The choice to end a life

When an ailing parent says, “I’m ready; I want to die’’


My mother was cornered. After four years of living with a rare autoimmune disorder that had partially paralyzed and largely blinded her, she was battling a systemic infection. She had been in the hospital for weeks. Antibiotics were causing her heart and lungs to fill with fluid, but stopping the drugs would have allowed the infection to take over. The doctors had nothing more to offer; and the nurses had told us, in a way that was laconic but compassionate, and unmistakable in its meaning, that they didn’t like the way this was going.

My mother was weak, slipping in and out of consciousness. Suddenly she said, very clearly, “I’m ready.” My sister, my husband, and I were in the room; we looked at one another, not sure if we’d understood. And my mother said, without opening her eyes but very firmly, “I want to die.”

So here we were, suddenly but not suddenly, at the end. My mother was tough, and she loved being alive. Fifteen years before she had undergone grueling treatment for advanced colon cancer, and had survived without a recurrence. Since then she had endured paralysis and blindness with a courage spiced with enough complaining and fury to prove that it really was courage and not some fake Pollyanna denial of the horrible toll her disease was taking. As recently as three weeks earlier, already hospitalized and feeling wretched, she had elected to undergo a colonoscopy her doctor had recommended, because, she said, “If they find something I want them to treat it.”


But now, unequivocally, she was telling us she was done.

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Over the next few days, we were able to arrange for her to receive hospice care in the hospital. The antibiotics were stopped. The nurses came in, spoke gently, made her comfortable, left. My mother was out of it, but then back in. “I want to die now,” she said again.

“We know, we understand,” I said. “We’ve told the nurses.”

My mother gripped my hand, looked at me. “You don’t mind?” she asked.

You don’t mind? The question was heartbreaking both in the simplicity of its phrasing – like something a child would say — and the complexity of its meaning. Of course I “minded”! We drove each other nuts; we fought all the time; we talked nearly every day; we adored each other. She was asking if I would be all right without her — but also asking if I understood and was okay with the choice she was making.


The question had its own resonance in our family. Nearly two decades before, her husband — my father — had shot himself. His death had devastated us. When she said “You don’t mind?”, I think she wanted to make sure I understood that her way of choosing death was different from his.

In her old age, my mother had taken prudent steps to try to preserve some say in the terms of her own death — a living will, a Do Not Resuscitate order. None of that had any bearing on her last days, but it meant she’d had some frank conversations with me and my sister over the years. We knew how much she valued life, and how important she felt it was to endure whatever life dished out — to “stay strong,” as she put it, “for you girls.” We also knew that when she said she was ready to die, she meant it.

I can think about death in terms of hypotheticals. If X were to happen, what would I do? Would I ask a doctor for pills, if it were legal? (Answer: I would at least want to have the option.) What if it were illegal? But discussing physician-assisted suicide is, in a way, beside the point. It’s a discussion about means, about methods. It matters, but what matters more is the nature, and the meaning, of a death. My mother did not have to choose to actively end her life, but she was choosing to die. Somehow she did it in a way that included us without making us responsible. She had little strength left, and only a few words, but we had a lifetime of knowing each other, a lifetime of — literally — familiarity. When she asked if I minded, I knew what she meant.

I told her that of course I minded, but that I also understood.

Joan Wickersham’s column appears regularly in the Globe. Her new book is “The News From Spain: Seven Variations on a Love Story.’’