Friday, May 27, 2011

Documentary review: 'How to Die in Oregon' opens the conversation

By Barry Johnson

Last night I watched Portland filmmaker Peter Richardson's How to Die in Oregon on HBO, and that wasn't easy. In the past months, both of my wife's parents have died, her father quite recently, so the anxiety and sadness are very close to the surface. No matter how it goes, you have doubts -- could we have made it easier for them? Which is another way of saying, could we have made it easier on ourselves?

"Easier" here is the tricky word, because honestly we don't know. We don't get to experiment with different ways of dying to find out the one we want. We assume the less pain the better, but when we are attending a loved one who is approaching death, we can't be sure what that means. Not even the doctors can -- how many milligrams of this, how many milligrams of that.

We also assume that the more control we have over the death experience, the better. That's the rationale behind Oregon's 1994 Death With Dignity Act: If you are consciousness and dying, you should be able to choose when you die, have the means prescribed to accomplish your death and do it legally.

Richardson's How to Die in Oregon tells several stories that explore real experiences connected to the Death With Dignity Act, all of which give human depth to the provisions of the law. The central story, though, is that of Cody Curtis, who has terminal cancer. And here, the use of the word easier become ridiculous, because her experience is not easy. It's painful physically (sometimes more than others) and in every other way you can imagine, because she lives with it, with her impending death, consciously all the time.

Cody Curtis, center, with her doctor and husband.
In my favorite part of the movie, Curtis talks about how she is feeling so much better physically than she thought she would -- or had any right to expect, given her cancer -- while she planted flowers near her house. I like to think that the physical activity, the sensation of earth and water and green things in her hand, occupied her attention, deflected her from this persistent awareness of her condition. As this implies, Curtis collaborates deeply with Richardson on this documentary, allowing him access to visits to her doctor, talks with her friends and family, her reflections as she passes through her day. She has friends and family, and she hates to give them up -- and they hate to give her up, too. Her life becomes one long goodbye, bitter and sweet, too.

When her health deteriorates again, she sets a time and date to take her leave. We can hardly believe it. One day, she is teaching her son the recipe for her famous Christmas cookies, and two days later she is gone.  So, yes, easier isn't the word, though this choice, her choice, is better to her than letting the cancer play out in her body in front of her family and friends. It's hard to argue, one way or another, which is another rationale of the law: Why should anyone argue with you (or attempt to stop you) when you've decided this is the course you want to take?

The only false note in How to Die in Oregon is the title itself. Very few Oregonians go through the process of the Death With Dignity Act to the end -- 65 in 2010 and 525 total since 1998, according to numbers released by the state's department of health. How do we die in Oregon? That's a very a good question. I started to type, "a lot like everywhere else," but I don't know for sure. It's possible that hospice care is better or more widely available in Oregon because of the Act or for some other cultural reasons. It's possible that Oregon hospitals are more concerned with pain management than most. I'm not sure how Oregon's specific culture deals with issues around the end of life compared to other states or other countries.

Curtis did not want to end her life in pain or unconscious in an intensive care unit as cancer overcame her. She didn't want her death to be financially or emotionally ruinous to her family. These fears, entirely understandable, suggest that the culture still hasn't adapted to changes in medical science and the hyper-capitalism that has come with it. We still haven't figured out, as a culture, what we value at the end of life, though as individuals we may know what we fear. Until we start talking to each other about those values, whatever they may be, the default will be to pass loved ones -- and ourselves -- over to the experts. As much as I appreciate experts, this may be a matter we keep for ourselves.

Death is personal, of course. Personal decisions about it are critically important. It's also social -- we affect the dying, the dying affect us. And anything social becomes legal. In some ways, though, I'm discouraged that the Curtis experience was framed from the outset by the law. In a better world, the culture has figured out ways to make the end of life softer and more affirming for everyone involved, without invoking a specific law.

From what I've read and heard, maybe we are heading in that direction with hospice care, but maybe we have to talk about death a little more to make this passage feel right somehow. I'm pretty sure that I do, anyway. And Richardson's contribution to us, to our culture, is to make this conversation a little easier to have, to help us understand what's at stake, to give us some common experience to discuss. For that, we must thank him.


Gwenn said...

I haven't seen the movie, but the Death With Dignity Act has been a part of my life since its inception. I remember talking with my parents about the law and about death--theirs and mine--when I was a teenager. Of everything that law may or may not do, I think its value (and, as you say, the movie's too) lies in getting us to talk about something that our society likes to keep hidden.

You make me want to see the movie!

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