assisted suicide

Witty, compassionate

The Farewell Party screens Nov. 10 in the Vancouver Jewish Film Festival. (photo from VJFF)

One could compile a very long list of movies whose enjoyment is enhanced by watching them with someone you love. The Farewell Party is the rare film that should be seen with someone you trust with your life.

Israeli filmmakers Tal Granit and Sharon Maymon set their funny, sensitive and ultimately moving tale among a small coterie of longtime friends heroically maintaining their independence and dignity in a Jerusalem retirement home. The suffering of a terminally ill member of their circle forces them to consider the merit, and confront the risks, of friend-assisted suicide.

There’s some pithy dialogue about the difference between helping a buddy and committing murder, but The Farewell Party isn’t interested in advancing a position on euthanasia or even grappling with the ethics or morality of one’s right to die. The film’s concern is for the spouse tasked with the agonizing responsibility of carrying out the decision of a suffering husband or wife.

Lest this sound like a must-avoid movie of the week, Granit and Maymon filter the proceedings through the deliciously absurdist mix of baleful fatalism and real-world pragmatism that is Jewish humor.

Through its first half, The Farewell Party smoothly glides from deadpan comedy to black comedy to bittersweet comedy. The chuckles taper off en route to a perfectly conceived anti-climax, a poignant coda to the lifelong love affair to whose last chapters we’ve been privy.

The Farewell Party screens Nov. 10, 6:45 p.m., in the Vancouver Jewish Film Festival (vjff.org). Wonderfully played by a cadre of veteran comic actors, it’s the film for anyone who’s ever grumbled that nobody makes movies for older audiences anymore.

After a marvelously droll opening scene in which Yehezkel (Ze-ev Revah) plays God to persuade a beloved friend to choose life and continue her treatment, the retired inventor is reluctantly corralled into helping ease the anguish of an expiring pal.

“They’re keeping him alive as though dying was a crime,” says the man’s wife, Yana (Aliza Rozen).

One of the movie’s refreshingly tart assumptions is that the elderly can’t afford the luxury of self-deception. Well, with one huge exception, that is: Yehezkel refuses to acknowledge that his wife’s steadily worsening memory lapses will necessitate moving her to an assisted-living facility in the not-distant future.

Notwithstanding the recurring presence of Yehezkel and Levana’s adult daughter and grandchild, this is a film about a stratum of society – older people – that is essentially invisible to everyone but its distinguished (and roguish) members. Out of necessity, they are compelled to create their own community.

There are moments in The Farewell Party, consequently, that edge toward a comedy about codgers executing a heist, or a drama examining the portentous final stages of long-term relationship. But Granit and Maymon maintain such a solid grasp on their film’s tone and esthetic that it never tips too far in either direction. The austere palette of cool blues and greys, combined with the near-absence of music, eliminates any whiff of sentimentality or, for that matter, situation comedy. What comes through in every frame of The Farewell Party is compassion for the human condition. If you think about it, movies can’t offer anything more compelling – or rewarding – than that.

Michael Fox is a writer and film critic living in San Francisco.

Compassion in the face of death

Last week, the Supreme Court of Canada unanimously struck down the law that makes it illegal for doctors in Canada to provide medical assistance to severely ill patients who wish to die.

The court decision permits physicians to assist in the suicide of “a competent adult person who clearly consents to the termination of life and has a grievous and irremediable medical condition, including an illness, disease or disability, that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”

The decision reflects a fundamental shift in societal opinions toward end-of-life issues. It is worth noting, at this point, that attitudes toward death, life and intervention have never been static. As medical technologies advanced in recent decades, some (primarily religious) voices argued that these technologies interfere with the will of God by “artificially” extending life. Now, the reverse is apparently true. It tends to be religious voices today arguing that, in some cases, the withdrawal of life-extending technologies and treatments is akin to exercising the prerogatives of the Divine in ending life.

Whatever moral concerns surround this serious issue, an understandable dissonance has affected Canadians’ attitudes: it has been noted that there are times when we force human beings to endure suffering at the end of life beyond what we would permit our pet animals to experience.

Many Canadians who have watched loved ones suffer excruciating and slow illness and deaths recognize that human suffering could be more compassionately ameliorated. Among the first steps should be the provision of the best palliative care available. When absolutely no better option exists, assisted death may be the best choice for some individuals. Most of us can see this. We may wish it weren’t so and, of course, we hope we and our loved ones are never faced with these decisions. The fact is, many of us will.

Yet, every instance in which an individual, their family and doctor make decisions about end-of-life preparations must be entirely individualized. There is absolutely no way that one can apply the same criteria to two cases. Circumstances are not transferable between diseases, patients, families or belief systems. Two people with identical conditions and prognoses may justifiably choose diametrical endings.

Indeed, we must ensure that assisted death does not become a go-to “solution” when alternatives exist, or that any patient feels the slightest pressure to choose it. There is a real danger that some people will weigh decisions not on what is best for themselves but what they perceive as best for others or based on what others in similar situations have done. Not wanting to be a “burden” should not be a legitimate justification for assisted death.

There is genuine and justifiable fear around the potential for a “slippery slope.” It is important to note that this Supreme Court decision deals

with the rights of an individual of sound mind to make a decision on their own in consultation with those they trust to end a life of suffering dominated by unbearable pain and the absence of hope for recovery.

