A Personal Case Study with Societal Ramifications- The Death of My Dad.
by Jude Crittenden
Preface
There are a few important and universally acknowledged truths that we all learn throughout life. Gravity – when we fall down, it hurts. Mothers – they love us all the time but only like us some of the time. Dogs become your proxy children when your actual, human kids grow up and leave the house.
And once we turn sixty, a universal truth that was previously abstract becomes concrete and self-evident; we recognize that we all get old and will, eventually, die.
Death becomes a stark and vivid reality when we watch our parents age, grow infirm and pass away. And, once an elderly parent does die, it’s normal to become self-reflective and look at an experience that you once thought abstract and personalize it from your own perspective.
My father Wayne recently died. And I did, indeed, get reflective. But, I didn’t just reflect on his life and death, I looked at the wide sweep of his quickly growing age cohort from an outside societal vantage. Wayne began an inevitable transition from a robust, energetic and proud man and descended down a slope towards physical degradation and mental confusion.
If the toll this downward journey took on Wayne wasn’t enough, the inherent financial costs borne by everyone else for Wayne’s unwanted and terrible remaining years were…more than catastrophic.
A quick Google AI search resulted in the following:
The budgetary problem faced by medical and related care for aging baby boomers is considered very extensive, with a significant impact on healthcare systems due to the large size of the generation and their increased need for chronic disease management and long-term care as they age, leading to rising healthcare costs across the board; experts predict this issue will become increasingly problematic as more boomers reach retirement age and require more intensive medical services.
Just below this description on my computer screen yielded a link to the National Institute of Health’s research piece titled The 2030 Problem: Caring for Aging Baby Boomers . The NIH report focused on the “aging shocks” we’re now facing pertaining to, in their words, the challenges related to caring for seniors that need to be faced by society (NIH, August 2002).
Questions then followed that, I don’t think we have answers for nor have we, as a society, prepared to deal with.
And the consequences are now front and center.
So, what’s to be done?
Essay
Around the time the American Colonies were fighting the British Crown for independence, the Englishman Jeremy Bentham was developing his axiomatic philosophical theory: utilitarianism. Bentham’s utilitarian principle stated that “it is the greatest happiness of the greatest number that is the measure of right and wrong.”
When Cato the Younger, a Roman Republican, realized that Julius Caesar had bested him in Rome’s civil war, …”Cato discussed with his friends at dinner the Stoic belief that a truly free man would never become a slave.” Recognizing that he was, by that day’s standard, an old man at 50 who had lived a long life according to his own beliefs, Cato committed suicide rather than suffer the indignities he was to face at the hand of Julius Caesar. He was also hesitant to lose his dignity and gravitas to the degradations of old age and decline. Slavery, either to old age or Caesar’s rule, was not an option.
In 1991 a Midwestern firefighter named Wayne, just shy of his 60th birthday, gathered his children and had a first and last family conclave. A decade earlier, in his forties, the husband Wayne, dutifully tended to his wife during her three year long, ultimately futile, battle with cancer. In his fifties Wayne cared for his mother during her seven year long struggle with Alzheimer’s. Wayne watched his wife, brother, mother and father die from the ignoble and grotesque consequences of cancer and old age infirmities.
Wayne, my dad, voiced a commitment to his three young adult children, that he would commit suicide when he thought his dignity, purpose and reason for living slipped away.
Dad vowed to not be a burden to those he loved and, more importantly, he was committed to dying with dignity. He casually and poignantly remarked: “We allow our dogs to die, pain free, with dignity and speed yet we torture our loved ones at the end of their lives.”
Unfortunately, years later at age 80, when dad’s dignity, purpose and reason for living started slipping away, he was asked the question: “What is your 1, 3 & 5 year plan now that you have crossed the Rubicon and are sliding into the degraded stage of life you detested as a younger man?”
With vacant eyes and diminished faculties, Wayne had no response. He could no longer understand the dimensions inherent in the simple yet complex question. Dad simply answered: “My perspective has changed.”
Now dad is confined to a bed, wearing diapers and riddled with pressure ulcers requiring daily tending. Wayne has no dignity, no purpose and no reason for living. He is a prisoner to the medical and caregiving establishment that profits greatly from our modern day’s increased life expectancies. The ravages of time have intervened to strip him of the ending he desired only twenty years ago: A death with dignity at the end of a purpose driven life.
Furthermore, his continued existence is costly to taxpayers, younger Americans and society at large; a crushing expense borne by those who can ill afford to pay for the care of their increasingly infirm elderly loved ones.
How did this all come to pass? How is dad’s present life being lived in direct opposition to Bentham’s utilitarian principles? How did his Stoic dignity slip away?
A famous mathematician / intellectual, whose name I’ve long forgotten, once said (paraphrased to the best of my memory), “A hundred years ago we died painfully, quickly and with dignity. Today we die painfully, slowly and without dignity.”
