Excerpt

From chapter 17

On December 12, 2003, John Williams of Chula Vista, California, rose with the sun. He spent some time that morning putting his affairs in order. Although he was in good health, John had recently made arrangements with a local funeral home. He put several envelopes on the kitchen counter detailing his retirement funds and bank accounts. One envelope was addressed to the adult son of his wife of two decades, Eiko.

The sixty-eight year old man walked outside his three-bedroom home on Blackwood Road. The yard and gardens were well maintained, as always. Then he drove to Sharp Chula Vista Medical Center, a 300-bed hospital in the South Bay area near San Diego.

John knew the way well. He had been driving that route for months while his wife battled lung cancer. Eiko, seventy-four, had received chemotherapy and radiation. But she suffered a blood clot at home and landed in intensive care.

By all accounts, John Williams was a devoted husband. He visited his wife so often, he knew the ICU staff and doctors by name.

That Friday morning he had a quiet early visit with his wife. Then staffers asked him to leave the room while they provided some care to Eiko. John went outside, but only for a few minutes. When he returned he followed his routine of walking up to the hospital’s security guard and showing him the identification required for entry. John reached his wife’s room for the second time at about eight a.m.

In some ways it had already been a long day.

While the ICU staff stood at a nursing station about twenty feet away, John Williams pulled out a .38-caliber revolver. He pressed the barrel against his wife’s chest, just below the breast, and fired. Eiko died instantly. Then he stepped back, placed the gun over his own heart, and pulled the trigger. He lingered only a few minutes.

Authorities say about 750 such mercy killings occur in America each year. There is nothing merciful about murder. But the only alternative may be prolonged torture, physical and emotional pain without relief, despair of recovery, and the indignity of overly invasive medical care.

This is not to say that Sharp Chula Vista Medical Center was doing a bad job for Eiko, at least according to current medical values. Perhaps her situation justified aggressive intervention at that moment. Confidentiality of medical records, while appropriate, makes it impossible to know. Since she had lung cancer, a slow terminal illness, it is fair to ask why Eiko was in intensive care so long that her husband knew the staff. ICUs are excellent for patients in a crisis or those experiencing trauma such as a car accident. They do not provide care tailored to the particular needs of the individual human being who is dying gradually and irreversibly. Think of it as simply as this: There is no music playing; there is no art on the walls.

Why would 750 people a year decide that death for their loved ones was a merciful escape from the foreseeable medical options? The only possible answer is that they cannot bear to watch their loved ones suffer. They act on a violent combination of compassion and despair.

Mercy killings are an aberration, but the emotions behind them are not. Rather, they represent the most dire expression of what thousands of families in America now face more quietly every day. They see their incrementally dying loved ones lying in hospitals – health professionals at the bedside unschooled in end-of-life care, medicine seeking cures long past any such opportunity, clinical interventions intensifying the pain rather than relieving it. Or they see their loved ones decaying in nursing homes, their days spent underfed, their pain ignored, their spirit crushed by boredom, their bedsores spreading. People witness all this, and they experience a new form of familiar agony.

As more deaths occur because of incremental illnesses, families are thrust into dilemmas for which they have no preparation. How do they decide when medical treatment has become futile, and perhaps contrary to the patient’s ultimate interests? How do they know when stopping treatment is cruelty and when it is merciful? How do they apply their loved ones’ values when healthy to their predicament while dying? How do they avoid letting their own biases overcome the patient’s wishes? How do they reconcile the spiritual event before them with the practical questions it raises? How do they make sure not to confuse medical care with love?