The Dignity of Death

Dear Doctor! My mother recently began complaining of sudden, very severe back pain. I took her to the emergency clinic, where several vertebrae in her back were found to be collapsed. Further examinations revealed a large tumor in her left breast that had metastasized to the lymph nodes, the spine, the lungs and the liver. They said it is inoperable… She was given a morphine patch for the severe pain.

According to what was told, this is an extremely severe, already advanced-stage cancer. It has metastasized not only at the primary site but also to nearby and distant organs. This can no longer be operated on, because even if the primary tumor were removed, there are metastases in the lymphatic system, the liver and the spine, and these would restart the disease.

They recommended chemotherapy to try to slow the spread of the tumor. That is why I am writing and would like your advice!

What is your question?

My mother objected. She did not want the treatments. She wants us to let her die. But the doctor says there is hope.

I suppose you took her for treatment then…

Yes. She received two different drugs…

And what was the effect?

The next day she became terribly ill. For six days she has been vomiting and retching nonstop, terribly weakened and exhausted. I should take her on Monday for the start of the next cycle, but she doesn't want to. I called the doctor, who said something like she should not have received the two together. But she did. The doctor was a bit upset.

So the next treatment is coming, your mother doesn't want it, and you do? You want my advice on this?

Yes.

Are you aware that your mother is in the terminal stage of cancer? Did they tell you that?

Yes…

Did they give you a prognosis about how much time this kind of disease usually allows?

Yes… they said a few months.

Your mother doesn't want the treatment, right?

She doesn't want it… But I love her very much and there is always hope and … I'm afraid she'll leave me…

I understand you're afraid of losing her! However, you must see that the condition is very advanced and the treatments only prolong the suffering. Have you been able to have any meaningful conversations with her in the past few days?

No, because she was in a terrible state. She just retched and vomited…

Don't you think your mother might be right? There are conditions where you can know there is no escape. If the cancer has already consumed so much, it will not let go of its victim. If it had been discovered much earlier there might have been hope. Have you heard of any case where, despite so many metastases and collapsed vertebrae, the patient recovered? One who, moreover, would rather “go” than continue living?

And I won't face repercussions? The doctor specifically said this treatment is terribly expensive, more than one and a half million, and that it took him a lot of work to get permission to give these drugs to Mom. What should I tell him now?

There is not much I can say to that! Your mother is dying of cancer and explicitly does not want her suffering prolonged. And certainly not intensified. And you are afraid of a doctor's disapproval???

A dear teacher of mine taught this for such cases:

"Give Death the respect it deserves!

When you know you have been defeated by the disease, acknowledge it.

Do not prolong suffering with meaningless or token treatments, but do not hasten death!

Especially not against the patient's will.

Be strong in spirit… so that you have the courage to do this."

The fear of losing a beloved parent or relative can lead to irrational decisions. In such moments many approach the issue from their own perspective: Your death would hurt me so much! I don't want you to go! Stay with me at any cost! Even if you suffer, even if I cannot talk to you, just don't die, because I am terribly afraid of it!

Out of attachment and fear of loss, people can even pressure doctors, who often extend the patient's suffering because of this. At the relative's urging, against the patient's wishes.

Yet in many cases there is no time to avoid confronting the loved one's death. It would be better to prepare together, to discuss the remaining open issues, to tie up loose ends. To say goodbye and let go. Nicely and with love.

Because this is the most natural thing in the world. We are born and we die.