End-of-life planning

Another subject I’ve been ranting on about for years to anyone who shows the slightest hint of interest, or (occasionally) no interest at all, has drifted to the top of the shallow pile of topics niggling at me for a chance to feature in for this blog. This one is slightly tricky to approach, and for an unusual reason – I have to be very careful to avoid running foul of the law. But more of that later.

For most people, end-of-life planning means writing a will; establishing whether you want to be buried at sea, or cremated, or buried, and possibly where; and noting down what aged pop songs you want everybody attending the inevitable solemn celebration (of a full and happy life sadly torn away after a noble battle with disease) to sit through, for no obvious reason except the possibility of an unseen smirk from beyond the grave. But that’s not what I mean. For me, it’s about planning how to end my life.

Having seen various people grow old, and experienced some others dying “before their time” has made me consider my own life, and what I would choose for it. And realistically, there seem to be only two choices.

The first is the default option, which consists of growing as old as possible, until something happens to stop that from continuing. Here in the UK, if you reach 80 without dying, it’s quite likely that our estimable NHS will be able to keep you going for quite a few years, but eventually, inevitably, something will kill you. The leading cause of death in the UK for people over eighty is Alzheimer’s, which is generally not a happy condition. The chances are you will spend at least the last 2-3 years of your life in some kind of care home, where you will be attended to (more or less) by people you don’t know, and who don’t know you. There will be a large turnover of both staff and residents – just the environment to be most disconcerning to Alzheimer’s sufferers. If you don’t have Alzheimer’s, you will probably not enjoy the company of those who do, and either way you will certainly suffer to some extent from a progressive reduction of faculties, possibly including walking, talking, thinking clearly, tasting, continence, sense of touch, memory – you get the idea. You may eventually give way to Covid, or flu, or some other cause of contracting a pneumonia which finally does for you. Or heart disease. The chances are, no matter how positive you have been throughout your life, that at some point you will start thinking that really, you’ve lived long enough. By then, of course, it will be far too late to do anything about it. Overall, it doesn’t look like a very appealing way spend one’s final time.

The second option is to do something deliberate, to avoid the first option. Most people immediately say “Dignitas” at this point, but I say, why? It’s perfectly possibly to effect a much more personalised result without all that inconvenient international air travel (not to mention expense), if you just do it yourself. And you don’t need to start thinking about knives, or poisons, or guns, or tall buildings, or anything violent, or even painful, at all.

This is where it gets tricky. Although suicide is no longer illegal in the UK, assisting someone else’s suicide still is. And so if I tell you that I intend to commit suicide some time around my eightieth birthday, or possibly before that if things take too much of a downward turn, that’s fine. But if I tell you exactly how I intend to do it, that could be construed as abetting in someone else’s suicide – even if I haven’t even met them, and had no idea that they were reading my words. Strange, eh? Anyway, I think with a subscriber base which currently numbers exactly four (one of whom is my wife) I should be fairly safe. Nobody’s going to wade through all this prose when the rest of the internet has so much to offer on the the pros and cons of all sorts of methods.

Back on topic, I’ve picked eighty because:

1) It’s certainly going to be downhill all the way from there. (In many ways it’s downhill all the way from a lot younger, but nobody would point to a huge increase in function after 80, would they?
2) It’s an average lifespan, more or less. Surely that’s enough?
3) It’s a nice round number.

But why pick an arbitrary number at all? Why not just see how it goes? “Pete – you might still be having fun at eighty, and not want to go! ” (I hear you cry). Well, if you don’t set a fixed date, it’s obvious what will happen – it will get harder and harder to decide “today’s the day!”, your loved ones will keep trying to talk you into delaying just a bit longer, and eventually you will have left it too long, and your ability to take action will have disappeared (or been removed – for your own good, of course). And it’s back to the default option.

Whereas, with the published plan, all the arguments can be done and dusted in a civilised way many years ahead of time, and I can have my dying wishes in peace. And I’ll be prepared to die, because I’ll have been expecting it for years, too.

And so I have every intention of slipping away somewhere around May, 2037 (if I make it that far). I just can’t tell you exactly how it will be done. What I can do, I suppose, is to give you a little science lesson.

It is a seemingly-little-known fact that a lack of oxygen doesn’t cause a feeling of being unable to breathe. Its actually a build-up of carbon dioxide in the blood which causes that feeling. If somebody is forcibly smothering you, it doesn’t matter which chemistry was the cause of your distress, but in other circumstances it can make all the difference. People in unpressurised aircraft, for example, can fly so high that there isn’t enough pressure of oxygen in the air to supply their needs, but they don’t feel short of breath, because the carbon-dioxide is still being scavenged out of their lungs in the normal way. The effect is, apparently, a bit like getting a bit drunk – sort of woozy, with some excitement, and a feeling of slight euphoria. If prolonged, and sufficiently extreme, unconsciousness follows. This tends to result in a loss of control of the aircraft, which loses height, and the pilot often recovers his senses in the thicker air nearer the ground in time to land the plane, which is how come he can tell us what it felt like. Importantly, it’s not uncomfortable.

