Living with a chronic illness and the knowledge that you are dying is hard to do. You may feel cheated, betrayed by your own body and the world. You sometimes feel that your doctor is just not doing enough, or that a cure should still be possible. Being treated for serious illness can be expensive, uncomfortable, and disheartening. Being sick requires many sacrifices and changes. Often, you have to ask others to do things you once did for yourself. Some days, you may feel so full of despair that the idea of just dying now seems like a reasonable alternative. In fact, attempts at suicide are often tied to clinical depression, a disease that makes people feel sad, unworthy, guilty, and overwhelmed. Depression is not the same as feeling sad: it is having no positive or hopeful feelings and often just no energy to care.
Many dying people who focus on suicide are depressed. Many others have alcohol and drug abuse problems. Many older people who commit suicide not only are depressed but suffer from long-term physical disabilities as well. Still others are depressed because of medication they take to treat diseases (such as hypertension). Most of the depression that leads patients to consider suicide can be treated effectively with medication and therapy. Most dying people are not depressed, and most who are depressed can be helped (often within days or a few weeks).
Being depressed is like wearing blinders or trying to read in the dark. Your perspective is just not what it should be. You may not even be able to remember times when you were happy and felt that life was worth living. You may feel that you have been depressed for years. It is certainly a time when the future seems irrelevant and bleak.
Many health care professionals can diagnose and treat depression, though you should know that depression is often overlooked. It can help for you to ask: "Is this depression that makes me feel so low?" Your doctor should talk to you about your symptoms and find a treatment. You can also get help by calling a local or national suicide prevention hotline or finding a community mental health center. These hotlines offer confidential help from trained and friendly volunteers who will listen to your troubles and lead you to resources. By asking for help, you open the door to support and hope. Getting help for depression can give you time to think about your life more clearly. Often you will come up with adequate options for the fear and loss of control you feel.
Your doctor might recommend that you join a support group, such as a breast cancer or stroke group, or even a depression or "12-step program" in your community. Talking to others who share your experience and concerns can take a weight off your mind. Sharing your feelings ó and just being with other human beings ó is a powerful way to heal.
You may find that you are not, in fact, depressed, and you may continue to feel that dying is just taking too long. If so, you should consider not only the other issues discussed in the rest of this chapter, but also the possibilities of hastening death by stopping treatments. Ordinarily, people who are very sick can stop a medication, can forgo artificial nutrition and hydration, and can accept sedating levels of drugs. These are not so definitive, or confrontative, as suicide or euthanasia, and they are usually fairly effective in avoiding prolonged dying.
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Forgoing Medical Treatment
|Copyright © 1999, 2006 by Joanne Lynn. This extract from the Handbook for Mortals by Joanne Lynn, M.D. and Joan Harrold, M.D. is used with permission. To learn more about improving care at the end of life visit the main web site for Americans for Better Care of the Dying.|