September 11, 2013

Quality of Life and of Mercy


I think most of us spend a certain portion of our lives thinking about or imagining what life will be like when we are old. The definition of what is "old" certainly changes, particularly as some of those previous benchmarks get closer! Some of us spend more time than others in this activity, and we all have different experiences to draw from that inform how we imagine that will look. But most of us do picture ourselves reaching some sort of state of decrepitude at some point in our lives.

    My own experiences in end-of-life and palliative care, geriatrics, and caring for many dementia patients has certainly colored my perceptions of what that can look like, and certainly caused a lot of contemplation of what my preferences are should I have any input. Certainly now struggling with my current disabilities has brought this into even sharper perspective. As you experience the losses of abilities you previously enjoyed, as you try to compensate or let go and anticipate future needs and losses your criteria for what constitutes quality of life is constantly being analyzed.

Untitled by Georgie Meadows via Flickr
Having had some earlier life experience with a friend who suffered severe Traumatic Brain Injury (TBI) my personal horror has been the loss of my cognitive and analytical abilities. Never having been much of an athlete, the loss of physical abilities has never been a great bugaboo. Having seen the gradual loss of cognitive abilities in various forms of dementia/organic brain syndromes it becomes obvious how difficult it is to pinpoint a particular time and say "OK, quality of life has dropped below my tolerable limit right there".

        The wonderful and delightful Terry Pratchett discusses this much more eloquently than I could ever hope to in this Guardian post discussing practical solutions in the UK.

        I have the good fortune to live in a very progressive state that has already enacted a law allowing doctors to assist their patients with terminal illnesses to die within strict criteria. Which leads us back to the whole quality of life question. When I am dictating those instructions to my doctor and family, at what point is my limit reached?

       And I think I finally have found the answer. As important as my intellect is to me, to be able to banter and tell stories, to understand xkcd (ok, most of the time)... the time when I am no longer me is when I can no longer choose to be kind, or to laugh. Those are both deal breakers for me.
        Just to be clear, this is my mental ramblings and not any sort of "message". Of course if anything spectacular happens in the next couple of weeks please feel free to credit me with all sorts of psychic abilities! Otherwise, just the mental musings of the moderately morbid *chortle*