Today, one in six Americans are over 65 years old; 17% of the population. By 2040, 22% of the population in America will be collecting Social Security and using Medicare. 25% of all Medicare spending occurs within a patient’s last 12 months of life. And these last months typically find an elderly Medicare recipient under hospice care and, by any qualitative measure, subsisting in a completely ghastly state of existence.
With this all said, a unique utilitarian theory conundrum presents itself: How does society educate our young, maintain infrastructure, find solutions for Climate Change, research cures for cancer, explore outer space…in short, build futures for tomorrow’s children while we are spending a king’s ransom on keeping our elderly loved ones alive well past their due date?
Furthermore, from a Stoic vantage, the enormous sums being spent on providing life-extending medical care and then warehousing older persons, many times against their wishes, creates an ethical paradox where our elderly family members and friends are living a life they would not choose to live otherwise.
How, with limited resources, do we make tomorrow better for those under 65 while being ethical, caring and supportive of those over 65?
eu·tha·na·sia (self-determined)
noun
the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma.
Euthanasia has been frowned upon by western societies in modern times. Euthanasia brings up memories of the eugenics movements of the last century. Works of science fiction are replete with societally enforced methods of euthanasia. In Harry Harrison’s 1966 book “Make Room! Make Room!”, an overpopulated planet relied on euthanasia to manage a dystopian future. The book became famous when it was released as the 1972 movie Soylent Green.
But, how does society allow for a compassionate, positive and responsible form of euthanasia to be practiced to both alleviate unnecessary suffering and save precious resources better allocated elsewhere?
More importantly, how do we, as individuals, determine when it is time to end it all?
The Tomorrow Test
A significant intellectual capacity that separates humans from our animal brothers and sisters is our ability to grasp the concept of tomorrow and plan for the future. Throughout the normal course of an average person’s life, one takes steps, makes plans and looks forward to tomorrow’s inherent possibilities. We look forward to the future.
Without giving it too much thought, we are all taking “The Tomorrow Test” each and every day we wake up and get on with our lives…when we move forward, with purpose, to a better or at least different tomorrow.
But, what happens when tomorrow isn’t any longer an event that is focused on? What happens when our tomorrows are filled with fear, discontent and cognitive disarray?
What happens when we fail The Tomorrow Test?
The philosopher Peter Singer came under severe and caustic public scrutiny and was labeled as dangerous and a eugenicist when he postulated an argument supporting a parent’s right to pursue euthanasia for severely disabled infants.
Mr. Singer’s argument followed a utilitarian methodology when factoring in the unnecessary pain caused to the disabled child by their continued existence and the parents’ prolonged anguish coupled with the expenses necessary for the child’s continued care.
If you, the reader of this essay, were to take The Tomorrow Test, you’d pass with flying colors. If my dad Wayne, the 83 years old bed-bound, diaper-wearing shell of the man he once was, took this same test…he’d fail simply because he couldn’t comprehend what the test meant.
Taking a test is NOT, nor should it be, an indicator of the test taker’s value in life. The meaning of life is esoteric and completely dependent upon an individual’s own personal experiences, goals, desires and plans for the future. Why and how, the two most important, existential and life affirming questions posed to any man or woman are overlooked when we attempt to judge an elderly person’s ability to “think.”
Today’s elderly must take competency tests when renewing their driver’s licenses, signing assisted living rental leases and conducting estate related transactions. And the test is shockingly easy. An eighty year old man can quickly exhibit a high state of mental alacrity by passing a senior citizen’s competency test while dismally failing a 3rd grader’s reading comprehension test.
Any adult daughter or son sitting with their elderly parent during a competency test walks away shocked and unsettled by the experience. One doesn’t have to “think” much to be judged competent by today’s courts, institutions and society at large.
But, the test questioners never ask the eighty year old man why or how he will spend the remaining years of his life.
No one ever administers to our old persons The Tomorrow Test.
There is only one simple question asked in The Tomorrow Test:
Mr. / Ms. ___________________, tell me about your tomorrow?
In the case of this essay’s main character, my father Wayne, an Ohio traffic court determined he was competent and didn’t rescind his driver's license following a catastrophic traffic accident where he, luckily, didn’t kill anyone. Dad continued to drive. But, he had no real reason to drive. Dad had nowhere to go.
The only real reason to live, from dad’s diminished perspective, was to smoke cigarettes. Dad stopped reading. He stopped walking. He stopped engaging with others. He stopped living in any capacity a “normal” person would have found reasonable. Although he lived on his own, he wasn’t independent in any true sense. His younger neighbors all worried about him hurting himself walking in and out of his condominium to simply…smoke. My dad’s life of service as a firefighter, a father, a friend to others, a mentor to young men, a figure of respect and esteem had faded into oblivion years earlier.
Now my dad was a burden to his son. A source of worry to his daughter. A dependent on the State. A liability to society. His existence ceased to have meaning in the way he would have wanted.
Yet he was never administered The Tomorrow Test.
