursing care, drugs, hospital visits, etc., costs will go down dramatically. And with family members and other charitable people keeping the money they earn, many who are now scraping to make ends meet will be able to help. Government meddling serves only to make things worse and makes health care a crushing liability."

Whether you agree with that, or just consider caring for the elderly a proper function of the bigger government you prefer, this care will not be affordable when the boomers reach retirement age if government continues to indulge in wasteful spending, corporate welfare, and its usual assorted nonsense.

Better to lower taxes so we can start our old-age saving accounts now; this will have an added benefit of encouraging government to begin setting priorities, knowing that the "Me generation" will consider its long-term care one of them.

If we don't face the financial future now, that soon-to-be-overtaxed Generation Z might as well turn over both kidneys for recycling, because it literally won't have a pot in which to catch what they produce.

Barbara Anderson is executive director of Citizens for Limited Taxation. Her syndicated columns appear weekly in the Salem Evening News and the Lowell Sun; bi-weekly in the Tinytown Gazette; and occasionally in other newspapers.

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