Similarly, underwater re-breathers, which work by removing carbon dioxide from exhaled air and adding fresh oxygen before supplying it for inhalation, must be carefully monitored: if the oxygen runs out (or you simply forget to turn it on), you won’t be alerted by any uncomfortable feelings – in fact divers call oxygen-starvation euphoria “rapture of the deep”. But for divers, an error leading to unconsciousness is more likely to result in accidental death.

Oxygen makes up about 20% of the air we breathe, and almost all of the other 80% is nitrogen. So nitrogen is pretty much just oxygen-free air. It has recently been proposed as a “more humane” method of execution than lethal injection in the U.S. because it’s simple, painless, and difficult to get wrong. The only real problem lies with the inevitable use of the term “gas chamber” which has, er – unfortunate connotations. Nitrogen is cheap, non toxic, and has a variety of industrial uses, including food storage and filling racing car tyres, so it’s quite easy to come by. Some suppliers just charge a deposit for the bottle, without any ongoing rental charge, so it’s easy to keep it in readiness, for years on end. With a regulator from Ebay providing the usual pair of pressure gauges , you’re all set to to leak it out into the small confined space of your choice.

Most people have convenient access to a mostly sealed box with comfortable seating and good visibility, which would be an ideal choice for a relaxing snooze of arbitrary length – I refer, of course, to your car. A car two other advantages: firstly you can take it to somewhere with a nice view; and secondly, should someone eventually open the door to see whether you are “all right”, they won’t find themselves in a state of accidental underwater rapture (or unconsciousness) while they are reading the note you left for them . One must think these things through, to avoid unintended consequences.

How long one can unwittingly survive without much oxygen at all? it’s a bit of a moot point, but half an hour unconscious should make sure you are absolutely beyond repair. Which isn’t too long to snooze undisturbed in a National Trust car park, for example.

There are a few issues with this whole scheme, of course. One’s wife, for example, may agree in principle with the strategy, and express a wish to join in, but then show a tendency to vacillate every time she thinks about her grandchildren. Discussions may ensue, but I think it’s important for me to be very clear about the plan well in advance, and absolutely refuse to give any ground. Some friends have tried to make me feel it’s my responsibility to stick around as long as I can, just to keep them company in their dotage, but I’m afraid I just don’t buy that. We all need to accept that our friends and loved ones may die before us, and surely the ideal way for that to happen would be pleasantly, in the manner of their own choosing, wouldn’t it? After all, who else should we burden with such decisions?

And if I am solidly inflexible, surely that makes it easier for everybody else to decide what they want to do with the end of their lives, at least as far as their relationship with me goes.

It wouldn’t be good news for the care sector if everyone started doing this, of course. But it would be good for the planet, and good for the next generation if they get to inherit some of my good fortune, instead of finding that I’ve spent it all on stretching my life out to the last grisly drop. It also makes financial planning A LOT easier if you know how long the money needs to last, which would make annuities much better value! I honestly can’t see a down side to deliberately choosing a pleasant end to a life which nobody could call “cut short”, rather than suffering a grinding, drawn-out decline into ghastly, frustrating, joyless incapacity. Can you?

8 Replies to “End-of-life planning”

  1. Good points, your argument is strong, I have the reservation that one like yourself should still be flexible though- like you may actually find peace and happiness in a slow demise of old age? (was anonymous by mistake)

    1. Well, it’s possible; but the arguments not to go of forever are still valid, I think. I’m in favour of finishing on a high – which means you have to forgo the possibility of future highs…

  2. Good points, your argument is strong, I have the reservation that one like yourself should still be flexible though- like you may actually find peace and happiness in a slow demise of old age?

  3. Yes, interesting since I have not yet ordered my gas bottle and valves but it is up there on my to do list. I suspect I might be dithering…My first dither is I would prefer a sliding decision date – something to grab if I need it – rather than a fixed one. Also I may be an emotional coward as my fantasy is of slipping off one day without warning rather than with a fanfare. Finally this has all helped me recognise the fear of this moment – my end – and whether I want it to creep up on me or plan it. With love, Colin

    1. Right with you there about the fanfare Colin. I agree. A quiet drive to a secluded spot is very appealing, I think. I don’t think it’s cowardice so much as gentleness.
      Can’t agree about the sliding scale though. It’ll never happen!

  4. Wise words ….. I completely agree . Culturally, we have failed to keep fundamental philosophy astep with medical, social and environmental development. End of Life issues are divisive as are pro-creational, medical life support and populational scenario’s where developing science may actually be long term counter-environmental when attached to old cultural mores….. some big conversations need to be started but to say they are contentious, isn’t the half of it !!!

    1. Indeed. Even expressing an opinion that goes against the “sanctity of life” presumption is still pretty much taboo. No politician or doctor will go within 100 miles of the question. I’m afraid it’s probably going to get grimmer before it gets wiser…

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