Over the past year dad’s life has been one of torturous pain, constant discomfort, confusion, detachment from his surroundings, misery, fear, bewilderment, mental and physical agony, trips to and from the hospital emergency department while he, a veritable inmate, impatiently awaits the delivery of his longed-for death sentence, which still has not arrived.
In fact, when my father was in his 60’s, he did choose not to live this way. He explained to his children that he was planning on committing suicide when he determined that his life held no further dignity or purpose.
Wayne didn’t realize that his physical and cognitive decline would strip him of his ability to take and then pass or fail The Tomorrow Test.
One year ago, if Wayne was administered The Tomorrow Test, and when he then failed, what should have been done?
When physicians take the Hippocratic Oath they pledge the following:
“First, do no harm” has at least 4 distinct meanings: (1) medicine is a moral enterprise, (2) take due care to prevent negligent harm, (3) balance harms and benefits to promote best interests, and (4) intervene only if the harm of doing so is offset by other ethical considerations.
It is commonplace in veterinary medicine to euthanize our beloved pets when they are in pain, terminally ill and would fail a K-9 version of The Tomorrow Test. To unnecessarily allow a dog to suffer at the end of life, as we routinely force our human loved ones to, would bring individual and societal opprobrium to the pet owner not to mention criminal charges of animal cruelty.
In light of all the information that has been discussed up to this point, it is easily understood that a societally mandated euthanasia program would be impossible to pursue, morally repugnant and existentially dangerous. No higher authority, governing body or societal structure could possibly create, roll-out and continue an ethically based program of euthanasia. The potential for abuse and the inherent violation of individual liberties makes this proposition a non-starter.
But, we do have workable, beneficial and compassionate euthanasia programs in veterinary medicine.
How do we then marry compassionate euthanasia, benefiting both the incapacitated and ailing elderly person and, at the same time, freeing up precious resources to be used elsewhere?
We then must pursue personal liberty married with The Tomorrow Test.
If euthanasia is inherently open to abuse when administered by outside agents, we must again pursue personal liberty. We must make The Tomorrow Test part of an individual’s personal liberty in his/her pursuit of “assisted dying.”
Australia and Switzerland already have laws promoting euthanasia in the form of assisted dying. In November, 2024, England and Wales passed a bill in Parliament to legalize assisted dying. This British legislation, although yet to be enacted into law, stipulates that individuals over 18 years old with a terminal diagnosis with less than six months to live have the right to pursue measures to end their lives.
Support for the assisted dying bill in the British Parliament centers around individual liberty.
If personal liberty is held sacrosanct in our secular, Western societies, assisted dying should be an available option to any individual and its protocols should be re-written and expanded to include The Tomorrow Test.
We have already determined, in many instances, that we keep individuals alive for longer than they would desire. The widespread incorporation of hospice services, palliative care and modern medicine merely prolongs death. Regrettably, affected individuals with diminished mental and physical capacity(s) are in no position to advocate for themselves.
The Solution
The Tomorrow Test should be enshrined in our already established end-of-life dialogue and protocols, while strictly pursuing individual liberty. The solution then becomes quite clear and easy: Each and every individual, when they turn 50, will be mandated to set-up a trust including a detailed will and testament. And in this trust, the individual can mandate whether or not they wish, in future days, to take The Tomorrow Test.
And if he/she chooses to take The Tomorrow Test when they begin their inevitable decline, this right will become a legal instruction to be followed by family(s), caregiver(s) and all those involved in the individual’s end-of-life well-being.
If an individual finalizes the provisions of their trust and opts FOR the inclusion of The Tomorrow Test…when they eventually fail, then the medical establishment and all concerned will be mandated, by law, to provide assisted dying services.
Some will say that a mandated trust of this type is, in fact, a violation of our civil liberties. Yet, we choose to live in a society replete with laws, conventions and structures that outline how we live our lives.
Mandatory seat belt laws save lives and lessen the cost to society at large for the car crashes that we all, statistically, will be involved in. Schoolchildren have no say in whether or not they have to attend school. Speed limits are not discretionary yet do not create an acute violation of our individual liberty. Sin taxes are levied on alcohol and cigarettes. No one has voiced too much opposition to these societal measures enacted to benefit the public at large.
A civil-mandated trust that all citizens must complete upon their 50th birthday would function in the same vein. Since The Tomorrow Test would be free from government, religious and other outside corrupting influences, the pursuit of assisted dying would fall squarely on the shoulders of the individual. At 50 years of age, each citizen could opt in or out of the administration of The Tomorrow Test in their later, declining years.
The individual opting for the administration of The Tomorrow Test would then be positioned to die with dignity in a manner that benefits him/her as a person and relieves society of the expensive and grotesque burdens we have inadvertently created with the increased care levels we condemn our elderly loved ones too.
Finally, and to be sure, in pursuing individual liberty, each person completing their 50th year trust can opt IN or opt OUT of taking The Tomorrow Test.
Freedom and Euthanasia will be our individual choice.
Wayne, the husband, father, firefighter, friend and dignified man…did not have the option to take The Tomorrow Test.
Jude Crittenden is a member of the Toledo community.
