It’s hard to know just where to begin with the pile of mush published in the Atlanta Journal-Constitution yesterday by columnist Jay Bookman.

“Time to pull suicide debate out of the shadows” starts out promisingly enough, accurately describes the practices and “eligibility” criteria necessary to get “help” from Final Exit Network. That puts him way ahead of Time magazine, for example, but that is a particularly low bar to clear.

Having summarized the story of the arrests, investigations with a degree of competence, Bookman veers into territory loaded with his own personal prejudices and baggage:

For example, do my inalienable rights as a human being extend to the right to self-destruction? If my life is truly my own, shouldn’t I be able to end it as I see fit?

Personally, I think the answer is almost always no. Societal consensus, backed by medical research and experience, dictates that a person in decent physical health who wants to commit suicide is by definition mentally ill — no fully sane person would make such a decision.

But how far does that line of reasoning extend? As a person’s physical health declines, that once-bright line begins to blur for many of us.

OK, you don’t need to be a rocket scientist to see where he’s headed with this, right? Ignoring the fact that the vast majority of old, ill and disabled people don’t want to kill themselves, he feels it’s somehow more rational when they do feel that way. He also buys into the overmedicalized view of suicide as a symptom of mental illness, rather than resulting to a state of despair or a loss of one’s feeling of worth. These latter factors tend to be brought on by failures in our social support networks.

He continues with a story:

During the Terri Schiavo controversy, for example, I stumbled across the case of David Mack, a Milwaukee police officer who had been shot in the line of duty and lapsed into a vegetative state.

Twenty months later, Mack miraculously returned to consciousness only to be horrified at his predicament. The shooting had left him totally paralyzed; he could communicate only by moving his eyes across a spelling board. He told his wife that he wished the bullet had killed him. He begged for a lethal injection or for feedings to stop.

Using the spelling board, he would send the same message over and over:

“I D-O-N-T W-A-N-T T-O L-I-V-E L-I-K-E T-H-I-S A-N-Y-M-O-R-E.”

He lived another five years.

In Mack’s case, like that of Schiavo, medical advances made it possible to artificially extend physical existence without extending the other aspects of life that give existence meaning.

So was Mack’s wish to die evidence of mental illness? No, it was an act of sanity. But we as a society refused him his final wish. He had been shot bravely protecting us, but we did not return that bravery by protecting Mack. By insisting that he live, we protected ourselves from a tough decision, but not him.

Legally, politically and emotionally, it is easier to simply deny suicide as a valid option in every case, even if it leads to inhuman and immoral outcomes. That approach forces real-life decisions to be made in the shadows, hidden from sight — back to the averted glance and whispered word.

But it also gives groups such as Final Exit the ambiguity they need to thrive.

First of all, Bookman is leaving something out here, either for simplicity’s sake or he doesn’t know and didn’t care enough to find out.

Bookman fails to tell us how Mack was “forced” to live for five years. Presumably, he was dependent on technology. He could have had his ventilator withdrawn, if he was using one. He could have refused to eat or asked for his feeding tube to be pulled. He had those rights but didn’t exercise them? Why? Did his family ask him not to do it? Was he ambivalent? Was he maybe waiting for some kind of support that could make his situation more bearable? There has to be an explanation for those five years – but Bookman isn’t sharing that with us.

That “right” to refusal of life-saving measures in Georgia is absolute – and established in the case of Larry McAfee case back in the late 1980s. McAfee was a ventilator-dependent quadriplegic who lived on his own for a period of time post-injury. He expressed no desire to die while he was living in the community. However, financial setbacks forced him into being bounced between nursing homes and hospital units, devoid of any control over his life. At this point, McAfee sued to have his ventilator shut off with a time-delayed switch he designed himself that he could operate himself.

McAfee, who had no help in trying to get out of institutional settings, suddenly found himself overwhelmed with “help,” understanding that of course this man would want to die. Disability activists, called “meddlers” at the time, opposed his suit. McAfee won his “right to die,” but chose not to. Those “meddlers” in the disability community were able to find another living situation. McAfee moved out into the community, and lived for several more years until he died of natural causes.

And what of people with even more significant disabilities than McAfee’s?

I have a story to match Mack’s typed message. It’s from the story of James T. Hall, who developed what is known as “locked-in syndrome” as a result of a rare type of stroke. As Hall lay in his hospital bed, two friends worked to establish a communication system with him, while an impatient and unbelieving hospital staff pushed to implement the treatment withdrawal provisions of his living will:

The therapist said, “I have been authorized to make a final determination here. Why don’t we use the plastic spellboard approved by my department? The question is `Do you want to live?’” He thrust it in front of James’ face.

Bill moved to the therapist’s side. “Good,” Bill said. “You hold the board, and I will use the pointer. Is this the group of letters you are looking at, James? Good. Now, is this letter to which I am pointing the one you want?” James’ eyes were floating around as he blinked. “No. This one? No. How about this one?” For a second, James’ eyes seemed to focus. “Yes, it is the letter I.”

The next letter was D. The message was supposed to be “I want to live.”

I was thinking, “Why doesn’t Bill fake it, help James to stay with the message? Yes, Bill is trying to suggest W, but James keeps bringing him back to D. This is not the time to get confused, James.”

The next letter was E.

The next letter was M, then A. I D E M A—30 minutes spent on just five letters already. Time was running out.

Then N, then D. I DEMAND. Come on, James, don’t try to be smart.

Then T and O. Then L and I and V and E. I DEMAND TO LIVE.

But more letters were coming: an A, an S, another S.

The next letter was an H, then and O an an L….

The therapist dropped the board.

Bill picked it up and said, “Let’s see what the next letter is.” E.

I DEMAND TO LIVE ASSHOLE.

Just goes to show that not everyone reacts the way Bookman and other “reasonable” people might expect them to.

As for the conclusion of Bookman’s essay, this is just a variation of the arguments that have suggested a lack of laws such as those on the books in Oregon and Washington would somehow eliminate the “need” for the death groupies at Final Exit Network.

There’s a concept called “critical analysis” and if you try to apply the concept, Bookman’s suggestion shatters. As long as there is a system saying some people are “eligible” and some people “ineligible” for assistance in suicide, there will always be people who were denied “help” who feel they were entitled.

And there will no doubt be members of Final Exit Network – or some successor organization – who will be more than ready to agree with them and provide “help.” No matter what those claims of a needed and rational suicide happen to be. The only thing we can know for sure is that the person they’ll be most likely to agree with will be old, ill, disabled – or all three. –Stephen Drake