Euthanasia is an entirely different matter. It does not involve an individual’s free and informed choice. The fear is that the acceptance of assisted death will make our society more amenable to – or at least less vigilant against – euthanasia. This is not a consideration to be dismissed. The sanctity of human life is too great to ignore the fact that human beings have the capability of justification for all sorts of things. So, as Canada engages in discussions about this ruling, we should also be vigilant in reasserting our fundamental beliefs that the value of life is not diminished by the legalization of assisted suicide, but rather our humanity and the right of all Canadians to a decent life and a respectful death is part of a worldview that is life-affirming.

Certainly there is nothing happy about this subject, but if this decision makes the end of life more bearable for some Canadians then it should be welcomed. Safeguards are absolutely crucial and, as a society, as families and as individuals, we must discuss and understand the limits and potential misuses of this new freedom.

It is so important that we as a society get this right. The federal government will address this issue in the coming months. The Supreme Court has spoken, as often happens in this country, leading legislators in social progress. It’s our turn now. Canadians should have a long, thoughtful and nuanced discussion on this topic.

With respect to assisted suicide, context is everything

I am an oncologist, and I am Jewish. Fortunately, at this moment, I am not terminally ill, nor do I bear an incurable disease. By virtue of my profession and my age, death, suffering and the indignity that can go with it are familiar to me.

That is my perspective. I lead with that declaration because, when it comes to the business of assisted suicide, context is everything.

The rationale for actively ending a life is always posited on the basis of ending suffering and, hence, preserving dignity. At face value, this appears both straightforward and without controversy. It is not. Whose suffering? What is dignity, and is it realistic to provide some idealized form of dignity in every instance, try as we may? Who is to judge? When to decide, and when to act? Who is to act, and on what authority?

Some years ago, at a palliative-care conference in Israel, I was riveted by a panel where Anglican, Catholic and Jewish physicians discussed suffering. The ordained Anglican, a highly respected surgeon, spoke of the purifying nature of suffering and its role in preparing people for the afterlife. For him, the total relief of pain was at cross-purposes with the spiritual transit of the end of life. For me, as a Jew, this was a striking perspective, certainly far from my understanding that pain of this sort had little redeeming value. Lesson No. 1: Cultural context is important.

More recently, I was asked to see a young man dying of cancer, whose pain seemed uncontrollable. He was desperate to go home. The complex logistics of pain management and support appeared to make this impossible. What to do? We talked, initially rather guardedly, then more openly. It turned out that, more than anything else, he wanted to see his dog. That was why he wanted to go home, for the absence tormented him. We arranged for the dog to make a hospital visit. The pain went away. My patient died quite comfortably in his hospital bed a few days later. Lesson No. 2: Understand the pain; you may be able to relieve it.

Almost 30 years ago, a small group of Winnipeg cancer physicians asked what was then a heretical question: Are we treating cancer, independent of the patient, or are we treating a patient who happens to have cancer? We created the “quality of life” concept, and objective measures of it. What happened to the tumor became less important than what happened to the person – physically, emotionally, socially and functionally. We broadened our understanding of our patients, and so were born the diverse range of interventions and supports we now routinely employ to more than keep people alive. We help our patients live lives. Lesson No. 3: It’s about the person, not the disease.

“Assisted suicide” is a euphemism for ending someone else’s life. Every civilized society holds life sacred. The idea of “Thou shalt not kill” echoes in every faith. The penalties for killing are severe, mitigated by an understanding of intent. Whenever we introduce a legal exception, we run into trouble. Similar arguments about relieving suffering were used by the Nazis to justify first exterminating the weakened and disabled, then the mentally ill, and then non-Aryans on the regime’s hell-bent descent into depravity. In order to execute the policy, a cohort of licensed killers was created. This, in a society once considered the world’s most sophisticated and cultured. Lesson No. 4: Assisted suicide is not a legal matter, it’s a moral one, and we can’t legislate morality.

So, where does this bring me in the consideration of assisted suicide? Full circle, to my ancient role as physician. Not as medical technician, nor as the master of prognostic statistics, derived from groups somehow extrapolated to an individual. I am a member of the one profession whose essential role invokes individual life and death decisions, and acts on risks that necessarily include adverse outcomes causing pain and suffering and death. I’m not doing my job unless I understand context, cause and possibility when it comes to suffering. That takes time, patience and experience. The responsibility is a great harbinger of humility.

Each dying patient has their own context and belief frame for their “suffering.” Each case has its own mix of causes, and things that make it worse or better. My contention is that when we fully understand what’s going on, it is rare that suffering can’t be greatly palliated. It then follows that the perceived need to end life to alleviate suffering is a very rare occurrence.

In this most intimate and delicate interaction between patient and physician, the physician also has context and values. I don’t think they can be legislated away.

For me, as a Jew and as a physician, I can give morphine to relieve pain, but not to end a life. I come down against legalizing assisted suicide as a product of my faith, culture, training and experience. Put as a dichotomy, I’m prepared that a few might suffer more than they can bear, rather than countenance in the name of some kind of generosity of spirit the active taking of a life. I know from history, and I have seen too much of the slippery slope of convenience, to find confidence in any permissive legislative process.

Harvey Schipper is a professor of medicine at the University of Toronto. This article originally appeared in the Globe and Mail.