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When my mother-in-law could not take it any more (her cancer had turned her leg into one huge sore, and her pain was unbearable), my wife reluctantly called in a physician who was also a family friend. Dr. L. explained that it was against the law for him to help my mother-in-law, who had battled melanoma for 13 months with a quiet dignity, to end her life. He could, though, leave in her room a syringe filled with a sizable dosage of morphine and teach her how to inject herself. His only request was that one of us would remove the syringe after her death and before we called the funeral home, which was sure to ask the police to certify that the death was due to natural causes. We were very reluctant. My mother-in-law had moved in with us a year earlier. She had had a small black mole on her toe, which she ignored. It turned out to be a malignancy that was removed, but the cancer had already placed its vicious tentacles elsewhere in her body. She battled it for months through chemotherapy and radiation, to which she had violent reactions. After additional months of various interventions, she decided to refuse all further treatment. She slowly grew weaker but continued to enjoy her grandchildren, although she found it hard to leave her bed. Sadly, what made her decide that she could not take it anymore was not merely her pain but also that our home was filling with the smell of rotting flesh to which we found no antidote. We got sort of used to it, but she registered the shock in the faces of those who came to visit-calls that soon became few and far between. When she refused to eat and repeatedly begged us to let her go, after many agonizing discussions, we finally yielded to her pleas. Dr. L.’s plan allowed her to pass on, just as he had said. The police visit was short and perfunctory. Informal mechanisms work The only reason anybody other than her family should heed this story is because when courts, the media and the police stay out of these matters, society develops informal mechanisms that work, far from perfectly but a hell of a lot better than when state institutions intrude directly into such highly personal situations. Indeed, four members of my family in the health care world all report that such passings are far from rare-although informal euthanasia usually takes place in hospitals or hospices, not in homes. When families and doctors are on the same page, painkillers are prescribed to a level that hastens death. I write that the state should not be directly involved because the fact that the law in all states but Oregon bans euthanasia is one valuable factor in this complex equation. (The endurance of the Oregon law will depend on the Supreme Court’s ruling this term in Gonzales v. Oregon.) The fact that there was no easy way to proceed helped us to reflect carefully and repeatedly about the final decision to help my mother-in-law let go, even though she had before-repeatedly-asked to die. Such passages should be allowed to take place only after all those involved are confident that the patient is not merely depressed and have had numerous opportunities to re-examine their decisions. (When my mother was 99 1/2 years old, she often said she had lived more than long enough, but in the next breath asked about the preparations for her 100th birthday. No one should heed her passing protestations about the travails of being “too” old.) Ending life is hardly the only major social realm in which allowing such informal mechanisms to work strongly recommends itself. Adultery, for instance, is best left to informal censure, as opposed to third parties dragging it into court. The same holds for behavior at work that people find annoying; thus, it is better to leave a bottle of Listerine on someone’s desk than to file a complaint about bad breath with human resources. For these reasons, when the family and doctor are united and the patient’s wishes are clearly established, there should be ways to end life when suffering becomes unbearable-even if the patient remains a conscious human being. If members of the family diverge, there should be an informal mechanism available, in hospitals and hospices, to help the family reach a shared conclusion. All this may not have applied to the family of Terri Schiavo, which was in such conflict from the get-go that arguably the courts had to be involved. But the Schiavo situation serves as a lesson, not about the right to die or the sanctity of life or about the rights of the husband v. those of the parents-all legal concepts. It highlights, in a particularly painful way, how much better off we all are when these matters are left out of the limelight and remain in the twilight of family life. Amitai Etzioni, an NLJ columnist, is the author of My Brother’s Keeper: A Memoir and a Message (Rowman and Littlefield 2003).

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